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Ep 353 – The Rogue Pharmacist: Melanogenesis
00:15:12
Why is pigmentation so tricky to treat? In this episode of The Rogue Pharmacist, Ben explains the science of melanogenesis, the process behind melanin production, and the many factors that influence pigment in the skin. Associated Skin Care...
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- [00:04]
A
Hello and welcome to ASCP and the Rogue Pharmacist with Benjamin Knight Fuchs. In each episode, we will explore how internal and external factors can impact the skin. I'm Maggie Stasik, ASCP's program director, and joining me is Ben Fuchs, skincare formulator and pharmacist. Hi, Ben.
- [00:19]
B
Hello, Maggie.
- [00:21]
A
When we think about skin color and pigmentation, melanogenesis is at the center of it all. But the process is far more complex than just making melanin. Ben, can you break down what's really happening?
- [00:33]
B
Yes, that is the. Probably the number one complaint for folks, older folks, kids, probably acne is the most important complaint. But I would say the number one complaint for people, for women especially as they get older, dermatological complaint, is hyperpigmentation. Wouldn't you say that as an esthetician?
- [00:49]
A
Yeah, yeah, probably.
- [00:50]
B
And not only is it problem because people don't like the way it looks cosmetically, but it's also a problem because it's really hard to treat. And it's kind of interesting how a lot of the treatments for hyperpigmentation can actually cause more hyperpigmentation. You know, like peels, for example, and lasers and ablative therapies, which is really what the most common treatment for hyperpigmentation is to get rid of it, you know, ablated away, either with a peel or laser or something like that. But if you're prone towards hyperpigmentation, a peel can cause more hyperpigmentation or laser can cause more hyperpigmentation. And obviously, you're gonna have a very unhappy patient if they come in for hyperpigmentation and you cause more hyperpigmentation. So what the heck is going on? Why is hyperpigmentation so difficult to treat and why is it so common? One word, stress. Hyperpigmentation. Melasma. Melanin. Melanization is part of the generic stress response in the body, and it's tied in with stress chemistry. You know, stress is kind of a weird thing because when we think about stress, we think about our credit card bills or our family or jobs or whatever. But stress really, from a biochemical perspective, is a survival threat. And it's not about our credit card bills or our family. It's about getting eaten by a lion, or in the case of melanization, it's about the sun. And these represent survival threats. And you can't really override a survival threat because you don't think it looks good. In other words, when the body senses its survival is at stake, which, from a Evolutionary standpoint, that's what melanization is protective against. It doesn't matter what you think. It doesn't matter, you know, whether you like that dark patch on your skin or not. To the body, that's critical. And that's why it's so darn hard to eliminate with our topical strategies or even our nutritional strategies a little bit easier. But our topical strategies make it very difficult to treat. And there really isn't an effective treatment for hypermelanization because it is so tied in with the stress response. And as I said, some of our, our treatments are actually making things worse. Topically, you're really not going to be able to address melanization except for with hydroquinone or retinol. I like retinol because retinol you get anti aging benefits. I hate hydroquinone, even though I do have to make it in my pharmacy because it's so toxic. So hydroquinone and retinol, pretty much the only topical strategies you have for dealing with hyperpigmentation from a chemical perspective, although alpha hydroxy acids can probably help a little bit. Peels. So what's going on with the whole melanization thing? Well, when we stress the body out, the stress manifests itself through hormones. And the major control point for hyperpigmentation is going to be the hormone system. Melanization is receptive to is responsive to estrogen, it's responsive to cortisol, and it's responsive to insulin. Those are the three major hormonal control points for melanization. And so if you really want to address melanization, you've got to address it at the level of the stress response. The steps that are required to produce melanin are very difficult to interfere with. And there are some things, there's some peptides that you can use that will interfere with those steps. In fact, I use a couple of those peptides that will give you some effect. But mostly you're going to be dealing with those three hormones, that is insulin, estrogen and cortisol, stress hormone. So the best way to deal with the melanization pathway is to deal with the stress response. In the case of insulin, which we talked about earlier, the best thing you could do is lower or lower insulin levels by lowering blood sugar levels. And that seems to me like the, the easiest way to control in, to control hyperpigmentation from the level of insulin is keep your blood sugar stable. Now you can also use nutritional supplements that will help your body process sugar and that will keep insulin levels low. And there's lots that you can use. The B vitamins, particularly vitamin B1 and B3, thiamine and niacin are very important. Magnesium and zinc are very important. And by the way, magnesium and zinc deficiencies can