Understanding Understanding Hyperpigmentation and Hyperpigmentation and

treating it with combined treating it with combined strategiesstrategies

MELANOCYTESMELANOCYTES

The pigment-producing cells of the skin are called melanocytes and their activity is the major determinant of the color of the hair and skin.

Within the epidermis, melanocytes reside in the basal layer in a ratio of about 10 keratinocytes to 1 melanocyte. However, each melanocyte via its dendrites supplies melanin to about 30 nearby keratinocytes.

www.skinpedia.org

www.skinpedia.org

When ultraviolet rays penetrate the skin it triggers the production of melanin as a defense mechanism. Melanin moves along arm-like structures called dendrites in a special container called a melanosome.

After the complete synthesis of melanin, melanosomes filled with this pigment are injected in the interior of keratinocytes. Once inside keratinocytes, melanosomes tend to spread through the cytoplasm, over the upper part of the nucleus, so as to protect it from ultraviolet radiations.

.

 

www.wikipedia.org/wiki/Melanocyte

www.google.com

Inflammation is the cause of Inflammation is the cause of HyperpigmentationHyperpigmentation

• External Causes– Sun Exposure– Skin trauma, burn, cosmetic treatment,

surgery– Acne wound, psoriaisis, eczema.

Inflammation is the cause of Inflammation is the cause of HyperpigmentationHyperpigmentation

• Internal Causes– Inflammatory hormones

• Pregnancy, Oral Hormone Therapy, Menopause, other hormones—primarily the sex steroids progesterone and estrogen

– High amounts of Omega 6, low amounts of Omega 3

What is Melasma?What is Melasma?What is Melasma?What is Melasma?

Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

www.add.org

Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.

www.add.org

Who gets Melasma?Who gets Melasma?Who gets Melasma?Who gets Melasma?

The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop melasma themselves. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called chloasma, or the "mask of pregnancy." Birth control pills may also cause melasma, however, hormone replacement therapy used after menopause has not been shown to cause the condition.

The most influencing factor seems to be estrogen and ultraviolet light.

www.add.org, Baumann

What causes Melasma?What causes Melasma?What causes Melasma?What causes Melasma?

•Brown color•Light brown color•Appears more obvious under black light •Responds well to treatment

•Blue gray color•Dark brown color •Unchanged under black light •Responds poorly to treatment

•Combination of light and brown patches •Partial improvement with treatment

Epidermal

Dermal

Mixed

What are the types of Melasma?What are the types of Melasma?What are the types of Melasma?What are the types of Melasma?

MELASMA / MELASMA / CHLOASMACHLOASMAIMPORTANT INFORMATION IMPORTANT INFORMATION

• UNDERSTANDING THE PHYSIOPATHOLOGY

• UNDERSTANDING THE MECHANISM OF ACTION OF THE CHEMICAL AGENTS TO BE USED

• CORRECT DIAGNOSTIC OF THE LESION TO BE TREATED (MIXED, SUPERFICIAL OR DEEP?)

• PLAN THE TREATMENT WITH YOUR PATIENT AND A TREATMENT PROGNOSTIC .

Romulo Mene, MD - Rio de Janeiro - Brazil

This new Yellow Peel Protocol was created to suit the

Spa/Skin Care Setting. This protocol will allow

professionals to perform the Yellow Peel within a 2

hours time frame. In order to achieve results similar

to Dr. Romulo Mene original protocol a series of

treatment will be required.

YELLOW PEEL YELLOW PEEL ProtocolProtocol

The slide show will explain the new protocol based on

skin classification and condition. The graphs will

guide you to choose the appropriate professional

treatment and home care for you client.

YELLOW PEEL YELLOW PEEL ProtocolProtocol

YELLOW PEELYELLOW PEEL

Retinol / Salicylic Acid / Phytic Acid

Kojic Acid / Azelaic AcidEmu Oil/ Alantoin

1. Photo Documentation

2. Skin Analysis

3. Check Up Peel - Glycolic Acid Soap 20%

4. Apha Beta Complex Gel (ABC)

or 30% Glycolic Gel

3. Yellow Peel Balm

4. Post Peel Recovery Formula

YELLOW PEEL YELLOW PEEL ProtocolProtocol

Check Up Peel1. APPLY CHECK UP PEEL TO ENTIRE FACE. LEAVE ON THE

SKIN FROM 5-20 MINUTES. THE MORE OILY AND/OR DAMAGED THE SKIN THE LONGER TO LEAVE ON.

