THE YELLOW PEEL 2010
YELLOW PEEL FOR MELASMA, HYPER-PIGMENTATION AND FACIAL REJUVENATION
The Yellow Peel is now available for treatment of facial skin hyper-pigmentation and melasma and results compare favourably with Cosmelan©/Dermamelan© and similar facial masks. The treatment of melasma and chloasma, affecting the face has proven to be the Achilles heel of the beauty salon, because of resistance to known treatments and recurrence. Firstly, the facial spots and blemishes are difficult to fade or remove by topical treatment and secondly, the condition recurs, necessitating some form of long-term maintenance treatment or plan. Important aetiological factors includes pregnancy and birth control medications. Post-acne pitting and hyper-pigmentation is especially resistant to treatment. Most honest salons admit this. Conventional peels, lasers and IPL have not proven that good for this condition, and often lead to disappointment or worsening of the pigmentation. The Blue Peel is only for experienced plastic surgeons or dermatologists.
Besides Cosmelan©, Amelan© and Dermamelan©, the non-invasive, non-hydroquinone, anti-melanin YELLOW PEEL has emerged recently and renders fairly good results in the hands of experienced salons. TheYellow Peel, contains a mixture of depigmenting agents such as kojic and azelaic acid, phytic and salicylic acid and Retinol. Much the same as found in Cosmelan© and Dermamelan©, with a few exceptions. Package inserts can be compared for more information. So the salon now has the choice of The Yellow Peel or Cosmelan© for the treatment of hyper-melanosis. Both are choices for the application of a depigmentation or hypopigmenting facial mask. More details on the Yellow Peel can be viewed at www.menemoy.com.
Both Yellow Peel and Cosmelan© are indicated for the management of facial pigmented spots ( hyperchromic lesions), photo-aging ( superficial wrinkles), reactive pigmentations, solar lentigines, senile lentigo, acne sequels, actinic keratoses and melasma. The two cannot be used in combination. If the Yellow Peel is selected the application should be preceded by an Alpha & Beta keratolytic pre-peel ( 30 seconds to 60 seconds depending on the thickness of the skin and sensitivity thereof. Then the Yellow paste is applied to the skin with a gloved finger. Dr Romulo Mene, a plastic surgeon from Rio de Janero, Brazil, mentions out that “it can be left on the skin for a continuous period of 2-hours and then removed with neutral soap”. All established and reputable salons know how to apply the Yellow Peel. Valuable information can be gleaned from U-TUBE VIDEO on Google. Establishing the degree of hyper-pigmentation blemish and underlying skin photo-type is important before application of the Yellow Peel. In the case of Cosmelan©, the facial mask is applied to the client in the salon or doctor’s rooms, who then goes home and removes the mask later, followed by maintenance skin treatment ( a two-stage protocol that involves the doctor’s rooms and then the patient’s home). In the case of the application of the Yellow Peel, Dr Mene stresses the importance of monitoring the skin inflammatory process during and after the peel. For acne sequels and medium wrinkles Dr Mene recommends 5 or 6 applications of the Yellow Peel for a 4 hour period. He recommends post peel Vaseline© or a hydrocortisone cream, the latter of which should only be prescribed by a specialist, and is a prescription drug.. The following protocols are available for the application of the Yellow Peel.
- Yellow Peel Revitalisation ( light phototype)
- Yellow Peel Classique ( phototypes 2 and 4)
- Yellow Peel Accelere ( actinic keratosis)
- Yellow Peel Expert ( for previously treated melasmas and old hyper-pigmentation)
A post-peel regimen is needed and sunscreen (UVA filters according to phototype) skin factor 30 is needed (see www.menemoy.com). “Skin rejuvenation” cycles can be repeated and more information is available at www.epi-centrum.pl. This explains that the Yellow Peel is an entirely medical peel, requires careful skin assessment before application, and post-care surveillance after treatment regarding future Yellow Peel treatment intensification. In the case that the Yellow Peel is used, peeling can be repeated once a month, provided the skin is not sensitive, no persistent blushing is visible and the skin does not feel delicate to the touch. All clients should realise that these treatments cost money and cannot expect cheap freebies. In order to gain a positive result from the Yellow Peel for hyper-pigmentation, the following protocol needs to be followed.
