Skin Discolouration

In clinic, we see all too often how skin discolouration greatly impacts a person’s quality of life. It is a subject that has been documented for many centuries and is widely discussed both online and in dermatology, aesthetic and beauty conferences around the globe.

 

There are various types of skin discolouration, and ‘hyperpigmentation’ – meaning a skin condition with patches of skin that are darker than the surrounding skin – is often used as a generic term. Skin discolouration affects all skin tones and is often the result of chronic inflammation at a cellular level, resulting in visible irritation with redness accompanied by hyperpigmentation.

 

Different forms of skin discolouration may be associated with different skin tones.

 

Melanocytes (pigment cells) produce excess melanin in the stratum basale through a process called melanogenesis, and the pigment travels to the skin’s surface. 

 

Although the primary trigger of melanogenesis is UV exposure, it can also be caused by inflammation from other causes, hormonal stress and skin injury.

 

People with darker skin are more prone to stubborn generalised discolouration and patches.

 

Melasma and hyperpigmentation treatment

Put simply, there is no quick fix – treatment takes months of daily compliance and consistent maintenance.

 

Historically, hydroquinone has been the gold standard; however, it is a very controversial treatment with serious potential side effects; it is known as a melano-cytotoxic agent that can cause ochronosis, and therefore it can only be used for a short period of time. Rebound hyperpigmentation is a serious concern for those treating hyperpigentary disorders with hydroquinone.

 

We have an array of non-hydroquinone products available to us, but traditionally, they have shown less efficacy, e.g. kojic acid, arbutin, azaleic acid, tranexamic acid, neoglucosamine, vitamin C, retinoic acid and niacinamide.

 

More recently, various forms of cysteamine have come to market. Cysteamine is a simple aminothiol produced naturally in human cells, with strong effects on melanogenesis pathways, and it is a potent antioxidant. It has been used as the gold standard positive control test agent in multiple studies demonstrating the efficacy of hydroquinone. The ability to now produce a topical application of this agent opens new treatment avenues for patients with pigmentary disorders.

 

Rosacea is a chronic inflammatory skin condition characterised by recurrent flushing, central facial erythema, and telangiectasia.

 

LL-37 peptide has a high prevalence and expression level in rosacea patients. This releases IL-8 inflammatory cytokine, which in turn leads to inflammation and underlying redness.

 

PDL therapy can positively affect telangiectasia but is not very effective on underlying redness. We need to bear in mind that laser treatment causes an increase in redness for up to two weeks due to irritation from the treatment.

 

Prescribed medication such as Oxymetazoline is used to alleviate underlying redness but is transient and only lasts 12 hours.

 

Rosacea – new approaches

Introducing heparan sulfate (HS), a naturally occurring molecule in the glycosaminoglycan (GAG) family that bathes ALL the cells in our body and contributes to skin development and homeostasis, actively promoting skin health. HS and other GAGs, such as hyaluronic acid, are well-known super hydrators that bind and retain water, contributing to skin hydration.

 

HS helps preserve the structural integrity of collagen and elastin fibres. In the skin, heparan sulfate plays a critical role, providing an environment to help decrease inflammation and increase the production of elastin and collagen, as well as providing epidermal and dermal hydration. Managing this immune response goes a long way in managing the irritation and potential subsequent pigmentation and redness.

 

As we age, our bodies make less and less heparan sulfate. Decreased levels of HS can lead to skin irritation and skin dryness. Dryness compromises the protective barrier, causing the skin to be more reactive to intrinsic and extrinsic factors, resulting in an inflammatory cascade. 

 

Hence, there is a need to replenish HS and return the barrier and skin homeostasis.

Aging skin loses heparin sulfate faster than collagen and elastin, impairing its ability to repair and renew.

 

Unfortunately, as with all glycosaminoglycans, heparan sulfate is a large molecule, too large to penetrate the skin. 

 

Endogenous heparan sulfate during inflammation

Heparanase is an enzyme that is upregulated during inflammation. HS is specifically degraded by heparinase; this results in GF and cytokines that are no longer bound to the cell by the HS, and therefore, they cannot effectively signal the cell toward repair, resulting in continued production of proinflammatory cytokines and hence a proinflammatory state (proteolytic environment).

 

Exogenous heparan sulfate analog during inflammation

Heparan sulfate analog cannot be degraded by heparanase and, therefore, is resistant to degradation by heparanase and so is able to penetrate and occupy the voids left by the endogenous HS. 

 

Once HSA fills the voids, growth factors and cytokines are bound back to the cell (even in the inflammatory proteolytic environment), allowing a return towards homeostasis and normal function.

 

The launch of a heparan sulfate analog (HSA) molecule in a topical range, reducing the size and polarity of the molecule and modifying the shape, all of which allow for easy penetration into the epidermis and dermis opens new doors for successful management of rosacea and the risk or inflammatory hyperpigmentation. 

 

The combination of HSA and cysteamine, therefore, holds great promise for the treatment of a wide range of pigmentary disorders.  

 

Both of these great ingredients are now available in the UK and Ireland, under the exciting US brand, Senté.

 

‘Senté Cysteamine HAS Pigment & Tone Corrector’ contains Heparan Sulfate Analog (HSA), Cysteamine HCI, Niacinimide, THD Ascorbate and phospholipids, among other ingredients. ‘Senté Dermal Repair Cream’ and ‘Senté Dermal Repair Ultra Nourish’ are both based on Heparan Sulfate Analog (HSA), the former has a light texture and also contains Vitamin E, and Green Tea Extract. The latter includes Ceramides, Omega, Fatty Acids 3, 6, 9, and Vitamin E, hence the name ‘Ultra Nourish’.

 

AestheticSource are delighted to be partnering with Senté in the UK and Ireland as exclusive distributor of this exciting range. For further details on training, business support and ordering call 01234 313 130, or email orders@aestheticsource.com.