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transportation of melanin from melanosomes to keratinocytes. In this sense, some depigmenting cosmetics actives, even by different mechanisms, have as their final objective the decrease of spots and melasma on skin acting by different mechanisms as: degradation of superficial melanin (peelings effect), inhibition of the melanin production through melanogenesis pathways control (tyrosinase enzyme activity inhibition), destruction of the melanocytes by autophagy mechanism; decreasing of the melanin granules transportation from melanocytes to keratinocytes, reduction of proinflammatory effects (antioxidant agents), decreases of the number of vessels on skin and finally by hormonal modulation of estradiol hormone [1,9-11]. Professional procedures for melasma treatment are summarized as: chemical (acid) peels, mechanical (abrasive) peels, electric peels, High-power laser therapy, intense pulsed light (IPL) and more recently the Low-level light therapy, using laser and LEDs, both therapies associated with professional and home care cosmetics [5,6]. Chemical peels act by accelerating the renewal of cells on surface and deep layers of the skin. High Power Laser Therapy and intense pulsed light acts by selective photothermolysis mechanism. Mainly Chemical peels and High Power Laser Therapy are widely used in clinical practice, but have a high rate of rebound pigmentation effect as they lead to post inflammatory hyperpigmentation (HPI) common to extremely sensitive skin with melasma [3,11-13]. In a deal with the literature there are a great number of cosmetics actives (topical and oral) that acts on melanogenesis pathways control. The best topical cosmetic actives found to melasma treatment can be described as: vitamin C, alpha arbutin, arbutin, kojic dipalmitate, kojic acid, curcumin, resveratrol, epidermal growth factor, fibroblast growth factor, TGP-2, retinol microspheres (cosmetic retinol like), mandelic acid, tranexamic acid, niacinamide, Hexylresorcinol, arbutin, belides, alpha arbutin, ferulic acid, phytic acid, prodizia, among others [14-17]. One of the latest technological developments in topical melasma treatment is the cysteamine active. Cysteamine is a reducing molecule, endogenous antioxidant, and this molecule is able to act on the enzymes responsible for the formation of melanin by modulating melanogenesis. Tyrosinase and peroxidase sequester iron and copper does not let the free H202 pre-radical react with iron and form the Fenton reaction, a reactive oxygen species generator that stimulates the entire melanogenesis pathway [14,15]. For oral cosmetic defined as nutraceuticals we summarized as: Pycnogenol, hydroxytyrosol, polypodium leucotomos, resveratrol, panax ginseng, nicotinamide, vitamin c, curcumin, panax ginseng, green tea, zinc chelate, melatonin, tranexamic acid, among others [16-18]. The most common strategies on melasma Management are to modulate inflammation, vascularization that "nourish" melasma, formation and transfer of melanin formed in the skin as well as cosmetic-like hormonal modulation. For this to occur safely and effectively the combination of low power light with laser and LEDs is necessary. Management of melasma should be performed 2020 Vol.6 No.3:10 using minimally invasive professional aesthetic treatments, ie, those that have modulation of the inflammatory response as well as the use of topical and oral home care cosmetic products such as nutraceuticals [3,16-18]. Therapy of photobiomodulation (PBM) is the best technical term for Low Level Laser Therapy (LLLT). It is a light therapy using lasers or LEDs to improve tissue repair, reduce pain and inflammation in the most frequently applications. Many clinical studies on pain with Photobiomodulation applications have been published. Photobiomodulation has been used for many years on sports injuries, arthritic joints, neuropathic pain syndromes, back and neck pain. Nowadays the photobiomodulation in dermatology is increasing since that PBM accelerates the healing of wounds (traumatic, surgical, acute, and chronic) as well as can be useful on cutaneous wounds and accelerating healing after aggressive aesthetic treatments (high power laser therapy and chemical peels procedures). also the pbm has a lot of application on aesthetic and dermatological approach for aging treatment, acne, spots, alopecia and other applications [6,18,19]. Low level light professional therapy using lasers and LEDs for professional uses can be useful to practitioners to performing various skin treatments for aesthetic and dermatological purposes [5,6,18-20]. In our previous paper we defined photodynamic cosmetic therapy (PDT) as a mixture between Phototherapy (now called Photobiomodulation Therapy) and Photodynamic Therapy behavior since that uses low power light radiation (mW) and low- medium light irradiation dose or fluences (J/cm2) in the presence of photoactives [3,18,21]. Also we defined photocosmetic as products that present chromophores photostable on its formulations capable to induce photophysical and photochemical mechanism to promote photobiological effects on the tissue [18,21]. The photocosmetic product contains photoactivated actives associated with other cosmetic components on formulation depending on cosmetic goal [3,18,21]. Photoactivated Peels, on the other hand, is defined as a cosmetic composition contend chemical peels (such as glycolic acid, salicylic acid, lactic acid, mandelic acid) in low concentrations (cosmetic proposes) associated with actives that increase light absorption in the skin called as photoactives, promote the Peeling effect in a controlled manner without distancing patient’s from professional and social life [3,18,21]. This photoactives used as methylene blue (absorbs light on 630 nm- red region), curcumin (which absorbs light on 450 nm – blue region), hypericin (which absorbs light in the region of 590 nm - yellow/amber - region) increase the light interaction of skin. Others photoactives or photosensitizers can be found on the literature on Photodynamic Therapy applications on cancer and dermatology skin diseases [3,18,21]. Finally, the Photoactivated Peels can be defined as less aggressive and non-invasive cosmetic formulations, and can be performed by non-medical aesthetic professionals with safe and effective results. Chemical peels associated with visible light on procedure can be applied also with safety [18]. 2 This article is available from: http://aesthetic-reconstructive-surgery.imedpub.com Journal of Aesthetic & Reconstructive Surgery ISSN 2472-1905PDF Image | Photodynamic Cosmetic Therapy on Melasma Management
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