Skin Hyperpigmentation + Photoaging

Question 1

What are the main agents of photoaging?

Answer 1

Hydroquinone (skin bleach) and AHA

Question 2

What are the causes of photoaging?

Answer 2

1. Endocrine
2. Inflammation
3. Trauma
4. Drugs

Question 3

How many melanocytes are typically found per mm^2?

Answer 3

800-1000

Question 4

What is vitiligo?

Answer 4

Loss of pigment

Question 5

What ingredient in self tanning products are used to increase the tanning of lightened areas?

Answer 5

Dihydroacetone

Question 6

What is dihydoracetone used for?

Answer 6

Ingredient in self tanning products are used to increase the tanning of lightened areas

Question 7

What are the general types of hyperpigmentation for self care?

Answer 7

1. Freckles (ephelides)
2. Age spots/liver (solar or senile)
3. Melasma at centrofacail region (can occur at pregnancy)

Question 8

What are ephelides?

Answer 8

Freckles

Question 9

How does hyperpigmentation present itself?

Answer 9

Discoloration; more intense brown due to overactive melanocytes

Question 10

Darker skin people have (more/less) active melanocytes, and vice versa with lighter skin people

Answer 10

more

Question 11

What endocrine conditions contribute to increased melanin?

Answer 11

1. Pregnancy
2. Addisons
3. Cushings
4. Hyperthyroidism
5. Liver changes
6. Nutrition deficiency
7. Dermatosis

Question 12

What are the main treatment approaches for hyperpigmentation?

Answer 12

1. Skin bleaching
2. Exfoliant/chemical peel
3. Certain product/drugs
4. Protecting the skin

Question 13

What is the main pharmacologic treatment for hyperpigmentation?

Answer 13

Hydroquinone 2%

Question 14

How does hydroquinone work?

Answer 14

Decreases tyrosinase enzyme, which decreases melanin

Question 15

What can you add to hydroquinone to increase its effect?

Answer 15

AHA, retinoin, or topical steroids

Question 16

How often should hydroquinone be applied?

Answer 16

Twice daily

Question 17

Should you apply hydroquinone before or after mosturizer?

Answer 17

Before

Question 18

What can you expect from the first few weeks using hydroquinone?

Answer 18

Transient inflammation; use topical hydrocortisone to alleviate it

Question 19

When should you see the doctor if you used hydroquinone?

Answer 19

No improvements in 3 months

Question 20

Besides hydroquinone, what are some other products to help with hyperpigmentation?

Answer 20

Lumixyl + Kojic Acid

Question 21

What are both Lumixyl + Kojic Acid MOA’s?

Answer 21

Inhibits tyrosine

Question 22

Which treatment of hyperpigmentation is a fungus species?

Answer 22

Kojic Acid

Question 23

Which treatment of hyperpigmentation has few AE’s than hydroquinone?

Answer 23

Lumixyl

Question 24

Which treatment of hyperpigmentation is NOT FDA approved and is used as an off-label?

Answer 24

Lumixyl

Question 25

What alternative agent for hyperpigmentation prevents transfer of melanin to skin cells?

Answer 25

Niacinamide/Niacin (B3)

Question 26

How is Vit. B3 different in terms of treatment of hyperpigmentation?

Answer 26

Does not affect tyrosinase activity

Question 27

If a pregnant pt comes up and asks if Hydroquinone is okay to use, what do you say?

Answer 27

Could be used if absolutely necessary (Category C), BUT best to refer to dermatologist/OB

Question 28

What are intrinsic factors of photoaging?

Answer 28

Stuff you CAN'T control; genetics, aging, sleep, endocrine

Question 29

What are extrinsic factors of photoaging?

Answer 29

Stuff you CAN control; environment, UVR, smoking, RX

Question 30

UVA vs UVB Which is the primary source of sunburn

Answer 30

UVB

Question 31

UVA vs UVB Which penetrates deeper, depletes collagen, and makes skin lose elasticity

Answer 31

UVA

Question 32

What is the clinical presentation of photoaging?

Answer 32

Change in color, texture, etc. Decreased elasticity, more wrinkles

Question 33

What are the treatment goals of photoaging?

Answer 33

1. Reverse damage | 2. Maintain skin from further damage

Question 34

What is the most common pharmacological treatment for photoaging?

Answer 34

Aquaglycolic Hand and Body Lotion 14%

Question 35

What are some pharmacologic treatment for photoaging?

Answer 35

1. AHA >20% 2. Safe concentration <10%? 3. pH ≥ 3.5 4. Combination w/ sunscreen

Question 36

What is AHA (Aquaglycolic) MOA?

Answer 36

Exfoliates dead skin cells, increases elasticity, decreases cracking,

Question 37

What is a way to improve AHA use on photoaging?

Answer 37

Lower pH

Question 38

How should you use AHA?

Answer 38

Wash skin, wait 10-15 min before applying Start QOD (night) for 1 wk, then increase to twice daily. Make sure to use sunblock (SPF30) and moisturizer