MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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produces arachidonic acid, which sets off a cascade that produces prostaglandins, and this is a huge trigger for melanin formation. "Another ingredient I like is lilac stem cell extract (Phyto-stem lilac 10, Resources of Nature)," she continues. "It is another tyrosinase inhibitor but it is also a botanical that's certifi ed organic, a plus in today's marketplace. What I love about it is that it also has a very strong anti-infl ammatory effect. Infl ammation is often a component of hyperpigmentation. We combine it with vitamin C and other antioxidants in Dr. Loretta Stremulous." "Antioxidants can also help to slow pigment production as they create a suboptimal environment for the production of melanin as well as inhibiting tyrosinase," says Jimenez. "Once melanin has been deposited in keratinocytes, cell turnover is the only way to lighten the skin. In Lumixyl, we include not only decapeptide-12 and a range of antioxidants, but also a buffered glycolic acid (at 10% and 20% strengths) so it can be safely used as a leave-on product. Glycolic acid has a long history of safety and effi cacy for all skin types." The latest published study on Lumixyl appeared in the January 2014 issue of the Journal of Drugs in Dermatology. It showed that a combination of topical Lumixyl and dermal infusion of decapep- tide-12 accelerates resolution of post-infl ammatory hyperpigmen- tation in skin of color. Dr. Thornfeldt has a very specifi c approach to combining lightening/brightening ingredients. "There are 14 major and three minor steps in pigment synthesis and distribution: HQ blocks three of these and Tri-Luma blocks fi ve," he says. "I set out to develop a technology that would modulate all steps with at least two compounds and allow safe long-term use." His company's MelanoLyte Skin Brightening System includes two products with a total of 21 active ingredients, all at therapeu- tic levels. "We did in vivo studies to screen for the best ingredi- ents, comparing them with traditional options," continues Dr. Thornfeldt. "From these tests we came up with some unique ingredients, such as turmeric (tumerone), a potent anti-infl am- matory, which is important since seven of the steps involved in pigment synthesis and distribution involve infl ammation. The chal- lenge with this ingredient was its bright orange color. We had to develop special techniques to use it successfully in a cosmetically pleasing formulation." NEW ALTERNATIVES Epionce's MelanoLyte Pigment Perfecting Serum, containing turmeric, paper mulberry—a proprietary extract of apple and date palm—and fi ve other active ingredients, was introduced in January 2014. Dr. Thornfeldt and his colleagues published a trial involving 56 women that compared the MelanoLyte two-product system with a prescription regimen containing 4% HQ and tretinoin (De- cember 2013 Journal of Drugs in Dermatology). The MelanoLyte system was shown to be equally effective in treating three types of hyperpigmentation with no sensitization. Improvement continued for another nine months with no reactions or rebound. The Lytera Skin Brightening Complex (SkinMedica/An Allergan Company, skinmedica.com) was unveiled at the 75 th Annual Meeting of the American Academy of Dermatology in March 2013. The hydroquinone-free product blends tetrahexyldecyl ascorbate, a stable, lipid-soluble ester form of ascorbic acid; nia- cinamide, which improves skin moisturization, helps to enhance the barrier function of the skin and promotes even-looking skin tone; and tetrapeptide-30, a skin brightening peptide, as well as retinol, hexylresorcinol and licorice extract. Texas dermatologist Suzanne Bruce, MD, tested Lytera in 26 subjects. After 12 weeks of daily use, she concluded that Lytera signifi cantly improved mottled pigmentation and melasma, and was well tolerated by all participants. The results were published in the March 2013 issue of the Journal of Drugs in Dermatology. ZO Medical introduced a new non-HQ approach at the 2014 AAD Annual Meeting with two alternating products: Brightenex Skin Brightener & Correcting Crème, which includes an AHA, a retinol and stabilized ascorbic acid in its list of ingredients, and Retamax Active Vitamin A Micro Emulsion. "Pulsed-HQ regimens increase effi cacy while reducing risks," says Zein Obagi, MD, founder of ZO Medical (zoskinhealth. com). To avoid bounce-back pigmentation, he recommends gradually introducing non-HQ products, like Brightenex and Reta- max, on alternate days of hydroquinone use to transition patients from the HQ approach to the non-HQ approach. "Allow the skin to adjust then discontinue use of hydroquinone, usually in two to four weeks," he says. Linda W. Lewis is the contributing editor of MedEsthetics. CYCLING OFF HYDROQUINONE Some naturally occurring active ingredients share the same concerns of toxicity as HQ. © ISTOCKPHOTO.COM 38 MAY/JUNE 2014 | Med Esthetics C y c l i n g O f f M E D 5 - 6 1 4 . i n d d 3 8 Cycling Off MED5-614.indd 38 4 / 1 6 / 1 4 4 : 3 9 P M 4/16/14 4:39 PM