Managing UV-induced pigmentary disorders: New, affordable products complement sunscreen

Boston - Patients and dermatologists have new options in the management of pigmentary disorders resulting from decades of sun exposure, according to Ranella A. Hirsch, M.D., clinical assistant professor of dermatology, Boston University Medical Center.

Safe, effective - and affordable - products are now as close as the health and beauty section of the nearest drugstore, she says, and it is important to know the ways these products are to be used.

"The fundamentals about pigmentary disorders haven’t changed," Hirsch says. "The story’s just gotten bigger. Patients still have to wear sunscreen. Once significant damage exists, lasers, peels, or both are still needed to remove much of the damage."

Complementing, not replacing

The new products complement the time-honored ways of avoiding the sun: using protective clothing and sunscreen.

"Now patients can do something additional and meaningful to manage their skin and improve their appearance," Dr. Hirsch says.

She stresses that dermatologists need to tell patients that the new products do not replace conventional sun protection. "You can’t just put on these products and go back in the sun," she says. She explains this to patients as being the equivalent of leaving on vacation after turning on the security system of one’s home, but not locking the front door.

Pigmentary changes

Pigmentary damage is the biggest complaint among patients with sun damage, she says. When former or current sun worshipers deny that they have sun damage, Dr. Hirsch tells men to compare the inside of their arm to the outside and see the sun damage on the outside. She tells women to look at the skin that their bras cover, which typically never sees the sun. "That’s the ‘a-ha’ moment," she says.

Another persuasive point is the way aging is often portrayed in films. When a character ages through the course of the film, to accentuate the appearance of aged skin, often the makeup artist will paint dark blotches characteristic of sun damage.

The new topical products cannot undo decades of sun damage, but they can help people look younger, Dr. Hirsch says.

"The exciting thing is that these products are available without prescriptions and available at multiple price points," she says. "Patients can get them at the drugstore. That’s just huge."

For those who prefer something stronger, a wide array of excellent topical options is also available at the dermatologist’s office, she adds.

Effective lighteners that actually target the pigment have been manufactured by Neutrogena, Oil of Olay and Vichy, and are available in drugstores, while SkinCeuticals’ products Phloretin CF and CE-Ferulic are available in dermatology offices, she notes. The former is for oily skin and latter for dry skin.

Mineral-based make-up is a new cosmetic category, and such products can be applied over sunscreen.

"Mineral-based make-up includes of ground-up minerals," Dr. Hirsch says. "In addition to cosmetic improvement, patients can have another layer that boosts the efficacy of, but does not replace, the sunscreen, covers extant skin damage and looks good. It’s natural-looking coverage."

Dr. Hirsch adds that dermatologists need to know about these products and discuss them with patients, as well as set realistic expectations for them.

"The development of new topical products for treating pigmentary disorders is a major advance," she says. #&34The fact that cosmetic companies recognize the magnitude of the problem is huge progress. Now dermatologists need to know that the products exist and are widely available and affordable. We’re the patients’ conduit for information. If they don’t get the information from us, where do they get it?"

Although the reputable cosmetics companies put new products through a research and development protocol, and then send the products to dermatologists, they may not always come up on the dermatologist’s radar.

"New cosmetics don’t necessarily make their way to us," Dr. Hirsch says. "Part of the process of getting a new prescription drug to market is letting physicians know. That’s not necessarily the case with these products."

Because dermatologists are busy, the new drugstore products being sent to them may not get their attention.

However, Dr. Hirsch stresses, "In my mind, derrmatologists do not have the luxury of not knowing about the products. They offer tangible benefit to patients for a relatively small investment."

Cosmetics aisles

One way to become more aware of the products being promoted to patients is to "walk in the shoes of the patient," Dr. Hirsch says. "You may have time on your hands when you’re at the pharmacy waiting for your own prescriptions to be filled. Use the time for your own research. Cruise the cosmetics section and see what they’re selling. Read the magazines your patients are reading, and definitely read the beauty pages, because your patients are."

Although the claims of cosmetics products need to be viewed differently from the claims of prescription drugs, many should be taken seriously, Dr. Hirsch says.

"A lot of these products are quite good," she says. "Not everything that improves appearance has to be expensive or require a prescription."

Patients can be taught to be astute consumers and to assess products intended to complement sunscreen. The goals should be coverage of the pigmented lesion, prevention of further damage, treatment, and a good cosmetic outcome. A patient can use a product that meets these goals for her, Dr. Hirsch says.

She notes that matching the product to the patient is an art, not a science, and that what is effective for one patient may not be for another.DT

Disclosure: Dr. Hirsch has worked as an investigator, consultant, or adviser for, or has used donated equipment for research from, the following companies: Allergan, ArthroCare, BioForm, Candela, Clarisonic, Clinique, Cynosure, Estée Lauder, Medicis,Medlite/ConBio, OrthoNeutrogena, Palomar, Stiefel, Vichy, Zars and Zimmer.