MOTIVATIONAL FACTORS AND USER AWARENESS IN PATIENTS USING SKIN LIGHTENING CREAMS REPORTING TO DERMATOLOGY OUT PATIENT DEPARTMENT IN COMBINED MILITARY HOSPITAL RAWALPINDI

Objective: To check the motivational factors behind the usage of skin lightening creams and users’ awareness in our setup by constructing a validated questionnaire. Study Design: Cross-sectional study. Place and Duration of Study: Outpatient Department of Dermatology, Combined Military Hospital Rawalpindi, from Oct to Nov 2020. Methodology: Two fifty patients who were using skin-lightening creams (SLC) were recruited after the informed consent. Questionnaire was made following seven steps as mentioned in AMEE (Association for Medical Education Europe) guide 87. Data was analyzed by SPSS version 21. Reliability was be checked by Cronbach@. Descriptive statistics of responses including frequencies and percentages were calculated. Exploratory factor analysis of questionnaire was made. Results: Skin lightening cream users had age range from 16-56 years, majority 190 (76%) were females. Out of 158 (63.2%) were married, 180 (72%) well educated and 146 (58.4%) had Fitzpatrick skin type 3-5 predominate. Cronbach alpha of our questionnaire was 0.802. The 5-point likert scale was used to record users’ perceptions in the domains i.e., motivational factors, awareness about product and intentions. Majority, 89 (35.6%) used the product on social media recommendation. Out of 201 (80.4%) developed side effects with telangiectasia and skin thinning being the commonest ones. Out of 88 (35.2%) were using other skin whitening practices besides these creams. Conclusion: False perceptions about fairness and lack of user’s awareness govern the skin lightening practices in our society resulting in increased usage and side effects experienced by users. A mass educational awareness program regarding “skin lightening.........

Skin-lightening practices in India

Skin lightening involves various practices to bleach the skin or to reduce the normal skin tone. The practice of skin-lightening spans several continents throughout the centuries and cultures primarily aimed at improving the quality of life. The main aim of skin lightening in medieval times was to increase the sign of femininity and thereby its benefits. In India, skin lightening is preferred as a mark of class, caste, and richness. Dermatologists are faced with many problems dealing with requests to make skin fairer, while in the west, there is a problem dealing with skin conditions in skin of color. Many skin-lightening agents are sold as over-the-counter products and are popularized or advertised through magazines, social media, and celebrity influences. These products are self-prescribed and used rampantly despite the side effects. There is a strong equation between caste, social class, marital prospects, and occupational status based on skin color. Multinational skin-lightening cosmetic brands have a lucrative market. The most widely used topical agent in skin lightening is hydroquinone, while other non-hydroquinone agents are also frequently used. In general, combining skin-lightening agents have increased efficacy. Systemic agents such as glutathione, tranexamic acid, Vitamin C, and other miscellaneous agents are also popular. Several procedures ranging from chemical peels to lights and lasers are increasingly practiced for more effective skin lightening. In India, all skin-whitening creams can be bought without a prescription as OTC products. These products are not considered pharmaceutical products and are not subject to testing and regulations. In addition, the injudicious use of intravenous glutathione by unqualified personnel poses a threat to the lay public. In our role as dermatologists, we should develop a holistic approach in counseling and treating those patients on a quest for skin lightening.

Expert opinion on current trends in hyperpigmentation management: Indian perspective

<p class="abstract">Hyperpigmentation is a common pigmentary disorder characterized by increased production of melanin. It is present in Asian skin phototypes, with a higher prevalence in the Indian population. Skin heterogeneity is seen in more than 80% of individuals of all age groups and genders in several cities across India. In children, the prevalence of hyperpigmentary disorders accounts for 1.54 per 1000 children.Sixty expert dermatologists participated in expert group meetings via teleconference webinar to elaborate on the current trends in the management of hyperpigmentary disorders. The major reasons for hyperpigmentary disorders in India include melanocyte function followed by exposure to ultraviolet radiation, race, ethnicity, use of medications, pregnancy, and use of cosmetic. There are wide varieties of skin-lightening or depigmenting agents and skin resurfacing procedures that aid in the management of hyperpigmentation. However, treatment becomes challenging due to compliance issues related to affordability, complexity of prescriptions, and treatment duration. Compliance increases only if the patient sees any improvement or discontinues treatment due to higher expectations. Hence, the success of the treatment lies in patient adherence. This article summarizes expert opinions on identifying, diagnosing, and managing hyperpigmentation with the help of topical depigmenting agents in the Indian scenario. It also emphasizes treatment adherence issues along with the role of patient counseling and education regarding disease awareness and treatment strategies.</p>

White Beauty: The Moderating Role of Social Media Addiction on Social Comparison and Skin Tone Satisfaction