2. WASH SKIN WITH FRESH WATER.3. Evaluate the sensitive points of the skin, as detected by CHECK UP

PEEL4. CHOOSE HOW TO PROCEED WITH TREATMENT

YELLOW PEEL YELLOW PEEL ProtocolProtocol

A B C OR 30% GLYCOLIC PEELA B C OR 30% GLYCOLIC PEELVERY SUPERFICIALVERY SUPERFICIAL PEEL PEEL ((MELASMA, ASIAN, AFROAMERICAN) MELASMA, ASIAN, AFROAMERICAN) PHOTOTYPES V & VI•APPLY APPLY ACID GEL ACID GEL ON THE SKIN AND ON THE SKIN AND REMOVE WITH WATER AS REMOVE WITH WATER AS SOON AS THE PATIENT REPORTS SOON AS THE PATIENT REPORTS FEELING A HOT SENSATION ON FEELING A HOT SENSATION ON THE SKINTHE SKIN

YELLOW PEELYELLOW PEELABC or 30% Glycolic PeelABC or 30% Glycolic Peel

• SUPERFICIALSUPERFICIAL PEEL PEEL (INICIAL PHOTOAGING) (INICIAL PHOTOAGING) PHOTOTYPE III & IV

APPLY APPLY ACID GEL ACID GEL ON THE SKIN AND REMOVE WITH WATER WHEN ON THE SKIN AND REMOVE WITH WATER WHEN THE SKIN THE SKIN DEVELOPS A PINK COLOR ERITHEMA

• MEDIUMMEDIUM PEEL PEEL (MIDLE PHOTOAGING) (MIDLE PHOTOAGING) PHOTOTYPE I, II & III

APPLY APPLY ACID GEL ACID GEL ON THE SKIN ANDON THE SKIN AND REMOVE WITH WATER WHEN REMOVE WITH WATER WHEN THE SKIN DEVELOPS THE SKIN DEVELOPS AN ERITHEMA OF MEDIUM RED COLOR

• DEEPDEEP PEEL PEEL (SEVERE PHOTOAGING)(SEVERE PHOTOAGING) PHOTOTYPE I & II

APPLY APPLY ACID GEL ACID GEL ON THE SKIN ANDON THE SKIN AND REMOVE WITH WATER WHEN REMOVE WITH WATER WHEN THE SKIN DEVELOPS AN THE SKIN DEVELOPS AN SHOWS A INTENSE RED ERYTHEMA IN THE TREATED AREA.

POST PEEL PHASE: MOISTURIZE THE SKIN FOR THE NEXT 3 DAYS WITH POST PEEL RECOVERY FORMULA

VERY SUPERFICIALVERY SUPERFICIAL PEEL PEEL (MELASMA, ASIAN, AFROAMERICAN) PHOTOTYPES V & VI

YELLOW PEELYELLOW PEEL

Very Superficial Peeling ProtocolVery Superficial Peeling Protocol• Indicated for: EPIDERMAL MELASMA, ASIAN SKINS, DARK SKIN,

SKINS HYPERPIGMENTATION DISORDERS. • PHOTOTYPES V & VI• Apply the yellow cream to the facial skin, and leave to work for 20-30

minutes. • Remove the inactive cream with a SkinRenu Micro-Bead Cleanser and

reapply a new layer of yellow cream, leaving it to act for another 20-30 minutes.

• Repeat these steps 1 to 3 times (1-3 applications), until the skin become HOT, BUT WITHOUT SIGNS OF ERYTHEMA.

• Apply Post Peel Recovery Formula for the next 8-10 days; use SkinRenu Micro-bead Cleanser soap for washing or plain water.

Professional Treatment

Home TreatmentVery Sensitive Skin/Epidermal Melasma/Phototypes V & VI

PHOTOS WITH PHOTOS WITH UV EFFECTUV EFFECT

COMPLEX MELASMACOMPLEX MELASMA

Rômulo MRômulo Mêêne, MD - ne, MD - Rio de Janeiro - BrazilRio de Janeiro - Brazil

PHOTO WITH EFECT UVPHOTO WITH EFECT UV

Rômulo Mêne, MD - Rio de Janeiro - Brasil PHOTO WITH EFECT UVPHOTO WITH EFECT UV

BEFOREBEFORE

BEFOREBEFORE

Superficial Peeling ProtocolSuperficial Peeling Protocol• Indicated for INICIAL HYPERPIGMENTATION and Sensitive

Skins. • PHOTOTYPE III & IV• Apply the yellow cream to the facial skin, and leave to work for 20-

30 minutes. • Remove the inactive cream with a SkinRenu Micro-Bead Cleanser

and reapply a new layer of yellow cream, leaving it to act for another 20-30 minutes.

• Repeat these steps 3 times (1-3 applications) until AN INTENSE, PINK COLORED ERYTHEMA appears on the skin.

• Apply Post Peel Recovery Formula for the next 8-10 days; use SkinRenu Micro-bead Cleanser soap for washing or plain water.

