A cream for the treatment of pigmentation spots

Before considering laser removal of the pigment spots or lightening by cold or acid treatment, simpler agents such as creams can be used. Many creams, especially prescription creams, are based on the effect of the bleaching agents they contain. These interrupt the formation of melanin in the melanocytes.

A very common bleaching agent is hydroquinone, among others. As hydroquinone is suspected to be carcinogenic, creams containing hydroquinone should only be used for a maximum of 3 months. Other common bleaching agents are rocinol and kojic acid. The success of a treatment with bleach-containing creams is usually only achieved after about two months, light pigment spots can be clearly brightened after about four weeks. In order to prevent undesirable side effects when using bleach-containing creams, a doctor should always be consulted before using them.

Cell types

The pigment spots can originate from different cell types and therefore have different characteristics. The melanocytes are the melanin-forming cells of the body and lead to the formation of brown pigment spots. Depending on the cell type, these pigment spots are called melanocytic nevi.

According to their position in the skin layer, the pigment spots are further subdivided into The nevus cells are closely related to the melanocytes, but do not have dendrites.They lie in the skin in the form of spherical to spindle-shaped cells, which are arranged in nests. In addition, they cannot give off their pigment to the surrounding skin cells. In addition to benign pigment spots, there are also numerous atypical cells that can degenerate into malignant cells.

These malignant cells can develop from melanocytes as well as from nevus cells. For various reasons (UV light, genetics, wrong repair mechanisms, …) these cells lose their normal shape and growth rate and degenerate.

Epidermal melanocytic nevi and
Dermal melanocytic nevi

Melanocytic nevi

These pigment spots develop from real melanocytes and are divided into epidermal and dermal melanocytic nevi. The following types of nevi belong to the epidermal pigment spots (pigment disorder): 1st freckles (ephelids): These are small yellowish and brownish spots on the skin, which occur particularly in people with a light complexion and red or blond hair. Freckles are pigment deposits that are mainly caused by sunlight.

In some people the freckles fade again in winter. The melanin produced by the melanocytes is stored in the surrounding keratinocytes and thus leads to browning of the skin. In contrast to liver spots, melanocytes do not multiply locally.

In most cases, freckles are a normal variant, which is caused by an innate genetic variation in the melanocortin-1 receptor. In the case of the NAME syndrome, the freckles are a symptom of a systemic disease, which is accompanied by further skin changes. 2. nevus lenticularis: This is a benign brownish liver spot with sharp edges.

The “lentigo simplex” refers to the normal mole, which develops in childhood due to the influence of sunlight. It is flat, brown, round or oval and usually smaller than 5mm in diameter. Histologically there are no nests of nevus cells, as in a junctional nevus, but only increased melanocytes.

For this reason no black skin cancer (malignant melanoma) can develop from lentigo simplex. The lentigo solaris (age spots) are also mainly caused by long-term exposure to the sun. The age spots multiply increasingly in late adulthood.

It is a flat, brown lesion at the level of the skin with a spotted or star-shaped outline that is always sharply defined. The spot is usually brown and irregularly pigmented. The age spots mainly affect light skin types.

Although they are not malignant, they can be confused with black skin cancer. Nevertheless, they are an expression of sun damage and for this reason only appear on sun-exposed skin areas. 3. nevus pigmentosus (café-au-lait stains): These are always benign, light to dark brown uniform moles.

They can be between 2mm and 20cm in size and, unlike other pigment spots, are never raised or knotty. For this reason the café-au-lait spots have no disease value and are found in 10-20% of the normal population. If more than 6 spots, each larger than 15 mm in adulthood and larger than 5 mm in childhood, as well as other symptoms, the diagnosis of neurofibromatosis type I is likely.

4. nevus spilus (“Kiebitz- Ei- nevus”): This pigment spot is characterized by a large, evenly brown colored skin spot, which additionally shows numerous small dark brown spots. The total diameter is often larger than 15cm, the small brown spots often have a diameter of 2-3mm. On average, this form of pigment spots occurs in 3 out of 100 light-skinned adults.

The small dark brown spots may be atypically altered, but the development into black skin cancer (malignant melanoma) is very rare. 5th Becker-naevus: This type of pigmentation spot mainly affects young men. Typically, a palm-sized, sharply and jaggedly limited hyperpigmented spot forms in the area of the shoulder.