Aims: To examine the prevalence of skin tone dissatisfaction among Malaysian young adults and to explore the associations between social media addiction, social comparison, and skin tone satisfaction. Study Design: Cross-sectional survey design. Place and Duration of Study: Universiti Pendidikan Sultan Idris, Perak, Malaysia, between December 2019 to January 2020 Methodology: Around 414 university students have partaken in an online survey consisting of a demographic questionnaire, Skin Colour Satisfaction Scale (SCSS), Upwards/Downwards Physical Appearance Comparison Scale (UPACS/DACS) and Bergen Social Media Addiction Scale (BSMAS). Results: Descriptive analysis shows that the prevalence of skin tone satisfaction among Malaysian young adults is on a moderate level (M = 5.791, SD = 1.630), and there is a significant difference in satisfaction level among those who never tried using skin lightening products versus those who have experience in using those products, t (410.808) = -3.850, p < .001. Multivariate analysis shows that skin tone satisfaction is significantly associated with upwards social comparison (β = -.45), but not with downwards social comparison and social media addiction. Multigroup invariance analysis showed that social media addiction significantly weakens the relationship between upwards social comparison and skin tone satisfaction but has no effect on the relationship between downwards comparison and skin tone satisfaction. Conclusion: Malaysian young adults are moderately satisfied with their skin tone, and upwards comparison can significantly influence skin tone satisfaction. The implications of this study are discussed in light of recommendations for policymakers to control the marketing of harmful skin lightening products online.

Using a Cellular System to Directly Assess the Effects of Cosmetic Microemulsion Encapsulated DeoxyArbutin

DeoxyArbutin (dA) is a tyrosinase inhibitor that has effective skin-lightening activity and has no obvious cytotoxicity toward melanocytes. With the aim of directly evaluating the effects of microemulsions containing dA on cells, we developed oil-in-water (O/W) microemulsions with relatively lower cytotoxicities by using polysorbate-series surfactants. Measurement of the transparent properties and particle size analysis at different storage time periods revealed that the developed microemulsions were stable. Moreover, the developed microemulsions had direct effects on B16-F10 mouse melanoma cells. The anti-melanogenesis activities of dA-containing microemulsions were evidently better than that of the free dA group. The results demonstrated that the developed microemulsion encapsulating dA may allow the use of deoxyArbutin instead of hydroquinone to treat dermal hyperpigmentation disorders in the future.

Landscape dynamic network biomarker analysis reveals the tipping point of transcriptome reprogramming to prevent skin photodamage

Skin, as the outmost layer of human body, is frequently exposed to environmental stressors including pollutants and ultraviolet (UV), which could lead to skin disorders. Generally, skin response process to ultraviolet B (UVB) irradiation is a nonlinear dynamic process, with unknown underlying molecular mechanism of critical transition. Here, the landscape dynamic network biomarker (l-DNB) analysis of time series transcriptome data on 3D skin model was conducted to reveal the complicated process of skin response to UV irradiation at both molecular and network levels. The advanced l-DNB analysis approach showed that: (i) there was a tipping point before critical transition state during pigmentation process, validated by 3D skin model; (ii) 13 core DNB genes were identified to detect the tipping point as a network biomarker, supported by computational assessment; (iii) core DNB genes such as COL7A1 and CTNNB1 can effectively predict skin lightening, validated by independent human skin data. Overall, this study provides new insights for skin response to repetitive UVB irradiation, including dynamic pathway pattern, bi-phasic response, and DNBs for skin lightening change, and enables us to further understand the skin resilience process after external stress.

A Prospective, Interventional Study of Oral Tranexamic Acid With Antioxidants and Local Glycolic Acid for The Treatment of Resistant Melasma

Background: Melasma is a common acquired hyperpigmentation of sun-exposed areas. It is highly treatment resistant and with high chances of recurrence. Treatment of melasma using oral tranexamic acid (TA) with antioxidants and glycolic acid is a novel concept. Objective: Aim of the study was to assess efficacy and safety of novel combination therapy for the treatment of resistant melasma. Method: It was a prospective interventional trial conducted on a total of 10 patients with melasma, who did not respond to topical skin lightening therapy. The severity and extent of pigmentation was assessed by modified melasma area severity index (mMASI). Patients were then prescribed oral TA with high dose of vitamin C, Iron & folic acid along with local glycolic acid. The response to treatment was assessed by mMASI and clinical photographs at 8th week and after 3 months on completion. Result: Significant difference between mMASI was observed among the study population. 60% patients showed 100% improvement and 40% showed 75% improvement from the baseline mMASI at 8 weeks after commencing treatment and 100% patients showed 100% improvement on 3 months completion. Conclusion: Based on the study results, oral TA in combination with antioxidants and glycolic acid can be used as a potential new, effective, and safe treatment for resistant melasma