A Systematic Review on Skin Whitening Product

Skin whitening is a term used for lightening the complexion of the skin through artificial means like creams, lotions, soaps and injections. Unfortunately, the appeal of these skin bleaching products is based on the obsession of people across the world with skin color. Melanins are produced by specialized cells, termed melanocytes, which are located primarily in the skin, hair bulbs, and eyes. The melanins can be of two basic types: eumelanin’s, which are brown or black, and phaeomelanin’s, which are red or yellow, in mammals typically there are mixtures of both types Increased production and accumulation of melanins characterize number of skin diseases, which include hyperpigmentation such as melanoma, post-inflammatory melanoderma, solar lentigo, etc. Several modalities of treatment for these problems are available including chemical agents or physical therapies. The aim of this review article is to show that some of the skin whitening creams, often sold illegally without a prescription may contain dangerous ingredients that could put people health at risk

ANATOMOCLINICAL CONFRONTATION BETWEEN MELANOMA, SOLAR LENTIGO AND SEBORRHEIC KERATOSIS: A CASE REPORT

The primary diagnosis in case of a rapidly developing facipigmented lesion in an elderly patient is Dubreuilhs melanoma . This case report is highlighting the issue of anatomoclinical confrontation between a clinically suspected melanoma and a pathologically confirmed solar lentigo and seborrheic keratosis.

Variability in the Histopathological Diagnosis of Nonmelanocytic Lesions Excised to Exclude Melanoma

Introduction. The differential diagnosis of lesions excised to exclude melanoma include a variety of benign and malignant melanocytic and non-melanocytic lesions. Objectives. We examined the variability between pathologists in diagnosing non-melanocytic lesions. Methods. As part of a larger study prospectively examining the diagnosis of lesions excised to exclude melanoma in 198 patients at a primary care skin cancer clinic in Newcastle, Australia, we compared diagnosis made by 5 experienced dermatopathologists, of 44 non-melanocytic lesions in 44 patients aged 22-90. Results. Forty-four lesions (out of 217 in total) were non-melanocytic. Among the 5 pathologists who examined each case there was marked variability in the terminology used to diagnose each case. The most common variability was found between seborrheic keratosis, large cell acanthoma, solar lentigo, and lichenoid keratosis. The diagnosis made by the majority of the pathologists was deemed to be the reference diagnosis. Versus majority diagnosis, 4% of benign lesions were considered malignant, and 7% of malignant diagnoses were considered as benign. Conclusions. The different terminology adopted and lack of consensus in the diagnosis of these non-melanocytic lesions in this setting suggests that training AI systems using gold standards may be problematic. We propose a new management classification scheme called MOLEM (Management of Lesions Excised to exclude Melanoma) which expands the previously described MPATH-dx to include non-melanocytic lesions.

Nanosecond Q-Switched 1064/532 nm Laser to Treat Hyperpigmentations: A Double Center Retrospective Study

(1) Benign hyperpigmentations are a common problem in cosmetic dermatology. Melasma, solar lentigo, and other acquired hyperpigmentations represent an aesthetic issue for an increasing number of patients. The gold standard in managing this condition is currently 1064/532 nanometers (nm) Q-Switched lasers. This study reports our experience on the use of a Q-switched laser with a nanosecond pulse to treat these conditions. (2) Methods: A total of 96 patients asking for benign hyperpigmentation removal were consecutively enrolled at the Magna Graecia University of Catanzaro and Tor Vergata University of Rome. Treating parameters were the following: 1064 nm with a pulse duration of 6 nanoseconds (ns) for dermic lesions and 532 nm with 6 ns for epidermal ones. Up to five treatments with a minimum interval between laser treatments of thirty days were performed. A follow-up visit three months after the last session assessed patient satisfaction with a Visual Analogue Scale (VAS). Two blinded dermatologists assessed the cosmetic result using a five-point scale comparing pictures before treatment and at follow-up. (3) Results: 96 patients were included; 47 participants were women (49.0%) and 49 men (51.0%). The mean reported age was 50.0 ± 17.3 years. All patients reached a good to complete hyperpigmentation removal at the dermatological evaluation with a mean VAS score of 8.91 ± 1.07. (4) Conclusions: Q Switched 1064/532 nm laser may be considered the gold standard treatment for benign hyperpigmentations. Our results confirm the literature findings on the effectiveness of these devices.

Langerhans Cells as Morphologic Mimickers of Atypical Melanocytes on Reflectance Confocal Microscopy: A Case Report and Review of the Literature

