By doctors Ghislaine Beilin and Luis Shotze Luis
Numerous therapeutic solutions exist that allow us to act at different levels to correct the pigmentary component of hyperpigmentations. New studies show which key ingredients represent an essential complement to treat at the same time the vascular component that characterizes those hyperpigmentations that present greater therapeutic resistance, such as melasma or PIH.
Immunohistochemistry reveals an increase in the number of vessels and VEGF in melasma. MSH and ACTH hormone secretion is induced, growth factors: endothelin-1, FGFb, NGF, beta endorphin melanogenic factor. Studies carried out in the mesoestetic laboratory have amended extracellular matrix abnormalities and the presence of solar elastosis from 83 to 93% of patients, which suggests that photoaging plays a crucial role in melasma and that there is vacuolization of the basal layer with focal absence of the epidermal basement membrane, which would favour pigment incontinence and the presence of migrating melanocytes. The capillary vessels increase in number, size and density, and the dermal mast cells increase in number.
There are three lines of action to treat skin hyperpigmentations:
- In the case of mild or moderate cases, the melanin deposits that cause the spots can be removed by using specific depigmenting methods.
- Melanin inhibition or control, thanks to the continuous action of ingredients that act on the melanogenesis process.
- Photostimulation control using sunscreen products that are specifically formulated to treat skin hyperpigmentation.
The treatment we are proposing combines three types of solutions: intensive depigmentation and control of the most resistant repigmentation using the dermamelan method, combined with peelings and transdermal solutions containing tranexamic acid, a key ingredient that complements the depigmenting action and consolidates the success of the treatment.
Numerous studies have proposed the topical use of tranexamic acid and micropuncture in patients with melasma due to its depigmenting effect. Tranexamic acid (TNA) is a synthetic analogue of lysine.
Used in combination with the dermamelan method, it offers two action mechanisms: the well-known mechanism acts on the arachidonic acid and prostaglandins, and another mechanism acts on the endothelin 1 pathway, inhibiting the melanocytic growth factor (MeGF), and on the tyrosinase, ultimately causing it to decrease along with the melanocytes, the dendricity and the inflammation. Thanks to its action on the keratinocytes, it prevents the secretion of substances that accelerate melanogenesis (PEG-2, ET-1).
Dermamelan: the dermamelan method consists of a session in which dermamelan mask is applied at the clinic. This mask contains a high concentration of depigmenting ingredients that remove the deposits of melanin in the epidermis. A thick layer is applied and it is allowed to act for 8-12 hours. Between the 3rd and 5th day after the treatment at the clinic, the patient must continue the treatment with dermamelan treatment, a home treatment that acts on the melanocytes by regulating the excessive production of melanin in a continuous and sustained way. The cream should be applied as follows: 3 times a day during the first 30 days, twice a day during the following 60 days and finally, once a day for three months.
In cases that combine melasma with areas of PIH, with highly resistant pigmentation, we administered c.prof depigmentation solution 210 via microneedling in 3 sessions/15 days. This solution, which contains tranexamic acid, works on the vascular component and provides a better localized response.
Cases of mild or moderate hyperpigmentations have a good therapeutic response to the application of specific peelings such as mesopeel melanostop tran3x, which contains 3% tranexamic acid, 20% azelaic acid, 10% resorcinol, and 6% phytic acid. To maintain and improve the results obtained and due to the chronic component of the most severe hyperpigmentations which have a greater tendency to recurrence, this product was used as a supplement after the intensive depigmenting method.
Results obtained after the application of mesopeel melanostop tran3x after 3 treatment sessions in which it was applied every 15 days, and with the daily home application of melan tran3x cream gel.
Results obtained after the application of mesopeel melanostop tran3x after 1 single treatment session and the daily home application of concentrated melan tran3x and melan tran3x cream gel.
In conclusion, in view of the latest physio pathological data of hyperpigmentation, the addition of tranexamic acid to dermamelan and mesopeel melanostop trans3x is the golden standard of the treatment of melasma.
Doctor Ghislaine Beilin
ESAAM President l European Society of Preventive, Regenerative and Anti-Aging Medicine. SNME Vice-President – French Union of Aesthetic Doctors.
Doctor Luis Shotze Luis
Medical Director Mesoestetic Pharma G. Plastic surgeon from Buenos Aires University, Member of the South American academy of Cosmetic Surgery.