Melasma is a common condition that affects mostly women and is characterised by excess skin pigmentation, usually located over the cheeks, between the brows, and on the upper lip. Melasma is triggered by oestrogen, and therefore is very sensitive to medications such as the oral contraceptive pill, HRT, and is usually worsened by pregnancy. UV radiation/sun exposure also worsen melasma, so sun protection/sun avoidance is paramount in the treatment of melasma.

Generally, melasma is a difficult condition to treat, and usually there is no ‘cure’ for the problem. However, with appropriate treatments, it can be kept to a minimum, but usually maintenance treatments are required to keep it diminished.

One method of treating melasma is with chemical peels. Chemical peels can help to exfoliate and turn over the skin to help ‘flush’ out the excessive pigmentation. Used carefully, chemical peels can help with melasma. To enhance the effect of chemical peels in the treatment of melasma, priming agents are often used on the skin to help prepare the skin for the peel and to also help in removing the excess pigmentation.

A recent study published in Dermatologic Surgery August 2008 compared the effectiveness of two priming agents , namely 2% hydroquinone, and 0.025% retinoic acid on the effect of enhancing the results of glycolic acid peels in the treatment of melasma.

60 patients were randomly assigned into three groups of 20 patients. Group 1 only received glycolic peels, whilst group 2 and 3 were primed with 0.025% retinoic acid and 2% hydroquinone respectively. The results were found to be more effective with hydroquinone – there was a greater decrease in the melasma, as well as a decrease in post-inflammatory hyperpigmentation after the peel (ie. worsening of the pigmentation after the glycolic peel).

Osmosis skin care is now available at The Victorian Cosmetic Institute. Osmosis skin care was founded by Dr. Ben Johnson who states that ‘Our philosophy begins with the understanding that aging and most skin condition issues occur primarily in the dermis. Unfortunately, the overwhelming majority of skin care companies target the epidermis instead. Research shows that the average absorption of skin care is 2% no matter what pH is used. This means that 98% of most skin care products remain in the epidermis exfoliating and irritating (which actually ages the skin) and creating a temporary plumping that has fooled us into thinking our skin is healthier when it is not. ‘ Osmosis uses a liposomal delivery system that allows higher concentrations of its active ingredients to be delivered into the dermis with less irritation.

One of the key ingredients in Osmosis is retinaldehyde. Retinaldehyde has a number of properties that help to promote skin health and reduce aging. Furthermore, it is also effective in the treatment of acne and rosacea.

Retinaldehyde is a topical retinoid that has much less irritancy than other retinoids.
The following are studies of the effect of retinaldehyde on the skin:

STUDY 1
Retinal is very well tolerated.
“Tolerance of Topical Retinaldehyde in Humans”
Sachsenberg, E.M, , Dermatology, 1999;(suppl 1)199:61-63
Key Points of Study

• This study showed that Retinal was much better tolerated (than RA) by a majority of the 357 patients tested.
• Unlike retinoic acid’s phototoxicity and inflammation potential, none of the 45 patients tested separately showed any phototoxic effects.
• Overall, Retinal had a side effect profile almost as low as the placebo as opposed to the much higher levels of irritation associated with Retinoic Acid.

STUDY 2
Retinal is the best choice when treating photodamage!
“Efficacy of Topical 0.05% Retinaldehyde in Skin Aging
by Ultrasound and Rheological Techniques”
Diridollou, S., Vienne, M.P., Dermatology, 1999;199(suppl 1):37-41.
Key Point of Study

• 40 patients were involved in this one year study that demonstrated that Retinaldehyde significantly increased both the thickness and elasticity of the skin.
• Dermatology 1999;199:29-31 (journal) found that Retinaldehyde has been shown to exert antibacterial activity. Propionibacterium acnes, the bacteria that is one of the causes of acne, is reduced with Retinaldehyde.

STUDY 3
Retinal as effective as Retinoic Acid without the irritation!
“Profilometric Evaluation of Photodamage after Retinaldehyde
and Retinoic Acid Treatments”
Creidi, P., Vienne, M.P., J. Am Acad Dermatol, 1998; 39: 960-965.
Key Points of Study

• Summary: This study showed that Retinaldehyde was very effective at reducingfacial wrinkles.
• Retinaldehyde was as effective as retinoic acid with much fewer side effects in this double-blind study.

STUDY 4
Retinal shows low irritancy so patient compliance was better.
“Tolerance Profile of Retinol, Retinaldehyde and Retinoic Acid
under Maximized and Long-Term Clinical Conditions”
Fluhr, J.W., Vienne, M.P., Dermatology 1999; 199(suppl 1):57-60
Key Points of Study

• Retinaldehyde had a much lower irritancy rate than retinoic acid on the 355 patients involved in this study.
• The patients on Retinal were much more compliant and had far fewer side effects than those on retinoic acid.

STUDY 5
Retinal is a powerful skin remodeler!
“Repair of UVA-Induced Elastic Fiber and Collagen Damage by
0.05% Retinaldehyde Cream in an Ex-Vivo Human Skin Model”
Boisnic, S., Branchet-Gumila, M.C., , Dermatology, 1999; 199(suppl 1):43-48.
Key Point of Study

• This study on human skin explants showed that all UVA treated skin had significant damage of collagen and elastin and ALL of that damage was repaired with the application of Retinaldehyde 0.05%.

