What Can Be Done About Broken Blood Vessels (Telangiectasia)?

Telangiectasia

Simply put Telangiectasia is spider veins, otherwise known as “broken capillaries.” It afflicts many, many people. In fact, two out of three women over the age of 30 have the appearance of blood vessels just below the surface of the skin. They can develop anywhere on the body but are most commonly seen on the face, around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles.  So how do you pronounce it anyway? Listen here.

Telangiectasia

Telangiectasia or broken capillaries are the abnormal dilation of red, blue, and purple capillaries (tiny blood vessels) localized just below the skin’s surface. Simply put your vein walls dilate, either from pressure or weakness, and become noticeable. And sometimes blood leaks from these vessels and pools, creating a bruising effect.

Causes of Telangiectasia

As we know, genetics pre-dispose us to many things, including Telangiectasia. But, broken capillaries also occur and re-cur due to other internal and external sources.

Internal sources include:

  • Genetics
  • Rosacea
  • Menopause
  • High Blood Pressure

Then, certain lifestyle choices worsen these internal causes. Examples of these are:

  • Free Radicals (and anything that raises free radicals because free radicals cause damage to the collagen cells that keep the walls of the vessels strong and healthy)
  • Sun Exposure
  • Tanning (either from direct sun exposure or tanning beds)
  • Constant blowing of nose
  • Alcohol
  • Smoking

These contribute to the damage of the vessel walls thereby causing a loss of ability for the vessels to shrink back down to normal size. Thus, laser treatments coupled with home maintenance and lifestyle changes, are necessary for maximum long term results. (Sorry, no miracle cure here!)

Topical Therapy

Perricone MD Advanced Face Firming Activator

When it comes to telangiectasia, topical products can only do so much and are best used in conjunction with laser treatment. Thus far, there is little scientific support for topical treatments; though some well-researched ingredients have been shown to improve skin elasticity and resilience — like coenzyme Q10 (ubiquinone), copper peptides, and niacinamide (Vitamin B3) — and may help diminish the appearance of broken capillaries.

Holistic R.N., and licensed esthetician Geraldine Macenski from the Dana Hotel Spa loves alpha lipoic acid (ALA), not only for prevention but maintenance of Telangiectasia. “ALA is an antioxidant that works synergistically with other antioxidants in the skin to reduce the inflammatory effects of UV exposure by neutralizing free radicals,” said Geraldine.

What makes alpha lipoic acid unique is that it functions in water and fatty tissues, meaning it can work throughout the body, unlike antioxidant vitamins C and E. It also has the ability to recycle or re-potentiate antioxidants such as vitamin C after they have been used up. ALA’s capacity to regulate production of nitric oxide, which controls blood flow to the skin when applied topically, helps to transform the complexion from dull and pasty to vibrant and glowing.

Geraldine also recommends products containing DMAE, like those found in the Perricone MD product line. DMAE or dimethylaminoethenol, is an anti-inflammatory nutrient occurring naturally in the human brain that protects us from free radicals, improves muscle tone, and stabilizes cell membranes. The most significant science I found on DMAE said the primary benefit of topical application is skin firming, which could potentially over time help diminish the appearance of broken capillaries. DMAE has also been clinically shown to significantly improve other visible signs of aging — bonus!

What’s more, products containing anti-inflammatory ingredients like green tea and red and brown algae, could potentially reduce excessive blood flow to the affected areas, making facial spider veins less obvious; but this would only work for very small veins. Once veins are dark red or purple — or have been there for several months or — they usually require laser treatment to make them less obvious.

We recommend Perricone MD Advanced Face Firming Activator, which contains alpha lipoic acid.

Lasers Work Best

The upside of laser treatments includes better, faster and more long-term results and clinical studies on efficacy and safety. There are many different types of lasers (i.e., YAG, IPL, Diode, VBeam) used to treat broken capillaries and a laser certified specialist will know which one is right for you based on your skin type.

