I have come across a lot of patients who wanted fairness and even to the point of luminant skin. Being an aesthetic physician in Asia this is not uncommon. The Asian's model for beauty is to have fair flawless skin like the Japanese, and Korean counterparts. So I've decided to give my two cents on it, based on the things that I have read and researched.
Before I start explaining on the products that claims to make a person fairer, first we need to understand the difference in skin types and tans which determines how fair or tan you will be and the factors that lead to a more exaggerated tanning. There are 6 skin types based on Fitzpatrick's Skin Colour Classifications ranging from type 1-Type 6. For Asians, Type 1 are the extremely fair Scandanavians with blue eyes and yellow hair, type 2-3 are mainly Caucasians some are the Japanese and Korean Asians and for people like us, living at the equator would likely have type 4-5 skin type. Type 6 are the African origins or dark Indians. This genetic predisposition to skin colour depends on the distribution of melanin at the basal layer of the epidermis (skin). The environment also plays a role, whereas, where there is a overstimulation of the melanin - leads to more tanner skin. The most common cause is exposure to UVA/UVB sunlight. What it means in simple tense is that, even if we were to exclude environmental factors, our genetic built up will be the limitation to the fairness that we can achieve despite any treatment. I usually tell my patients that if you want to be fair, you can only achieve fairness as much as your non sun exposed areas and not more than that unless you bleach yourself.
According to most of the clinical studies that I have come across, topical Vitamin C in high concentrations does lead to a brightening of the skin because of its anti-oxidant effects and skin healing properties which allows better new skin formations. However, a lot of the creams/serums in the market have problems in delivering the vitamin C into the skin effectively leading to reduced efficacy. (Check out blog entry What's Up with Vitamin C -
http://faceworksclinic.blogspot.com/2011_04_01_archive.html ) The better ones are more expensive and prices range from a few hundred for a bottle. Furthermore, you need to use it on a more consistent basis in order to achieve lasting results.
Similarly, there are some bleaching agents such as hydroquinone (HQ) - which is still the gold standard for treating pigmentary problems. However, long term use of hydroquinone will lead to a condition called onochronosis which is a bluish discolouration of the skin at the area of usage. Onochronosis is really difficult to treat and require multiple laser treatments to reduce the appearance. This was the main reason why there is a lot of bad press and reports on HQ. A lot of beautician products use HQ in the creams to get fast results as fast as 1-2 weeks but in long run causes damage to the skin. The FDA approval for concentration of HQ in skin products is only 4%. I know some beautician products that use up to 8% HQ and is sold over the counter with no restriction. Therefore, if you plan to use HQ to treat your pigmentation issues, please make sure you are under a follow-up by a doctor who actually know what they are prescribing.
Then we come to the non-HQ bleaching agents such as kojic acid, arbutin, mendelic acids etc. The most common nowadays are the kojics and arbutins. In high topical concentrations, you can see an instant lightening of pigments. However, if you are using a topical cream, containing these products, you will only see results after perhaps 4-6 weeks, in contrast to HQ where you see improvement in 2-4 weeks. Because these bleaching agents are taken from natural sources, you can actually use them up to whenever you feel like it without much side effects. However, I have noticed that after 6-9 months, some patients feel that the bleaching ingredient does not give any additional effects and sometimes I shift them back on HQ. Although this may appear to be the miracle product for avoiding and brightening up pigmentation, some people are allergic to these products and develop rash and itchiness. I see this more common with kojic acid preparations.
There are some products in the market which claims oral intake can help lighten up the skin. Some offer vitamin C in high doses of 1000-2000mg daily, others claim glutathione up to 5000mg daily oral intake. Although these may appear appealing, the high concentrations may not benefit in view that the gut can only absorb as much and overconsuming of vitamin C can lead to orange discolouration of skin, gut disturbances, etc. There are some products in the market which contain melanin blockers and acts at the cellular level of melanin production. I found one product interesting called White Beaute. It is an oral supplement that acts as a melanin blocker. I have seen some of my patients who improved in skin tone when taking this product after 3-6 months. The only thing with oral supplements, it takes longer to see the results compared to other methods, and that may be the reason some people prefer not to try it out. I have also tried out oral sunblocks such as Heliocare Oral Sunblock Pynocare - I find that it does give a fair results for about 3 months but prolonged use did not appear to benefit much in terms of skin brightening. But I did notice that I got less sunburnt compared to prior being on the product and you need to take it 2 weeks prior to any sun vacations to get the best results. My consultant consumed this product only 1 week before a beach holiday and she still got burnt, so perhaps the other general precautions such as hat, umbrella,shades and topical sunblock and sunscreen should be applied despite using the product.
Now we go to the injections. The most common injections for whitening sold are the Vitamin C's and Glutathione injections. Personally, I've never tried since I'm pretty happy with my tan, but maybe for research purposes, I would subject myself to this trial in the future. However, I do have girl friends who swear that it really does work. It works fast, but you need a maintenance program to keep yourself fair and you still have to avoid direct sun exposures. Furthermore, in view that you are trying to get the anti-oxidant benefits and the glutathione overdose side effect, you need to understand that there are factors that will cause these injections to not work. Basically, oxidative stressors.
There are many different processes and substances that chronically damage cells and contribute to oxidative stress including:
- Toxic chemical compounds and pollutants in your body
- Hydrogenated fats
- All kinds of pollution , including air, water, and food
- Oils that have been heated to very high temperatures
- Cigarette smoke, directly inhaled or secondhand
- Dehydration
- Too much sugar
- Too much animal protein in your diet
- Geophysical stress like living near power lines or waste dumps
- Microbial imbalance, including bacterial, fungal and viral infections
- Preservatives in your food
- Drugs (over the counter and prescription)
- Artificial food colorings and flavorings
- Plastics
- Chemical cleaning supplies
- Chlorinated water that you drink, shower in or swim in
- Alcohol
- Pesticides in your food
- Radiation exposure
- Psychological and emotional stress
Which is why in smokers, sometimes the whole course does not work. Another issue is gaining a good IV access and being careful enough to not shoot the products too fast because it will cause damage to the vein endothelium. And the most problematic part would be the commitment to come to the clinic according to the recommended intervals. If you skip 1 even, it may not work. I have come across a few alternative studies which links the usage of Vitamin C extreme high does as a cytotoxic agent to treat cancer cells. Therefore, injections for whitening using vitamin C and glutathione although some say may not benefit the person much, I do believe would help reduce oxidative damage that causes aging and is not just an expensive urine. But whether you are willing to fork out for a treatment that you may or not become fair from, its up to the person's personal choice. I would rather the person comes to a proper doctor in a clinic who understand the benefits and complication rather than shoot it up in a beauty saloon or a hotel room by some unlicensed person. Its always better to be safe than sorry.
So maybe one day we will find a way to lighten up skin even from darker skin subtypes. But is fairness really that important? Perhaps, since we have all been brainwashed since we were really young- remember snow white? Mirror, mirror on the wall........ who's the fairest of them all? My belief is beauty is not just skin deep, it comes from within.
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