- Pre-peel skin assessment (anamnesis or cosmetic CV) and diagnosis to rule out skin sensitivity, allergies, and to establish skin photo-types as well as suitability of the client for such treatment. Skin examination under the Wood Light is valuable( this will help localize the melanin either in the epidermis, dermis, combination mixed type, and non-visible types)
- Keratolytic pre-peel
- Yellow Peel application for the designated time (modest epidermolysis or peeling is visible at 48-72 hours). During the Yellow Peel process, the level of discomfort, swelling and skin erythema is monitored. The Yellow Cream/Balm is applied under controlled conditions to the forehead, glabella, cheeks, lower and upper lids, chin, upper and lower lip and temporal regions. Care is needed when application is near the nares and corners of the mouths. Advanced Nutrilip© can be used for protection here or Vaseline©.
- Post Peel maintenance treatment ( moisturisers)and use of appropriate sunscreens
SCIENTIFIC MOTIVATION FOR THE APPLICATION OF DEPIGMENTING PEELS SUCH AS THE YELLOW PEEL: EVIDENCE
Hypo-pigmentation or skin-lightening under controlled conditions, in man can be induced by tyrosinase inhibition, interference with melanosome maturation and transfer, melanocyte loss, desquamation and chemical peeling. This means inhibition of eumelanin via depigmenting topical treatment such as The Yellow Peel or Cosmelan©/Dermamelan©. Skin embellishment can also be improved this way. But elimination of skin spots and blemishes is a slow process and can take weeks and months depending on the case. However the current hypo-pigmentation mask applications cannot eliminate dermal spots. Tyrosinase inhibition by hydroquinone has been a popular approach. And still is in good hands and small areas of melasma or chloasma. It does have side-effects that can be managed. Most depigmenting masks contain a combination of anti-melanin agents such as retinoids, mequinol, azelaic acid, arbutin, kojic acid, aleosin, licorice extract ascorbic acid and soy proteins. But these too, can lead to bad skin rashes and allergies. But mainly triple-fixed combinations are used in masks to treat melasma, because it is so resistant to treatment. Combinations of some of the above depigmenting agents to fight EUMELANIN, are found in The Yellow Peel, Cosmelan© , Dermamelan©, Cosmelan Active System© for spot treatment and acne pigmentation, and Dermazelan Spot Treatment©. These treatments are available in South Africa but are fairly costly ( > R 5000). Whatever is selected, long-term follow-up maintenance treatment is needed, often for periods up to 12 months. Indeed, depigmenting cycles are needed, and each lasts about 3 months. One must expect non-responders , and that applies to the application of Cosemelan©, other depigmenting agents, and The Yellow Peel in the treatment of hyper-pigmentation. And of course one has to stay out of the sun and wear sun-block ( SPF 30+). Neostrata Pigment Lightening Gel© ( containing glycolic and gluconolactone formulation with kojic acid is very effective treatment of focal solar lentigenes , but application is needed for a few months. This is very cost effective topical treatment compared to depigmenting face masks. Combination facial masks are aimed at:
- Reversible inhibition of melanogenesis and tyrosinase, thus working on melanosomes and the eumelanin pathways (examples of such agents include hydroquinone, tyrosinol complex, aloesine, liquorice extract ( glabridin),ascorbic acid derivatives).
- Anti-oxidant function
- Possibly stimulation of dermal fibroblast and collagen formation, resulting in revitalization of the skin ( induction of a glowing skin with enhanced radiance)
- Gentle exfoliation eliminates melanin in the superficial layers of the skin. But has no notable effect on dermal trapped melanin.
- Reduction and elimination of melasma blemishes ( to use the products one must know how to establish the skin phototypes I-VI (Dr T. Fitzpatrick)
- At the time of writing there is no evidence that THE YELLOW PEEL is more effective than Cosmelan©/Amelan©/Dermamelan©/ Cosmelan Active System©/Dermazelan©. Each salon has its own preferences.
