Melasmas

Melasma is a chronic skin condition that causes discoloration on the face. It usually appears as brown, tan, or blue-gray patches along the upper cheeks, upper lip, forehead, and chin. Sometimes appear as dark irregular skin patches. It is unsafe to remove all pigmentation which can lead to irreversible damage. Melasma and hyperpigmentation can be very distressing for sufferers so it is important to treat the condition in a safe and effective way.

While hydroquinone and AHAs will lighten the pigmentation, prolonged use of these chemical ingredients will create an unnatural looking mask effect that is totally irreversible.

The results are often worse than the condition itself. It is important to properly diagnose hyperpigmentation using a Wood’s lamp (wavelength 340-400 nanometres). Epidermal pigment is enhanced during examination with a Wood’s lamp, whereas dermal pigment is not.

Dermal pigment is very difficult to treat; however, 70 per cent of the population has hyperpigmentation spots on the epidermis.

The primary factors causing melasma are hormonal changes and external sun exposure, so the most effective and long-lasting treatments are aimed at these causes.

Dr Georghy will give you a physical exam and ask about your medical and family history. He may also perform tests, such as: Blood test, hormonal study, light microscopy.

The treatment and the result vary from patient to patient. 

Treatments for melasma may include: IPL, IPH, LED, Polarized Light and Infrared Heat, Medical Laser, WISHPro and Natural supplements.

Vitamin C and Glutathione IOV therapy can be helpful. Glutathione is an ubiquitous compound found in our bodies. Aside from its many ascribed biologic functions, it has also been implicated in skin lightening. We review in vitro and in vivo studies that show evidence of its involvement in the melanogenic pathway and shed light on the its anti-melanogenic effect. 

Mechanism of action: 

  • Direct inactivation of the enzyme tyrosinese by binding with the copper-containing active site of the enzyme;
  • Mediating the switch mechanism from eumelanin to phaeomelanin production; 
  • Quenching of free radicals and peroxides that contribute to tyrosinase activation and melanin formation; and 
  • Modulation of depigmenting abilities of melano-cytotoxic agents. 
  • These concepts supported by the various experimental evidence presented form basis for future research in the use of glutathione in the treatment of pigmentary disorders

MELANOGENESIS and MELANOCYTE

Case Studies

Consumer warning - North Shore Cosmetic: Medical and Dental, use 'before and after' photos to showcase possible outcomes and empower patients to make informed decisions. They are not intended to be misleading or deceptive. We have made an effort to ensure that all photographs are taken under the same light, with the same camera, with the same exposure and positioning. No photo has been re-touched or altered in anyway. All Photos are Copyright Dr Joseph Georghy, 2017.

Consumers must be aware that all Cosmetic results can vary from person to person. Please view with caution.

‘Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.’

Case Study 1

Before and After

Case Study 2

Before and After

Case Study 3 

The results are permanent (4.5 years follow up)

Before and After

Case Study 4

The result after 15 year follow up

Before and After (right)

Before and After (left)

Article

Skin Hydrating and Whitening effects of Vitamin C and Glutathione in Asian skin types
BY KEITH ONG / POSTED IN ANTI-AGEING, DERMATOLOGY ON OCTOBER 14, 2015

Keith Ong describes the results from his study on the effects of multiple intravenous injections of vitamin C and glutathione;

Conclusion

Most patients (n=270, 95.4%) perceived a certain degree of skin hydration and whitening after six Vit C and GSH intravenous injections and most patients (mean score 4.99 out of 7) were satisfied with the results, without experiencing any serious adverse event.

More studies could be conducted to evaluate the efficacy of intravenous Vit C and GSH injections, especially on the areas of skin whitening, post-operation wound healing, repair of second and third degree burns, and repair of photo-aged skin.

References:
1.    El-Domyati M, Attia S, Saleh F et al. Intrinsic aging vs photoaging: a comparative histopathological, immunohistochemical, and ultrastructural study of skin. Exp Dermatol 2002; 11(5): 398–405
2.    Gilchrest BA. A review of skin ageing and its medical therapy. Br J Dermatol 1996; 135(6): 867–875
3.    Farris PK. Cosmetical Vitamins: Vitamin C. In: Draelos ZD, Dover JS, Alam M, editors Cosmeceuticals. Procedures in Cosmetic Dermatology. 2nd ed. New York: Saunders Elsevier; 2009 pp 51–6
4.    Traikovich SS. Use of Topical Ascorbic acid and its effects on Photo damaged skin topography. Arch Otorhinol Head Neck Surg 1999; 125: 1091–8
5.    Masaki H. Role of antioxidants in the skin: anti-aging effects. J Dermatol Sci 2010; 58(2): 85–90
6.    Meister A. Glutathione-ascorbic acid antioxidant system in animals. J Biol Chem 1994; 269(13): 9397–9400
7.    Matsuda S, Shibayama H, Hisama M, Ohtsuki M, Iwaki M. Inhibitory effects of novel ascorbic derivative VCP-IS-2Na on melanogenesis. Chem Pharm Bull 2008; 56: 292–7
8.    Fumiko Watanabe Erika Hashizume, Gertrude P Chan and Ayako Kamimur Skin-whitening and skin-condition-improving effects of topical oxidized glutathione: a double-blind and placebo-controlled clinical trial in healthy women Clin Cosmet Investig Dermatol 2014; 7: 267–274
9.    Arjinpathana N, Asawanonda P. Glutathione as an oral whitening agent: a randomized, double-blind, placebo-controlled study. J Dermatolog Treat 2012; 23(2): 97–102
10.    Jara JR, Aroca P, Solano F, Martinez JH, Lozano JA. The role of sulfhydryl compounds in mammalian melanogenesis: the effect of cysteine and glutathione upon tyrosinase and the intermediates of the pathway. Biochim Biophys Acta 1988; 967(2): 296–303
11.    Villarama CD, Maibach HI. Glutathione as a depigmenting agent: an overview. Int J Cosmet Sci 2005; 27(3): 147–153
12.    Matsuda S, Shibayama H, Hisama M, Ohtsuki M, Iwaki M. Inhibitory effects of novel ascorbic derivative VCP-IS-2Na on melanogenesis. Chem Pharm Bull 2008; 56: 292–7
13.    Rees DC, Kelsey H, Richards JD. Acute haemolysis induced by high dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency. British Medical Journal 1993; 306 (6881): 841–2
14.    Nankivell BJ, Murali KM. Renal failure from vitamin C after transplantation NEJM 2008; 358 (4): e4
15.    Institute of Medicine. Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington, DC: The National Academies Press, 2000
16.    Thomas LD, Elinder CG, Tiselius HG, Wolk A, Akesson A. Ascorbic acid supplements and kidney stone incidence among men: a prospective study. JAMA Intern Med 2013; 13 (173): 386–388