zxing barcode generator java example FIGURE 13-6 Blue light can be used to visualize facial pigment in .NET framework

Generation QR in .NET framework FIGURE 13-6 Blue light can be used to visualize facial pigment

FIGURE 13-6 Blue light can be used to visualize facial pigment
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BOX 13-1 Regimen for Patients With Melasma Morning: 1 Wash with a cleanser that contains an alpha hydroxy acid 2 Apply a product with hydroquinone, kojic acid, or azelaic acid 3 Apply a UVA/UVB broad-spectrum sunscreen 4 Wear a hat and avoid sun and heat when possible 5 Take an antioxidant supplement such as pycnogenol (see 34) Evening: 1 Wash with a cleanser that contains an alpha hydroxy acid 2 Apply a retinoid such as Retin-A, Renova, Differin or Tazorac, or a product with hydroquinone and a retinoid such as Tri-Luma Undergo an in-of ce peel every 2 weeks (ie, Jessner s, glycolic, or salicylic acid) Slowly increase the strength of the peel as tolerated Some physicians use microdermabrasion prior to the peel to increase penetration of the ingredients Note: Some patients develop exogenous ochronosis, or increased pigmentation, on exposure to hydroquinone A good history should be taken and if the patient is sensitive to hydroquinone, it should be avoided Azelaic acid (Azelex) is another option that is useful in all patients but especially those who cannot tolerate hydroquinone
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there are specialized pharmacies that will prepare formulations with higher concentrations of hydroquinone The stability of such creams is questionable as retinoids and hydroquinone can work in opposition, thus diminishing overall efficacy if not formulated properly The author advises using the FDA-approved formulations rather than those compounded by a pharmacy Topical steroids have depigmenting effects with an unknown mechanism It has been proposed that they decrease both production and secretion of melanin in the melanocytes46 However, because of potential side effects, such as skin atrophy as well as triggering acne and telangiectasia, the use of steroids is limited to low-potency formulas unless they are combined with a retinoid Retinoids have been shown to help prevent the atrophy that occurs with topical steroids47 Recent studies have shown that glycolic acid is also beneficial in enhancing the effectiveness of hydroquinone48 The addition of glycolic acid facilitates penetration of both agents and hence
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promotes efficacy Glycolic acid can be used in a chemical peel formulation or as an additive to home products Glycolic acid peels and/or Jessner s peels can be used in combination with topical agents to hasten the resolution of melasma (see 20) Lawrence et al found that Jessner s solution and 70% glycolic acid (combined with tretinoin and hydroquinone between peels) worked equally well in the treatment of melasma41 The addition of kojic acid may also improve the efficacy of topical agents according to other recent studies Research performed in Singapore followed 40 Chinese women treated with 2% kojic acid in a gel containing 10% glycolic acid and 2% hydroquinone on one-half of the face49 The other half was treated with the same application but without kojic acid The patients were observed for 12 weeks All patients showed improvement in melasma on both sides of the face; however, the side treated with the combination containing kojic acid showed more improvement More than half of the melasma cleared in 24 of the 40 (60%) patients receiving kojic acid compared to 19 of 40 (475%) patients receiving the gel without kojic acid A tretinoin acid peel is another acceptable option in patients with melasma In a study of 10 Asian women with melasma, although a 1% tretinoin peel was as effective as a 70% glycolic acid peel, the tretinoin was better tolerated by the patients50 Because there are so many treatment options and compliance is a vital aspect of treating this condition, the regimen should be easy for the patient to understand Many companies such as La Roche-Posay, Obagi, and Topix package products in an easy-to-follow treatment regimen Skin care regimens are often combined with microdermabrasion, light treatments, or laser; however, it is the author s opinion that proper skin care and education are paramount for the successful treatment of this disorder Intense pulsed light (IPL), a noncoherent broadband light source ranging from 500 to 1200 nm, is another available option for melasma treatment This procedure is very popular because there is minimal down time and it offers a low risk of side effects In a study conducted by Wang et al on 31 Asian women with dermal and mixed melasma, IPL treatment on a monthly basis was compared to 4% topical hydroquinone; 35% of patients in the IPL group showed more than 50% improvement, compared to 14% in the control group51 The initial
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cutoff filter was 570 nm, and 590 to 615 filters were used for the remaining treatments to target deeper components As expected, epidermal melasma treated with IPL seems to have more promising results as compared to dermal melasma52 Although IPL is considered a safe treatment, postinflammatory pigment alteration (PIPA) remains a possibility Therefore, IPL must be used with caution for individuals with darker skin tones This treatment will not be successful without a proper skin care regimen and sun avoidance The Q-switched Alexandrite laser (755 nm) has also been successfully used to treat melasma53 In addition, this laser has been used in conjunction with the UltraPulse CO2 laser54,55 In one study, the combination of the Q-switched Alexandrite laser and UltraPulse CO2 was associated with more side effects than the Q-switched Alexandrite laser alone, though the combination treatment was more effective55 Fractional photothermolysis is a new option for lightening hyperpigmented areas of the face In a study performed by Rokhsar et al, 10 patients with refractory melasma and Fitzpatrick skin types III to V received four to six treatments with a Fraxel laser (Reliant Technologies, Palo Alto, CA, USA) at 1to 2-week intervals; 60% of the patients showed 75% to 100% clearance of their melasma based on the physician evaluation56 (see 26) Patient education is one of the most important aspects of a melasma treatment regimen Most patients do not realize the important role of UV radiation in this condition, particularly the capacity of UVA rays to penetrate glass Patients should be instructed to wear, during all daylight hours, a broadspectrum UVA and UVB sunscreen of the highest SPF that they can tolerate Patients should also understand that no sunscreen offers complete protection; therefore, sun avoidance should also be practiced Because patients may have difficulty seeing the improvement in their skin, serial photography with a regular camera and a UV camera can be used to document treatment response57
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