LIQUID FACE LIFT: A NEW DIMENSION FOR YOUTHFUL RADIANCE
Some salons offer carefully administered Botox© in combination with fillers such as Juvederm©, into different sites, at one sitting after skin phototype and wrinkle assessment, and as anti-aging treatment. It is meant for wrinkle relief and not reduction of hyper-pigmentation. This approach is quick and effective, but costs money and needs repeating. The advantage, over peels and excessive photo-light therapy, is that the tiny injections can be given in less than 30 minutes by an experienced doctor, and results are normally predictable. Indeed, a quick fix, but alas, temporary, non-sustainable result. The fillers, containing natural hyaluronic acid, can soften the nasolabial grooves and marionette lines around the mouth for 6-8 months. Both injectates are safe, proven, almost no down time, and very little side-effects except slight bruising, lumpiness that resolves and skin discoloration for a few days at worst. At the same time the Botox, will remove the frown lines for a period of 3-4 months. So, for this rejuvenation approach, no IPL, RF, lasers or peels are needed. And the client does not have to come back every week for treatment sessions. Another alternative has been the use of Anti-Aging Acupuncture that is thought to improve frown lines. The clinical and cosmetic effects of Botox© and Juvederm© are most often apparent within a week while the reversal or partial amelioration of hypermelanosis ( melasma/chloasma) by The Yellow Peel or Cosmelan©/Dermamelan© takes weeks if not months. Cosmetic outcome and QOL scores after Botox© and fillers is 8-9/10, whilst the results of depigmenting or hypo-pigmentation facial mask therapy to reduce spots, melasma and blemishes is 4-5/10. At times , clients become despondent with depigmenting mask-therapy because of the explainable slow onset of results, reliability and costs ( R 5000+)compared to prescription –based, hydroquinone (R200). The two treatments are not really comparable, as the former is geared at rapid and temporary wrinkle reduction and the latter, at skin-lightening for hyper-pigmentation. Therefore, the one treatment is for wrinkles and the other for pigment ablation or reduction.
SCIENTIFIC REFERENCES REGARDING HYPER-PIGMENTATION
- Hermanus JF et al: Dermatology 2002; 204:281-6.
- Schallreuter KU et al. Exp Dermatology, 2008: 395-404, EPUB 2007.
- Schallreuter KU. Dermatol Clin. 25 (2007), 283-291.
- Zhang XJ et al: Dermatol Clin 25 (2007), 439-447.
- Gupta AK et al: J Am Dermatol 2006: 55; 1048-65.
- Grimes P et al: J Am Dermatol 2006; 54: S255-61.
- Pasricha JS, et al: Dermatol Clinic 25 (2007), 343-352
- Prignano F et al: Dermatol Clin 25 ( 2007) 337-342
- Falabella R et al. Dermatol Clin 25 (2007) 419-430
- Rendon M et al. J Am Acad Dermatol 2006: 54 ( 5 suppl 2): S272-81
- Erbil H et al. J Dermatology 2007: 34, (1), 25-30
- Draelos ZD. J Dermatol Ther 20 (5): 308-13
- Solano F et al. Hypo-pigmenting agents: an updated review on biological, chemical and clinical aspects. Pigment Cell Research 2006; 19 (6): 555-571.
- Gilchrest BA, et al. Mechanisms of ultraviolet light-induced pigmentation. Photochem Photobiol 1996 : 63 ; 1-10
BEAUTY RESOURCE REFERENCES: Woman’s Home, Fair-Lady, Femina and Essentials (2008-2009). www.health24.com (Sunbeds: not a safe tan).
DISCLAIMER: This site provides no treatment advice and accepts no responsibility. Clients selecting these treatments need guidance from a dermatologist or plastic surgeon skilled in the art of facial masks and or use of botulinum and fillers. Contents of this page have been reviewed by an experienced Biomed Expert.
Posted: 26 April 2009.