For example, IPL (Intense Pulsed Light) is frequently used to diffuse redness and facial telangiectasia. Recent studies have shown that IPL also helps reduce heightened levels of VEGF (vascular endothelial growth factor) in rosacea patients, thus hindering new vascular growth. But IPL scatters its light energy and can create unwanted reactions like transient hypopigmentation.

Is there a Cure?

No, you cannot “cure” Telangiectasia, because, although you can treat it by shutting down the blood vessel(s) in question, the body likes to “repair” itself by forming what is known as collaterals or new blood vessels to compensate for those you shut down. Thus, treating broken capillaries requires maintenance on your part. Skin care experts often give their patients “homework” of:

  1. A Topical Antioxidant (like ALA or Vitamin C)
  2. Physical Defense Sunblock (Titanium Dioxide and/or Zinc Oxide)
  3. Topical Collagen

And, laser treatment typically requires multiple visits, with healing time of 4-8 weeks between treatments. Don’t let anyone tell you they can fix it with one treatment and you’re done. This is virtually impossible (i.e., find another practitioner!).

See Your Doctor

Every state has their own guidelines for who can and cannot perform laser treatments so your best bet is to see a plastic surgeon or dermatologist who has been laser certified. I also suggest asking for references, two to three patients that you can speak to privately about their experience, results, etc.

Costs vary as some professionals charge per pulse (that is laser pulse) while others charge based on time spent. Expect to spend about 30 minutes per treatment session and a minimum of $175 per treatment depending on where you live (major metropolitan areas may see significantly higher costs per treatment).

Contributing author: Leah Argento

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What Are the Best Products with Hydroquinone?

Skin Bleaching

In one of my favorite episodes of Sex and the City, Miranda talks about her “secret single behavior,” where she likes to go and clip her toenails while watching bad TV.

Skin bleaching is a little like that: It’s something that many people do, but refuse to share with others. In fact, 77% of women in Nigeria admitting to using skin bleaching creams (World Health Organization), and 258 tons of skin bleaching creams were sold to women in India in 2012 (Bloomberg Business Week). And its popularity is only growing stateside, with estimates on skin bleaching cream sales estimated to grow to $19.8 billion in the United States alone by 2018.

The real secret behind skin bleaching creams is hydroquinone, a controversial ingredient. Here, I’ll talk about the benefits, the risks, and who should and who should not be using it in their skin regimen.

My Favorite: Clinicians Complex 6% Skin Bleaching Cream

Clinicians Complex 6% Skin Bleaching Cream

My favorite skin bleaching cream is Clinicians Complex 6% Skin Bleaching Cream, a formulation that contains hydroquinone, kojic acid, and bearberry extract. I estimate from the ingredients list it contains about 2% hydroquinone, 2% kojic acid, and 2% bearberry extract — which is the highest concentration of hydroquinone currently available in the U.S. over-the-counter. Its efficacy has been well-established over time, including in a 2003 study in The International Journal of Dermatology, where it was found to reduce signs of hyperpigmentation associated with melasma by a whopping 76.9%, beating another skin whitening complex at 66.7%.

I’m a fan of hydroquinone, so long as you: a.) do not have dark skin (darker skin tones run the risk of ochronosis); b.) apply in four-month on, four-month off cycles; and c.) do not combine with benzoyl peroxide or resorcinol (see below). Overall, however, I like it and I think it is the major secret behind this cream.

Ingredients: Deionized Water, Mineral Oil, Glyceryl Stearate, Sodium Lauryl Sulfate, Poloxamer 188, Alcohol, Passionflower Fruit Extract, Pineapple Fruit Extract, Grape Fruit Extract, Hydroquinone USP, Kojic Acid Dipalmitate, Cetyl Alcohol, Emulsifying Wax NF, Bearberry Extract, Glycerine, Magnesium Ascorbyl Phosphate, Stearyl Alcohol, Octyl Palmitate, d-Alpha Tocopheryl Acetate USP, Cetyl Esters, PEG-40 Stearate, Hydroxyethylcellulose, Propylene Glycol USP, Sodium Sulfite, Sodium Metabisulfite, Diazolidinyl Urea , Methylparaben, Propylparaben.

