Ep 54: Thiamidol Lightens Pigmentation Without Laser Treatment
There are various underlying causes of hyperpigmentation. Dark spots is the colloquial term for solar lentigo, which is a form of age-related hyperpigmentation. Melasma is hormonally triggered and is more common in skin of color. It’s important for us to understand that there are now non-laser treatment options for all these types of hyperpigmentation, including post inflammation hyperpigmentation left by acne scars. Eucerin has patented the active ingredient Thiamidol, which is a potent tyrosinase inhibitor, and it is incorporated in their Spotless Brightening range. It is clinically proven in peer reviewed studies to reduce dark spots by up to 75% without laser treatment when used regularly twice a day. It’s important to highlight that not only does the effectiveness of a cosmeceutical active ingredient matter, but also how tolerable it is. More in this week’s podcast episode by Dr. Teo Wan Lin.
Dr. Teo: Hey guys, this is Dr. Teo Wan Lin of TWL Specialist Skin & Laser Centre and welcome to my podcast Dermatologist Talks: Science of Beauty. In this episode, we’re going to be talking about hyperpigmentation treatment today. The causes of it as well as some treatment options.
Chelsea: This episode is brought to you by Eucerin. The relaunched Spotless Brightening Range incorporates the patented dermocosmetic ingredient Thiamidol. It clinically proves to reduce dark spots by up to 75% without laser treatment, when used regularly twice daily.
Non-laser hyperpigmentation treatment
Dr. Teo: Many individuals refer to hyperpigmentation as dark spots on their face. The commonest perceptions of dark spots are that the sun induces them, and you require laser treatment to get rid of it. Well, in today’s episode, I want to, first of all, shed some light on how not all hyperpigmentation is equivalent to dark spots. I will also share a little bit about the scientific terminology of the different diagnoses that can present as dark spots, as well as treatment options that do not require laser treatment.
Chelsea: You’re right, hyperpigmentation is one of the commonest skin problems that lots of people face. Whether it is dark spots from spending too much time under the sun. Or, even a leftover mark from a pimple, or dark spots during pregnancy. Those who have hyperpigmentation know how tricky it is to get rid of.
What is hyperpigmentation?
Dr. Teo: Hyperpigmentation is essentially a visual descriptor of pigmentation that increases in a focal area on the skin. For the purposes of this podcast, we’re going to zoom in on the causes of facial hyperpigmentation. The causes of facial hyperpigmentation can be due to post inflammation hyperpigmentation. For example, in the case of acne scars. Individuals who suffer from any form of dermatitis or facial eczema that leads to inflammation can have scarring in the form of post-inflammation hyperpigmentation. This is very distinct from the other types of hyperpigmentation. The focus of our podcast today is sun-induced hyperpigmentation or sun-aggravated hyperpigmentation.
Differentiating sunspots and freckles
Chelsea: I see, sunspots are so common. They can show up as flat areas of skin discoloration that can be tan or different shades of brown. They often show up on more sun-exposed areas of the skin, such as the face, shoulders, back and hands. Well I have a question- are sun spots similar to freckles?
Dr. Teo: Solar Lentigo, or in layperson’s terms, sunspots, are likely the most common cause of facial dark spots. You should not confuse this with ephelides. These are freckles that are present from a young age in genetically predisposed individuals. For example, individuals with certain eye coloration, such as blue, green eyes and red hair. These individuals tend to have genetically more freckles. Those are not a sign of photo damage, don’t require treatment and also don’t respond well to treatment.
Some also refer to sunspots as age spots. This is because we find that solar lentigo increases with age more specifically after the age of 25. That is when photoaging sets in. The skin is usually able to fight off oxidative stress when one is younger. Therefore, in spite of environmental stressors such as ultraviolet radiation, it is still able to clear the excess melanin formation. Hyperpigmentation in these forms can occur as a result of photoaging induced by ultraviolet exposure.
Chelsea: I see, well you mentioned before that there are various different types of hyperpigmentation.
What is another common type of hyperpigmentation and what are its causes?
Dr. Teo: Another category of hyperpigmentation is Melasma. This is fairly widespread, especially in skin of color populations such as Asians and Hispanics. Melasma commonly affects women after pregnancy. There is a postulated link to hormonal fluctuations. In terms or what it looks like, it has a shape of a butterfly-like pattern over the cheeks. However, it can also progress in areas such as the forehead. Additionally, the key appearance of it that distinguishes it from dark spots is the fuzzy appearance around the borders. Another thing to note is that the area where it affects the skin is fairly large and confluent.
Chelsea: Well what are the treatment options for the different types of hyperpigmentation? How would you usually treat it at your practice?
Hyperpigmentation treatment options
Dr. Teo: We’re going to talk a little bit more about traditional treatments for hyperpigmentation at this juncture. Traditional methods of treating hyperpigmentation involves, first of all, sun protection advice, simply because UV exposure activates melanin formation. What happens in a dermatologist setting is once we establish a cause of hyperpigmentation, such as in the case of post inflammation hyperpigmentation, we very often would emphasize treating the underlying disorder and ensuring that you have a good moisturizer that repairs the skin barrier. However, in the case of solar lentigo or age spots and melasma, you need a more specific treatment. So, for sunspots, solar lentigo, I have found that laser treatments were necessary in a large proportion of cases. In my practice, what I usually recommend is treatment with the 532 nanometer Q switch laser, in combination with certain cosmeceutical ingredients.