STUDY 6
Retinal is great for wrinkles
“Clinical Use of Topical Retinaldehyde on Photaged Skin”
Creidi, P., Humbert, Ph., Dermatology 1999; 199(suppl 1): 49-52.
Key Points of Study

• 85 patients with photodamage were treated with 0.05% Retinaldehyde and had an improvement in coarse and fine wrinkling rated as improving from “moderate” to “slight”.
• The 85 patients in the study showed substantial improvement in facial redness and telagestasias while a majority reported brighter, more radiant skin. This study also showed improved hydration, reduced oil and roughness in a vast majority of the patients.

STUDY 7
Retinal is great for Rosacea
“Retinaldehyde Alleviates Rosacea”
Vienne, M.P., Ochando, N., Dermatology 1999; 199(suppl 1):53-56.
Key Point of Study

• In this 23 person study, 75% of rosacea sufferers had reduced redness and only one of these sensitive skin types had any side effects (and they were mild).

STUDY 8
Retinal is antibacterial, Retinoic acid is not
“Antibacterial Activity of Retinaldehyde against P. Acnes”
Pechere, M., Pechere, J.C., , Dermatology 1999; 199(suppl 1):29-31.
Key Point of Study

• This study showed Retinaldehyde was highly effective at reducing P Acnes bacteria populations. All-trans retinoic acid does not have a direct antibacterial effect.

STUDY 9
Retinal is great for acne
“Comedolytic Effect of Topical Retinaldehyde in the Rhino Mouse Mode”
Fort-Lacoste, L., Verscheure, Y., Dermatology 1999; 199 (suppl 1):33-35.
Key Point of Study

• Retinaldehyde had statistically similar comedolytic effect to retinoic acid while showing less irritation.

STUDY 10
Retinal normalizes VEGF helping hide capillaries
“Effects of Retinoids on Vascular Endothelial Growth Factor Production
by Cultured Human Skin Keratinocytes”
Lachgar, S., Chalveron, M., Dermatology 1999; 199(suppl 1):24-27
Key Points of Study

• Retinal regulates VEGF which is increased in a variety of skin conditions.
• The normalizing ability of Retinal makes it an excellent choice for actinic
• keratosis, telangectasias and rosacea.

STUDY 11
“Metabolism of Retinaldehyde”
Sorg, O., Didierjean, L., Dermatology 1999; 199(Suppl 1): 13-17
Key Points of Study

• Retinal is the closest chemical form (of the retinoids) to retinoic acid and is
• quickly converted to retinoic acid.
• Retinal is stored by the skin for easy access unlike retinoic acid which cannot be
• stored and thus becomes a source of irritation.
• All-trans retinal is the most potent form.

STUDY 12
Retinal is the best retinoid available
Topical Natural Retinoids
Saurat, J.H., Sorg, O., Dermatology 1999; 199(suppl 1):1-2
Key Points of Study

• Retinoids have an average of 2% penetration which means that 98% sit on the
• surface of the skin causing irritation.
• Retinoic Acid cannot be stored by the skin so any excess is a source of irritation.
• Retinal is the precursor to retinoic acid and is quickly converted to retinoic acid
• in the skin to maximize the stimulation of RA receptors.
• Retinal that is not used is stored by the skin for future use.
• The preferred form of retinal is all-trans retinal.

In 1983 Tim Finn sang ‘There’s a fraction too much friction’ which listed as New Zealand’s 41st most popular song of all time according to APRA (the Australasian Performing Rights Association).

In 2008, ‘fractionated’ lasers are have become the new craze in laser technology with multiple laser companies releasing various versions of fractionated lasers. Instead of treating the whole skin surface, fractionated lasers, as the name suggests, treat only a fraction of the skin surface. Usually, multiple individual microscopic columns of laser energy are fired into the skin.

The creation of fractionated lasers were a response of the laser companies to the needs of people in today’s society who cannot afford prolonged recovery times, yet still want to look their best. Most commonly, fractionated lasers are used for reducing acne scarring, and reversing the hallmarks of sun-damage (wrinkles and pigmentation).

Fraxel was one of the first fractionated laser systems on the market. Mosaic is the latest fractionated laser to hit Australian shores. Their patented Controlled Chaos Technology randomises the beams and helps to even delivery of the laser. Other examples of fractionated lasers include Cynosure’s Affirm, that combines two laser wavelengths in the same pulse to help to target various skin layers.

The concept of fractionated treatment of the skin is something that is not limited to lasers however. Skin needling is a non-laser treatment that involves involves puncturing the skin multiple times with small needles attached to a cylindrical roller to induce collagen growth and improve similar skin concerns.

The Victorian Cosmetic Institute will soon be trialling various of the new fractionated lasers including Cynosure’s Affirm and comparing them to skin needling to test which provides the best results in terms of skin rejuvenation, reduction in acne scarring and skin pigmentation.

Dr. Gavin Chan performs lip enhancement on Anissa from Kiss FM. See video;