How Does Hydroquinone Work?

How Hydroquinone works futurederm

Hydroquinone works by inhibiting the enzyme tyrosinase, which is important in skin melanin (pigment) development. So for as long as you continue to use hydroquinone, you will inhibit tyrosinase, and hence pigment production.

Unfortunately, when you discontinue use of hydroquinone, your skin’s natural supply of tyrosinase will no longer be inhibited. Slowly but surely, your skin’s natural pigmentation will return.

Is Hydroquinone Risky?

In darker-skinned patients, continued hydroquinone use has been associated with ochronosis, a darkening of the skin. It has been proposed this occurs because hydroquinone inhibits homogentisic acid oxidase within the skin, which in turn causes the dark-colored homogentisic acid to build-up within the skin with continued use. Interestingly enough, this phenomenon has only been documented in darker-skinned patients.

Still, to be on the safe side, most dermatologists recommend everyone uses hydroquinone in four-month cycles, alternated in the off months with other milder tyrosinase inhibitors, such as azelaic acid, kojic acid, and arbutin.

Despite popular belief that hydroquinone may cause cancer, hydroquinone’s most serious human health effect is pigmentation of the eye and permanent corneal damage (Journal of the European Academy of Dermatology and Venearology, 2006). While this only occurs when the eye is directly exposed to hydroquinone, it is still a risk factor. It is therefore vitally important to avoid the eye area in applying hydroquinone-based creams.

Some believe that hydroquinone may cause cancer. This is false. This rumor arose from a study that demonstrated mice exposed to hydroquinone developed liver tumors. However, these results were reported in a misleading fashion, as dermatological experts explained in a 2006 review in the Journal of the American Academy of Dermatology:

Instead of being harmful to the skin, hydroquinone increased the number of benign (non-cancerous) liver tumors, reducing the proportion of cancerous liver tumors in the mouse, showing a protective effect of hydroquinone. (For you science buffs out there, there was an increase in hepatic adenomas and a decrease in hepatocellular carcinomas).

As for other studies associating mouse kidney tumors with hydroquinone use, it has been argued that these are not relevant to humans. As Dr. David J. Goldberg, a clinical professor of dermatology at the Mount Sinai School of Medicine states, “Over 100 scientific articles confirm hydroquinone is a safe topical for humans; no independent studies prove the opposite.

Do NOT Use Hydroquinone Together with Benzoyl Peroxide or Resorcinol!

Never Combine Hydroquinone with Benzoyl Peroxide or Resorcinol

Use of hydroquinone with any products containing benzoyl peroxide, hydrogen peroxide, or other peroxides may cause temporary staining of the skin (Drugs.com). This staining is temporary and can typically be removed with soap and water washing, but it’s best to avoid benzoyl peroxide-based acne treatments and oxygen-infusing skin care treatments, which typically contain hydrogen peroxide.

Philosophy Miracle Worker(R) Dark Spot Corrector

In addition, you also want to avoid using resorcinol with hydroquinone. Ochronosis occurrence in persons with darker skin is a well-documented occurrence with combined use of resorcinol and hydroquinone. Hundreds of ochronosis cases have been documented from using resorcinol/hydroquinone combination treatments in South Africa before 1984 (Journal of Dermatological Treatment, 1997).

Bottom Line

Hydroquinone Warnings

Of the skin-lightening and age spot-brightening agents out there, 4% hydroquinone is the most effective. Overall, it is considered to be safe, but it is important not to use hydroquinone in conjunction with any creams containing peroxides or resorcinol, to avoid the eye area completely, and to switch off with other agents every four months to lower the risk of ochronosis (skin darkening from the build-up of homogentisic acid). In addition, if you have darker skin, you may wish to speak to your dermatologist first, as ochronosis is much more common in those with darker skin tones.

I hope this guide helps you. Please, keep the great questions coming!

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