Pagetoid spread of melanocytes in the epidermis is a common indicator of melanocytic atypia, both histopathologically and with reflectance confocal microscopy (RCM). Specifically on RCM, large, bright, atypical dendritic and/or roundish cells are characteristic of melanoma. However, intraepidermal Langerhans cells (ILC) create the potential for diagnostic ambiguity on RCM. We describe one case of a pigmented facial lesion that was initially diagnosed as lentigo maligna (LM) due to numerous atypical perifollicular dendritic cells on RCM. Additionally, we present the findings of a literature review for similar reported cases conducted by searching the following terms on PubMed: reflectance confocal microscopy, RCM, lentigo maligna, melanoma, Langerhans cells, dendritic cells, and atypical cells. In our case, the lesion was determined to be a solar lentigo on histopathology. Immunohistochemistry (IHC) with CD1a identified the atypical-appearing cells as ILC, as it did in 54 reported cases of benign lesions (benign melanocytic nevus, Sutton/halo nevus, labial melanotic macule, and solar lentigo) misdiagnosed as malignant on RCM (melanoma, lip melanoma, lentigo maligna, and LM melanoma). According to our case and the literature, both ILC and atypical melanocytes can present with atypical-appearing dendritic and/or roundish cells under RCM. Currently, there is no method to distinguish the two without IHC. Therefore, the presence of pagetoid cells should continue to alert the confocalist of a potential neoplastic process, prompting biopsy, histopathologic diagnosis, and IHC differentiation.

Citral-Containing Essential Oils as Potential Tyrosinase Inhibitors: A Bio-Guided Fractionation Approach

Excessive melanin production causes serious dermatological conditions as well as minor aesthetic problems (i.e., freckles and solar lentigo). The downregulation of tyrosinase is a widespread approach for the treatment of such disorders, and plant extracts have often proven to be valuable sources of tyrosinase inhibitors. Citral (a mixture of neral and geranial) is an important fragrance ingredient that has shown anti-tyrosinase potential. It is highly concentrated in the essential oils (EOs) of Cymbopogon schoenanthus (L.) Spreng., Litsea cubeba (Lour.) Pers., Melissa officinalis L., and Verbena officinalis L. However, only L. cubeba EO has been investigated for use as a potential skin-whitening agent. This work evaluates the in vitro tyrosinase inhibitory activity of these EOs and studies, using bio-assay oriented fractionation, whether their differing chemical compositions influence the overall EO inhibitory activities via possible synergistic, additive, and/or competitive interactions between EOs components. The inhibitory activity of C. schoenanthus EO and that of M. officinalis EOs, with negligible (+)-citronellal amounts, were in-line with their citral content. On the other hand, L. cubeba and V. officinalis EOs inhibited tyrosinase to considerably greater extents as they contained β-myrcene, which contributed to the overall EO activities. Similar observations were made for M. officinalis EO, which bears high (+)-citronellal content which increased citral activity.

LASER 532-NM ND:YAG PICOSECOND IN TREATMENT OF SOLAR LENTIGO AND EPHELIDES

Aims: To evaluate the efficacy, side effects of laser 532-nm Nd:YAG picosecond in treating solar lentigo and ephelides at HCMC hospital of dermato-venereology. Objectives and Method: Prospective - descriptive study. There were 43 patients dealing with solar lentigo and ephelides treated with laser 532-nm Nd:YAG picosecond. Each patient went through 3 treatments with one month interval, three months follow up for delayed side effects and recurrent. Evaluating the treatment by MI, VLCS, self-patient evaluation with 5 grades scale. Evaluating side effects of the treatment by 5 grade Wong-Baker scale. Collected data were analysed with SPSS.20.0. Results: Based on MI at the end of the study, the effectiveness of the treatment gained 81.4% good, 16.3% average and 2.3% bad. Self-patient evaluation revealed 76.7% good, 20.9% average and 2.3% bad. VLCS of post-treatment reduced 7.44 ± 2.14 unit compares with of pre-treatment. Recently after treatment, 100% patients had erythema and mild pain in 5 grade Wong-Baker scale, 20.9% had mild edema, 2.3% had post imflammatory hyperpigmentation (PIH). Two ephelides cases recurred 3 months after treatment (4.6%). Conclusions: Laser 523-nm Nd:YAG picosecond has high efficacy and less side effects in treating solar lentigo and ephelides. Key words: solar lentigo, ephelides, laser 532-nm Nd:YAG picosecond

Prevelance and Causes of Facial Hyperpigmentation in Egypt: Dermoscopic and Histopathological Study

Background One of the most common dermatological complaints from patients with skin of color is dyspigmentation, particularly hyperpigmentation. The challenge for clinicians is to establish correct diagnoses along with successful treatments to meet the needs of the increasingly diverse population. Aim of the Work To identify the prevalence and the causes of facial hyperpigmented lesions in Egyptian people by using dermoscope and histopathological examination. Patients and Methods This study is a prospective cross-sectional non-controlled study that included 125 patients with facial hyperpigmentary lesions on the face. The patients were randomly recruited from the outpatient clinic of Dermatology at Ain Shams University Hospitals, during the period from July 2017 till December 2018. Results In our study, 67 patients (44%) had melasma; 25patient (16%) PIH and 23 (15%) patients showed freckles. In addition, SK was diagnosed in 10 patients (6%), phototoxicity in 4 patients (2.5%), 11(7.5%) patient was diagnosed with LPP, riehls melanosis was also diagnosed in 3 patients (2%), 2 patient presented with epidermal naevi (1.8%) and one patient presented with naevus of ota (0.5%) and one with solar lentigo (0.5%). Conclusion Dermoscopic examination can be dignostec in some diseases like SK and it can be helpful the determine the level of pigmentation and to expect the treatment results. And correlation between histopathology and dermoscopy can be helpful to reach the final diagnosis ant to determine the best treatment choice.