1、Facial Hyper-Pigmentation Current Thoughts:,David A.F. Ellis M.D. FRSCS Professor, University of TorontoMedical Director, Art of Facial Surgery Toronto, Canada 416 229.1050drfaceArtofFacialS,Normal Skin Color,RED = Oxy-hemaglobin in red capillariesYELLOW = exogeneous produced cartenoidsBROWN/BLACK =
2、 melaninBLUE = reduced hemaglobin in blue capillaries,Pigmentation & Melanin Synthesis,Melanocyte Formation,1. They are the key to skin pigmentation2. They are derived from the neural crestcells as the neural plate forms a tube3. They migrate along blood vesselsthrough dermis to epidermis4. They bec
3、ome visible in 10 weeks under light microscopy,Melanocyte Location,1. Found at the tips of the rete ridges at theepidermal-dermal junction2. The Epidermal-Melanin Unita) the melanocytes dendrite processforms a melanosome that is deposited in the keratocyteb) 1 melanocyte feeds 36 keratocytesc) the m
4、elanosome manufactures melanin,Melanocyte Location,3. Pigment IncontinancePigment gets into the dermis4. Density*Ave: = 1155 melanocytes/mm2*Male Genitalia: = 1668 melanocytes/mm2*Remains the same for 3 decades + thendeclines 10% per year,Bio-Chemistry of Melanin Formation,1. Tyrosine DOPA2. DOPA do
5、paquinone3. 5,6-dihydroxyindole(DHI) to indole-5,6 quinone4. all indoles polymerizes to form melanin,tyrosinase,tyrosinase,Types of Melanin,Melanocytes actually produce two different pigments: 1. Eumelanin (brown-black) 2. Phaeomelanin (yellow and red). Red heads happen to produce more phaeomelanin
6、and less eumelanin, which is why they dont tan very well,Regulation of Human Pigmentation,1. Baseline color2. Genetic Effects3. Solar Effects4. Biologic Modifiers5. Hormones,Regulation of Human Pigmentation,1. Baseline color* genetically determined basalmelanin synthesis * Lysosomal hydrolase degrad
7、espigment and is desquamated viathe stratum corneum,Regulation of Human Pigmentation,2. Genetic Effects* Genes not yet identified* Genetic conditions i.e. Albinism,PKU, Freckling, Familial Dyplastic,Regulation of Human Pigmentation,3. Solar Effects*Continuous UVA: Immediate darkening Can last for da
8、ys blending with melanin from UVB*Continuous UVB 72 hr delay of darkeningDarker than UVA,Regulation of Human Pigmentation,4. Biologic Modifiers* Prostaglandins produced bykeratocytes stimulate melanin synthesis* Postinflammatory Hyperpigmentationinduced by prostaglandins E1 + E2,Regulation of Human
9、Pigmentation,5. Hormones* MSH darkens the skin by bindingto melanocortin-1 receptors in the melanocytes stimulating tyrosinase,Racial Differences,Color depend on the size, number, and distribution of the melanosomes in the melanocytes and keratocytes and is more efficient in dark skinned individuals
10、Dark skinned individuals have a large single melanosome in the keratocyteLight skin individuals have smaller grouped melanosomes in the keratocyteThe strength of the melanocyte is not dependant on race but autosomal dominance,Causes of Hyperpigmentation,1. rate of melanosome production2. # of melano
11、somes transfer tokeratocyte3. in size and melaninization ofmelanosomes,Causes of Hypopigmentation,1. Tryrosinase Activity i.e. Phenol2. Loss of melanocytes caused by a) inflammationb) immunologically diseasesi.e. Vitilagoc) laser resurfacing,Melanogenesis in Aging,1. Decrease in melanocytes in UV un
12、exposed skin2. Increase in melanocytes + melanogenesisin UV exposed skin3. Leads to formation of lentigines Tan-brown-black 2-20mm spots melanogenesis Hyperplasia of highly active melanocytes Focal hyperpigmentation of keratocytes,Lentigines,Afghan Girls 18 years apart,Age 14,Age 32,Transcutaneous M
13、esodermic Therapy (TMT),1. 50% Mandelic Peel for a maximum of ten minutes immediately prior to mask application 2. Dermamelan Mask Treatment for 12 hours both sides3. Dermamelan Cream tid on face bilaterally 4. TMT (Transcutaneous Mesodermic Therapy) system weekly for 12 weeks5. Random face study 6.
14、 N = 10 patients,Ingredients in Dermamelan Part 1,Ingredients in Dermamelan Part 2,AMINOETHYLPHOS- PHINIC ACID PEPTIDE-1 RETINOL TOCOPHEROL ASCORBIC ACID BISABOLOL ETHOXYDIGLYCOL SALICYLIC ACID,Dermamelan Mask,12 hours,Transcutaneous Mesodermic Therapy (TMT),Stratum Corneum The Major Skin Barrier,1.
15、 This lipid structure represents approximately5% to 30% of the principle obstruction to trans-dermal skin crossing,2. It is the skins principal barrier to substancepermeation. 3. Pore size and sweat glands,10-40 m 15-20 cells deep,Electrophoresis (electrorepulsion),Electrophoresis represents the tra
16、nsportation of substances through the skin in ionic form by means of a direct current. The entrance channels are basically the sweat glands and hair follicles (low efficiency because Is only the 0.1% of the cutaneous area and as the Stratum Corneum is not very permeable to ionic (cationic) substance
17、s,Electroporation,Electroporation consists of the application of brief voltage impulses on the cells and tissues that act on the cell membranes and the lipidic intercellular spaces, causing molecular changes leading to the forming of ultramicropores which increase the permeability of the skin, parti
18、cularly on the stratum corneum,Results,1.600% greater penetration of the active substance in the corneous stratum.2.1200 % greater penetration of the activesubstance in the epidermis.3. 4000% greater penetration of the active substance in the dermis.,TMT Treatments,Polarity: negative Energy Level: 9
19、5% System #7:,Face Cleanser,Mix ingredients,After care skin moisturizer,TMT Treatments,1. Weekly interval X 12 weeks2. 20-30 minutes3. face only,Assessment,MASI Scale: Melasma Area + Severity Index ScoreDarkness: 0,barely visible, mild, mod, severe Homogeneity: speck, 2cm, uniform Area Involvement:
20、10%,11-29%,30-49%,50-69%,70-89%,90-100%Facial areas: Forehead, Cheek, ChinEach area gets a evaluation number with the cheeks waited more,Lentigines,D: Mod H: 2 cm A: 30-49%,D: Mod H: 1.5 cm A: 90%,BeforeAfter,Early Outcomes,1. Dermamelan Mask shows the greatest positive change in hyperpigmentation improvement 2. TMT system improves the pigmentation3. Cheek raising secondary to electrical energy of TMT system,CONCLUSIONS,1. Dermamelan Mask may irritate skin and may cause post inflammatory hyperpigmention in Asian skin2. 10 TMT system treatments = 1Dermamelan Mask 3. Fast Results = Combination,
