Dr. Seemal R. Desai is a Diplomate of the American Board of Dermatology, and a Board Certified Dermatologist. He graduated with honors from Emory University. He received his medical training at Morehouse School of Medicine in Atlanta, Georgia, and received his Doctor of Medicine degree with Magna Cum Laude with honors. He’s also an expert at treating skin of color and pigment disorders, and is the Immediate Past President of the Skin of Color Society. He also serves on the AAD Board of Directors, and is Past President of the Texas Dermatological Society.
1) Could you tell a little more on Cyspera and the main ingredient in it?
This is a very interesting product in my opinion, the active ingredient is cysteamine. This is an amino acid derivative of the naturally occurring amino acids cysteine in the body.
2) What’s the typical patient you recommend Cyspera to? Are there any contraindications for using Cyspera?
In my practice, I am recommending this product as a non-hydroquinone-based option for skin lightening. This has been especially helpful for patients who don’t want to be on prescription-based therapy and want to try an alternative. It is also helpful for patients with sensitive skin and who want to take a more tailored approach to their hyperpigmentation and specifically melasma. In my practice, this product has been extremely well tolerated. The only contraindications for me have been if the patient is allergic to any component of the product. Otherwise, this has been a very successful Incorporation into my treatment regimen.
3) What skincare products (other than sunscreen) do you recommend pairing with Cyspera? Should it be used in the AM/PM?
Patients with hyperpigmentation require a combination approach that takes into account both their pigmentation process, aesthetic goals for their skin overall, and any other important components of their medical history. I often time combine cyspera both with topical antioxidants such as topical vitamin C, photoprotection with sunscreen, and sometimes even with prescription therapy that may be on or off label. For example a patient could use a prescription based product in the morning and then use the Cyspera at night. The most important thing and of paramount importance in any form of hyper pigmentation is photoprotection using broad spectrum sunscreens minimum SPF 30 or higher. In general, I typically have patients use the Cyspera in the evening.
4) Azelaic acid (Finacea) is used a ton for pigmentation and acne. Can this be safely used with Cyspera?
I can speak to this from personal experience, that I have combined these two options together. For example, the azelaic acid is used in the morning whereas the system is used at night. There have not been any direct studies on the combination use of this. It’s important to remember that many prescription products for hyperpigmentation are considered off label so it’s based on your clinical judgment and counseling the patient for their best treatment outcomes. I have found this to be effective in my patients. I do like using azelaic acid for hyperpigmentation and for acne.
5) Should anyone leave Cyspera on their face for longer than 15 minutes?
I recommend my patients to 15 minutes of treatment to avoid irritation and to create a consistent pattern of application. There are some colleagues of mine who do this for longer in areas of more stubborn pigmentation, however I find the 15 minutes is quite effective and allows for a consistent pattern of results.
6) Can Cyspera be safely used in conjunction with hydroquinone based topicals like Tri-Luma or with Tretinoin/Retinol?
For some of my patients with more stubborn hyperpigmentation, I have used hydroquinone and retinol-based therapy in a prescription compounded formulation and I typically have patients do that in the evening. In that case, I would have them use the cyspera in the morning. I do not have patients use a prescription and something like Cyspera at the same time as I think they can be irritating. Even in these patients photo protection is of paramount importance and I often even combine topical antioxidants like vitamin C.
7) Tranexamic acid has been the latest buzzword in the skincare world. Could you tell us how it works both topically and orally?
This is indeed a buzz word and an exciting option for patients with melasma. It’s important to note that this is an off label use of tranexamic acid. This works in essence as an anti-inflammatory because it blocks the production of prostaglandins and a record on an acid metabolites which ultimately up regulate tyrosinase enzyme activity. If you up regulate the enzyme activity you make or pigment. So the tranexamic acid through multiple complex mechanism steps actually stops the production of pigment via down regulation of tyrosinase enzyme activity.
There are oral formulations available as well as cosmeceutical‘s in topical formulation. Topical formulation could also be compounded for some patients.
In the topical form it’s typically a 3% concentration that works best in my opinion. There are a variety of publications that have been published on this and I would encourage readers to take a look at those. More studies are needed but it is indeed a promising option for recalcitrant pigment patients.
8) Lastly, do you have any advice for someone dealing with stubborn melasma that’s resistant to topical treatment?
The most important thing that I think as a board-certified dermatologist who specializes in pigmentation of the skin of color is that I offer my patients hope. Many of my patients have been to multiple other physicians have tried many treatments and are really frustrated with their condition. I tell my patients that melasma is not something that gets cured, but I can help them control the disease process as best as we can using combination treatment modality. I also encourage more research funding for pigment in skin diseases and skin of color. We do perform clinical trials and try to enroll patients in these type of studies. There are newer combination approaches both prescription and nonprescription like cysteamine that are available now and give our patients increase optimism for treatment outcomes.
Credits
https://www.innovative-dermatology.com/index.html
https://twitter.com/seemalrdesaimd
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