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Skin whitening Agents
Brown spots on skin are called chloasma or melasma and can happen for several reasons. One side effect of sun damage is the skin discoloration (solar lentigenes), also known as liver, sun or age spots. On lighter skin types, solar lentigenes emerge as small brown patches of freckling that grow over time. On women with darker skin tones, they appear as small patches of ashen-gray skin.

Brown or ashen patches of skin can also occur due to birth control pills, pregnancy, or estrogen replacement therapy. In those instances the discoloration is referred to as pregnancy or hormone masking.

Regardless of the source, the issue is the same: site-specific, increased melanin production, or hyperpigmentation. Melanin is the pigment or coloring agent of skin.



When it comes to selecting treatment for these areas, one factor to consider is the depth of the discolored pigment. Most of the time discoloration is superficial. In a few cases, the discoloration lies deep in the dermis (the deeper layer of the skin). If the pigment is in the epidermis, it can be helped with skin-lightening products. If the pigment is deeper, laser treatments are a consideration. For topical treatments, Topical hydroquinone 2 to 4% alone or in combination with Vitamin A cream (tretinoin) 0.05 to 0.1% is an established treatment. Other products which are probably as helpful are the ones containing topical azelaic acid 15 to 20% or, Kojic acid, alone or in combination with glycolic acid or hydroquinone.

Sunscreen

Sun exposure is one of the primary causes of skin pigmetation. Diligent use of a sunscreen alone allows some repair as well as protection from further photodamage (sun damage). No other aspect of controlling or reducing skin discolorations is as important as the use of sunscreen, SPF 15 or greater with the UVA-protecting ingredients of titanium dioxide, zinc oxide, or avobenzone. Using skin-lightening products or laser treatments without a sunscreen is a waste of time.

Laser Treatments and Chemical Peels

Pigment deep in the dermis does not respond well to topical agents. Resurfacing procedures such as chemical peels and laser treatments may help some of these problems, but the results are not consistent, problems can occur, and without the strict use of a sunscreen with UVA-protecting ingredients the discolorations almost always come back. Moreover, laser treatments of this kind are often a problem for those with darker skin tones. However, when laser treatments do work they can make a marked difference in the appearance of the skin. The results can be startling, and completely eliminate any appearance of the problem.

Much like laser treatments, alpha hydroxy acid peels (using 50% concentrations) have impressive results for removing skin discolorations. Only a physician should perform these types of facial peels.

Hydroquinone

Over-the-counter skin-lightening products often contain 2% hydroquinone, while 4% concentrations are available only from a physician. Hydroquinone is a strong inhibitor of melanin production, meaning that it lightens skin color. Hydroquinone does not bleach the skin; it only disrupts the synthesis of melanin hyperpigmentation.

In the medical literature Hydroquinone is considered the primary topical ingredient for inhibiting melanin production. Using it in combination with the other options listed can make a difference in skin discolorations.

Some concerns about hydroquinone's safety on skin have been expressed, but the research indicates reactions are minor or a result of using extremely high concentrations. Overall, adverse events reported with the use of hydroquinone have been relatively few and minor in nature. To date there is no evidence of adverse systemic reactions following the use of hydroquinone, and it has been around for over 30 years in skin-care products.

Hydroquinone can be an unstable ingredient in cosmetic formulations. When exposed to air or sunlight it can turn a strange shade of brown. It is essential, when you are considering a hydroquinone product, to make sure it is packaged in a non-transparent container that doesn't let light in and minimizes air exposure. Hydroquinone products packaged in jars are not recommended, because they become ineffective shortly after opening.

Tretinoin

A great deal of research shows that the use of tretinoin (vitamin A cream) is effective in treating skin discolorations. However, the response to treatment is less than with hydroquinone or azelaic acid. Results can also take far longer with tretinoin than with other treatments, requiring at least six months or so before improvement is seen. Because of this, tretinoin is generally not recommended as the only option for skin discoloration but it can be used in combination with other effective topicals. Even though tretinoin can be disappointing for skin lightening, that should in no way diminish the role it plays in the improvement in skin's cell production, collagen production, elasticity, texture, and dermal thickness. Tretinoin, combined with more effective skin-lightening treatments, is a powerful alliance in the battle against sun-damaged and aged skin.

Combination Treatments

Diligent use of a sunscreen with the UVA-protecting ingredients of titanium dioxide, zinc oxide, or avobenzone is the first line of defense when tackling skin discolorations. Many researchers feel that 2% to 4% hydroquinone lotions can be more effective when combined with Retin-A or Renova (vitamin A creams) and Alpha Hydroxy Acids. Higher strengths of hydroquinone (over 2%) are available only from a physician and can possibly help deeper sources of pigment discoloration, although they can be a problem for darker skin tones. Chemical peels or laser treatments can be used to remove or lighten deeper skin discolorations and then topicals may be used to maintain the improvement.


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