Professional Treatment

Home TreatmentSensitive Skin/ Initial

Hyperpigmentation/ Phototypes III & IV

Professional Treatment

Home TreatmentSensitive Skin/ Moderate

Hyperpigmentation/ Phototypes III & IV

Professional Treatment

Home TreatmentSensitive Skin/ Severe

Hyperpigmentation/ Phototypes III & IV

BEFOREBEFORE AFTER 14 DAYS WITH AFTER 14 DAYS WITH YELLOW PEELYELLOW PEEL

Rômulo MRômulo Mêêne, MD - Rio de Janeiro - Brazilne, MD - Rio de Janeiro - Brazil

PHOTOS WITH EFECT UVPHOTOS WITH EFECT UV PHOTOS WITH EFECT UVPHOTOS WITH EFECT UV

BBEFOREEFORE BEFOREBEFORE PHOTO WITH EFECT UVPHOTO WITH EFECT UV

AFTER TREATMENT WITH SUPERFICIAL CHEMICHAL PEEL AFTER TREATMENT WITH SUPERFICIAL CHEMICHAL PEEL AND SKIN BLEACHING GELAND SKIN BLEACHING GEL R

ômul

o M

Rôm

ulo

Mêê n

e, M

D -

Rio

de

Jane

iro

- B

razi

lne

, MD

- R

io d

e Ja

neir

o -

Bra

zil

Medium Peeling ProtocolMedium Peeling Protocol• Indicated for MODERATE and SEVERE

HYPERPIGMENTATION in PHOTOTYPES I, II & III • Apply the yellow cream to the facial skin, and leave to work for

15-20 minutes. • Remove the inactive cream with Check Up Peel soap and

reapply a new layer of yellow cream, leaving it to act for another 15-20 minutes.

• Repeat these steps 3 times, until the SKIN SHOW A STRONG ERYTHEMA (similar to intense sunburn).

• Apply Post Peel Recovery Formula for the next 8-10 days; use SkinRenu Micro-bead Cleanser soap for washing or plain water.

End Point of Medium PeelEnd Point of Medium Peel

Professional Treatment

Home TreatmentInitial Hyperpigmentation / Phototypes I,

II, & III

Professional Treatment

Home TreatmentModerate Hyperpigmentation /

Phototypes I, II, & III

BEFOREBEFORE 15 DAYS AFTER YELLOW PEEL15 DAYS AFTER YELLOW PEELRômulo Mêne, MD - Rio de Janeiro, Brazil

AFTER 4 DAYS AFTER 4 DAYS YELLOW PEEL 2001YELLOW PEEL 2001

BEFORE 1996BEFORE 1996 AFTER 2 YEARS AFTER 2 YEARS YELLOW PEEL 2004YELLOW PEEL 2004

BEFORE 2001BEFORE 2001AFTER 2 YEARS AFTER 2 YEARS YELLOW PEELYELLOW PEEL R

ômul

o M

êne,

MD

– R

io d

e Ja

neir

o -

Bra

sil

Fig 1. Pre-treatment.

Fig 2. Patient showing crusts on the 4th day after the application of YELLOW PEEL

Fig 3. 30 days after the initial peeling with YELLOW PEEL and maintenance with Phytic Acid

Fig. 1 Fig. 2

Fig. 3

AFTER 6 YEARS AFTER 6 YEARS (YELLOW PEEL/LIGHTENING GEL)(YELLOW PEEL/LIGHTENING GEL)

Rômulo MRômulo Mêêne, MD - Rio de Janeiro - Brazilne, MD - Rio de Janeiro - Brazil

BEFOREBEFORE

BEFOREBEFORE

PHOTOS WITH EFECT UVPHOTOS WITH EFECT UV

HIPERPIGMENTATION AND HIPERPIGMENTATION AND HIDROQUINONE SEQUELESHIDROQUINONE SEQUELES

10 DAYS AFTER THE 1TH 10 DAYS AFTER THE 1TH YELLOW PEELYELLOW PEEL

BEFOREBEFORE

Rômulo Mêne, MD - Rio de Janeiro, BrazilRômulo Mêne, MD - Rio de Janeiro, Brazil

AFTER 2 YEARSAFTER 2 YEARS

ALPHA BETA, ALPHA BETA, NUTRI CREAM, LIGHT. GEL, FADE SHADENUTRI CREAM, LIGHT. GEL, FADE SHADEBLEPHAROPLASTY (2007)BLEPHAROPLASTY (2007)

BEFOREBEFORE

PHOTO WITH EFECT UV

Rômulo Mêne, MD - Rio de Janeiro, BrazilRômulo Mêne, MD - Rio de Janeiro, Brazil

AFTER 2 YEARSAFTER 2 YEARS

ALPHA BETA, ALPHA BETA, NUTRI CREAM, LIGHT. GEL, FADE SHADENUTRI CREAM, LIGHT. GEL, FADE SHADEBLEPHAROPLASTY (2007)BLEPHAROPLASTY (2007)

Professional Treatment

Home TreatmentSevere Hyperpigmentation/Phototypes I,

II& III

Jordana LewisFlorida/Caribbean DistributorTrainer

305-335-8719877-646-RENU