Chelsea: Well I do know that there are certain traditional ingredients for hyperpigmentation treatment. For example, hydroquinone, kojic acid. Can you tell us more about these?
Does hydroquinone have any side effects on the skin?
Dr. Teo: The issue with the ingredient hydroquinone, which some of you may have heard of, is that it has this phenomenon known as rebound hyperpigmentation or ochronosis. This is when you use the ingredient hydroquinone beyond a period of six months, which is not what is recommended. Instead of becoming lighter, the pigmentation can actually come back even darker. We’ve seen this with pigmented skin especially in the treatment of melasma. Melasma itself is a very tricky condition to manage. We have had success with combination treatments, chemical peels and also laser treatments in combination with hydroquinone. But, one big problem exists, and that is the irritation potential of hydroquinone. Additionally, there are individuals who actually do not respond well to laser. Instead, they get even darker hyperpigmentation, which is a risk of laser itself when treating hyperpigmentation.
So in light of all this, I feel that there definitely is a role for more research into the effectiveness of cosmeceuticals which have high tolerability for the treatment of hyperpigmentation. I was very excited to know about this paper published by the Beiersdorf Group, which actually owns the Eucerin brand. The paper titled ‘Effective tyrosinase inhibition by Thiamidol results in significant improvement on mild to moderate melasma’ was published in the Journal of Investigative dermatology in 2019. I feel that it is important for us to talk about this ingredient, Thiamidol. Eucerin Beiersdorf group has the patent for this ingredient, but it is very special because the overall landscape for topical treatment for hyperpigmentation is rather limited.
Chelsea: I have heard stories of hydroquinone having some pretty risky side effects. So I have always been keeping my eyes and ears open for new ingredients that could possibly be effective in treating dark spots! Thiamidol is pretty new to me, can you tell us more about why this study is so important, and how this ingredient compares to traditional options?
Dr. Teo: The importance of a highly tolerable yet effective active ingredient in the treatment of hyperpigmentation is very relevant in this aspect. Out of 50,000 compounds that were screened for their ability to inhibit recombinant human tyrosinase, which is the enzyme involved in pigment production, Thiamidol was identified as a very potent inhibitor of human tyrosinase. In fact, it was found to be superior to other ingredients such as arbutin, Kojic acid, and of course, Hydroquinone. It was actually found to have reduced the appearance of sunspots or solar lentigo at concentrations as low as 0.1% within just four weeks of treatment.
The basis of this study was that Thiamidol was going to be an effective and safe active ingredient that was available over the counter for the treatment of melasma in particular. I think it is very relevant because melasma itself is a challenging disorder that responds best to a multi-pronged approach, and I have always emphasized cosmeceuticals as part of treatment for hyperpigmentation.
Thiamidol vs Hydroquinone
Thiamidol was also compared with hydroquinone- which we know has a good efficacy record apart from its lack of tolerability. The results for this trial, which was a double blinded randomized split face study, was that after 12 weeks, the modified Masi score index- the melasma area and severity index scores – actually significantly improved on both the thiamidol and hydroquinone treated sides of the face. In fact, the thiamidol treatment improved the Masi scores even better than hydroquinone. There were also a higher number of subjects that showed improvement after treatment of thiamidol, with 79% of them reporting improvement as opposed to hydroquinone, which is just at 61%.
The critical factor here is that sometimes hydroquinone can show rebound hyperpigmentation as a side effect. During this treatment in the study, we saw that happening. In contrast, no subjects displayed worsening of these modified Masi scores on the thiamidol treated side. Whereas, 10% of the subjects actually showed worsening of the modified Masi scores on the hydroquinone treated side.
Chelsea: So we do have some data on how it directly compares to hydroquinone. It looks like it does hold up very well, or according to the study, even better at eliminating dark spots as compared to hydroquinone. It is certainly very promising, considering the significantly better tolerability and fewer side effects, which will probably be very useful for those who are looking for a more gentle ingredient that is more effective.
Tolerability of thiamidol
Dr. Teo: I think it’s important for us to also talk about the tolerability of thiamidol. So thiamidol is very well tolerated by even individuals perceived to have sensitive skin. There was also a separate study by the Beiersdorf group about the tolerability of this active ingredient. But for the purposes of this study, we find that it was significantly better, not just for the overall effects in decreasing the intensity of dark spots, but also the overall appearance at all the study time points.
Chelsea: Well that’s it for today’s episode. We’ve talked about the different types of hyperpigmentation such as sunspots, post-inflammation hyperpigmentation, and melasma, and their causes. We’ve also discussed how the relaunched Eucerin Spotless Brightening Range utilizes patented Thiamidol, a tyrosinase inhibitor, to reduce the appearance of dark spots. Also covering how Thiamidol is highly tolerable and has fewer side effects compared to traditional ingredients used for treatment of hyperpigmentation, making it suitable for even those with sensitive skin.
The Eucerin Spotless Brightening Booster Serum is a light emulsion that helps to reduce dark spots while renewing the skin’s look. It contains thiamidol, an effective ingredient that acts at the root cause of hyperpigmentation that prevents its re-appearance with regular usage.
Thank you for joining us today. You can follow Dr. Teo on Instagram @drteowanlin for more podcast updates, head on over to eucerin.sg to find out more about their Spotless Brightening range, and make sure to check out www.scienceofbeauty.net for the full podcast transcript.
This podcast episode is sponsored by Eucerin Singapore as a joint collaboration to create scientific educational content relevant to skincare and dermatology.