This occurs exclusively due to increased melanin formation. The skin change should be complete within one year and then no longer change. As a rule, a subsequent paling of the Becker nevus occurs only rarely.

It has no malignant potential, so that removal by laser therapy can be done for purely cosmetic reasons.The following subgroups belong to the dermal melanocytic nevi: 1. mongol stain (breech stain sacral stain): This stain is usually irregular and bluish. In newborns it is located on the back, buttocks or sacrum and is harmless. It is a remnant of embryonic development and usually fades or disappears after 4 to 8 years or at the latest by puberty.

Altogether, the Mongolian spot is found much more frequently among Asians of the black Africans. It is most rarely found in fair-skinned and blond children. 2. nevus fusco-coeruleus: This is a dark bluish to brownish pigment disorder, which is caused by the ectopic accumulation of melanocytes in the deep dermis.

Due to its two different layers, it is called nevus ota and nevus Ito. The nevus ota usually affects the area of the first and second trigeminal branch and is located on the forehead, eye area, cheek and palate. It can also include the conjunctiva, sclera and eardrum.

The nevus Ito is located in the shoulder area. In exceptional cases, this pigment spot can degenerate to malignant. Since the nevus ota in particular can be very disfiguring, there is the possibility to treat it with laser therapy.

3. coeruleus nevus (blue nevus, dermal melanocytoma): It is characterized by a dark blue to gray-black color, sharply defined and benign. The unusual color is due to the accumulation of melanocytes in the deeper skin layers. It is assumed that the melanocytes accumulate ectopically in the deeper layers of the skin in the course of development.

The blue nevus occurs most frequently on the back of the hand and the back of the forearm. However, it can occur anywhere and is usually harmless. The development to a malignant melanoma is very rare, so that the removal can take place for purely cosmetic reasons.

These cells have no dendrites and cannot give off their pigment to neighboring cells. Typically, the nevus cell nevus undergoes a development during childhood and in some cases completely recedes. 1st junctional nevus: In this first stage, the nevus grows exactly at the border between the epidermis and the dermis.

This zone is called the junctional zone. It is sharply defined, dot-shaped, brown or black. These first junctional nevi develop during childhood.

2nd compound nevus: This is the second stage of nevus cell nevus development. Here the nevus migrates into the depth of the dermis and thus expands into both skin layers. The surface of the pigment spot may be fissured.

This makes the mole thicker and it can have knotty parts. In this phase the pigmentation often becomes more irregular and lighter. 3. dermal nevus: This is the last stage in the development of a nevus cell nevus.

It often assumes a large, round, hemispherical shape. The nevus cells have completely penetrated the dermis and the nevus has usually lost its brown pigment and is covered with hair. 4. connatal nevus: These pigment spots are already present at birth (konnatal) and have a light to dark brown color and often have a nodular to cobblestone-like surface.

These pigment spots can be from 1.5cm to over 40cm in size. In this case they are called giant nevi, which are most often found on the belly or back. In addition, these giant nevi can have bristly hairs, which is why they are called animal fur nevus.

The risk of developing a malignant melanoma increases with the size of the congenital nevus, which is why the giant cell nevi should be removed in the first year of life. 5th halonevus: These pigment spots are characterized by a white, pigment-less ring. It occurs mainly in childhood until young adulthood.

It is assumed that autoimmunological processes cause the destruction of melanin and melanocytes and thus promote the development of the white spots. Usually the halo-nevus disappears after some time and is harmless. 6. pointed nevus: This nodular, benign pigmentation spot occurs mainly in children and adolescents.

It grows quickly and forms a reddish to brown color. It is often hemispherical, rough and hairless. In diameter it is usually smaller than 1cm.

Usually this type of nevus does not regress by itself. However, they are usually benign, but can look similar to a malignant melanoma and can therefore easily be confused.7th dysplastic nevus: Dysplastic nevi occur in the white population in about 5% of the people. They show a more unsteady picture on the skin than the normal nevus cell nevi.

They often have different pigmentation and their boundaries are often blurred with frayed edges. Usually they are larger than 5mm and can sometimes show raised parts. The transition from a dysplastic nevus to a malignant melanoma can take months or years. The risk of developing a malignant melanoma increases from 0.8% to 18% in the presence of dyplastic nevi. For this reason, dysplastic nevi that change or look abnormal should be completely removed.