Whether it is treating the face, the chest or other parts of the body, a successful procedure can be marred by a defensive reaction in the patient’s skin that can cause an uneven tone on what would otherwise be the patient’s fresh new look. This troubling challenge is known as “post-inflammatory hyperpigmentation” (or “PIH”), a patchy darkening or discoloration of skin, often occurring after a cosmetic procedure.
Historically there has been little to offer to counter PIH, other than time and the hope that it will resolve on its own, which it often does – eventually. However, “eventually” does not meet the patient’s expectation, and their dissatisfaction with their outcome often takes hold about the same time the discolored skin does.
In the past, hydroquinone (HQ) has been most commonly used to try to quickly correct or prevent the occurrence of PIH after facial procedures such as laser resurfacing, Botox and filler injections or facial peels. It is, after all, a powerful inhibitor of the tyrosinase enzyme – the key enzyme used in producing (or in this case over-producing) melanin. That being said, hydroquinone is itself somewhat of a cytotoxic irritant. So treating trauma-induced hyperpigmentation – with contact dermatitis–inducing hydroquinone – is a dicey proposition. In fact, it seems to be a true example of trying to put out a fire with gasoline.
Though not the stated reason for the recall, perhaps it is only a small wonder that the manufacturer of the leading hydroquinone prescription drug, Tri-Luma, took their product off the market in the United States in August of 2010, where it remains unavailable as of the date this article. Prior to that recall the FDA issued a warning to the makers of Tri-Luma, instructing that they specifically caution physicians and their patients against using the product for anything more than short term treatments under specific conditions – not as an ongoing skincare product.
The good news is that new alternatives to HQ that have appeared on the market over the last two years have been making steady inroads into physician protocols for a variety of cosmetic procedures.
The best case-in-point may be Decapeptide-12, sold under the Lumixyl® brand. The Lumixyl peptide’s skin brightening properties were discovered by Dr. Basil Hantash
and a team of Stanford research dermatologists. Clinical studies performed there showed the peptide to be more potent as a tyrosinase inhibitor than HQ. Perhaps more importantly, those same studies showed it to have no toxicity, and therefore a much more attractive safety profile than HQ. Armed with those results, study sponsor Envy Medical, Inc. launched the Lumixyl Topical Brightening Creme in August of 2009.
Since that time, physicians around the world have been expanding their experience with Lumixyl, as well as the number of situations in which they prefer to use Lumixyl to solve the PIH issue for their patients.
In an interview from the annual congress of the American Society of Plastic Surgeons, Dr. Bryan Forley, M.D., a board-certified plastic surgeon based in Manhattan, commented that Lumixyl “can be used as a preventive means, for example in some of the procedures that we do, just the inflammation from the procedure and the body’s healing response can produce pigment,” but he noted that, “If you pretreat the patient and then continue to treat them afterwards, then you can often either lessen or completely avoid those pigmentation issues.”
Dr. Forley also noted that Lumixyl “can be used for an extended period of time safely for those who need to use it for a longer duration without causing the type of reaction or hypersensitivity that had been seen in the past with other products.”
Dr. Forley is one of a growing number of physicians developing protocols for Lumixyl as a pre- and post-treatment for more invasive procedures, or as part of a combination therapy. Dr. Lisa Zdinak, M.D., Chief Surgeon and Medical Director of Precision Aesthetics in New York, commented on her success in using Lumixyl to improve tone and texture of skin on the chest.
“I have been leaning away from hydroquinone due to the controversies abroad about dangerous side effects,” said Dr. Zdinak in a recent interview, “I have my patients mix the Lumixyl with Retin-A at bedtime and apply it to the décolleté region. They notice an effect after about three weeks.”
Another cause of PIH is the skin trauma caused by acne flair-ups. This is a more traditional need, yet it is still challenging to treat with HQ because acne is irritating to the skin to begin with, and that can easily be compounded. So this is also a case where physicians are seeing success with the HQ alternative. Speaking about treating this type of hyperpigmentation, Dr. Ashish Bhatia, M.D., a dermatologist at Northwestern University is emphatic.
“The results [using Lumixyl] are spectacular,” commented Dr. Bhatia. “Until now we really haven’t had anything that works so effectively on hyperpigmentation and discolored skin.”
So while this peptide technology is young, it is getting a startling amount of
attention because of its profile as the safe alternative to HQ – and an alternative that both physicians and their patients have been looking for here in the United States, and perhaps even more so abroad. Because of its safety profile, Lumixyl has been able to make inroads into physician and drugstore channels in countries all around the world. According to Envy Medical public information, having just launched in early 2010, the Lumixyl Topical Brightening System is already available in over 25 countries around the world, with more coming online in the months ahead. High profile launches include Japan, Hong Kong, Germany, and a recent announcement by Mumbai based partner Themis Medicare to market Lumixyl throughout India.
“It’s an exciting time for the company, and we really think it is an exciting time for patients worldwide that have been looking for a viable alternative to hydroquinone,” said Curtis Cluff, CEO of Envy Medical. “We are thrilled to be able to provide that solution, and to build an effective skincare line around such a safe and effective peptide technology.”
With cosmetic trends moving increasingly toward more natural, subtle looks and minimal downtime, the introduction of effective alternatives for promoting an even and brighter skin tone appears to be well placed.