also be associated with hyperpigmentation and excess melanogenesis. So those are a couple things to think about. And a lot of people are deficient in those two vitamins. In fact, I would. Or those two minerals. Those two minerals are probably the two most common mineral deficiencies. And considering that they play such an important role in sugar metabolism and insulin secretion and ultimately in pigmentation or hyperpigmentation, it seems like that might be one of the causes for people at least, at least a minor cause, if not a major cause of our melanization crisis or hyper hyperpigmentation crisis that dermatologically a lot of people are going through. So supplementing to help control in control blood sugar and then ultimately control insulin can be helpful and alpha lipoic acid can be helpful. Sulfur and selenium are also important. And selenium deficiency also is associated with hyperpigmentation too, by the way. And then estrogen, that's a little trickier because we have this love hate relationship with estrogen and there's a big misunderstanding with estrogen. I just had a conversation with a friend of mine yesterday, went to a naturopath and there's a book that came out that said estrogen, fear of estrogen is misplaced and it's a big myth. Not true. Estrogen is a very problematic hormone, particularly for the stress response. So that's one of the reasons why people who are estrogen dominant, you probably heard that term estrogen dominance, have things like anxiety and depression and nervousness and jitteriness. And a lot of has a lot of that has to do with either excess production of estrogen or out of balance estrogen. I'll tell you about that here in a second. Or exposure to xenoestrogens or foreign estrogens or incomplete detoxification of estrogen. And all of these play a role in ultimately in high levels of estrogen, which can lead to hyperpigmentation. Anybody who's dealt with what's called a mask of pregnancy, when women are pregnant, their estrogen goes up and they can end up with these raccoon eyes and they call that the mask of pregnancy. Women on HRT are more susceptible to hyperpigmentation issues. The thing about estrogen is estrogen is a very, very, very powerful steroid hormone. It's the most powerful of the steroid hormones. And so the body has to eliminate it. And there are mechanisms in place in the liver and in the intestine and the gallbladder, actually, that help the body eliminate estrogen. However, if you got intestinal problems, which is a lot of people, dysbiosis, messed up gut bacteria, which is a lot of people, liver problems, which is a lot of people, gallbladder issues, which is a lot of people, what can end up happening is you can end up with elevated levels of toxic estrogen in completely processed estrogen. So while estrogen is an important hormone, it has to be cleared out quickly. And if you're dealing with any of those issues, intestinal issues, liver issues, or gallbladder issues, which is a lot of folks, you can end up with functionally toxic estrogen, High levels of functionally. Of functionally toxic estrogen. So clearing out estrogen becomes a very important strategy for reducing melanogenesis for the melasma patient. And that's things like fiber for improving bowel movements. Probiotics are good bacteria for improving bowel movements. Lecithin or phospholipid supplementation for improving bile secretion. The amino acids glycine and taurine can help with the meat with bile secretion. Anything you do to protect the liver, if you have issues with blood sugar, that. In fact, that's probably the most important reason for liver problems. Fatty liver, they call it. And these days, like a third of Americans, a hundred million plus Americans, have fatty liver disease, which is crazy, because that's a serious health challenge. And it's almost to the point now where people think it's normal to have a fatty liver after a certain age. And it's definitely not normal. So correcting liver problems is very important. And then also using supplements like. I don't know if you heard of DIM i3C. Yeah. In fact, DIM was created by a guy in Boulder. I don't know if you know that.
- [08:38]
A
Oh, I didn't know.
- [08:38]
B
By a doctor in Boulder. Anesthesiologist in Boulder. And I was actually one of the first pharmacies to work with Dim back when he developed it. But anyway, Dim i3C, one of the ways estrogen is cleared is through a process called methylation, which I think we may have talked about. Methylation.
- [08:55]
A
I think we did, yeah.
- [08:56]
B
So methylating agents like Sammy can be very helpful. They're amino acids. Choline can help with methylation. There's something called betaine, which can be helpful for methylation. So improving methylation is important. Using cruciferous vegetables. In fact, anybody who's got hyperpigmentation issues or estrogen issues. I think cruciferous vegetables are a woman's best friend personally, especially older women because they're so important for liver health and for, for hormonal health. And then balancing estrogen is also important. Progesterone. In fact, I've been working, I have a nice progesterone serum in my pharmacy that we sell for people who are estrogen dominant or dealing with estrogen problems that are causing hyperpigmentation. Probably progesterone deficiency may be a more common problem or more important or relevant health problem as women get older than estrogen deficiency. Estrogen is, is made in fat, in body fat. So as long as you have body fat, you're going to make some estrogen. Progesterone levels tend to drop much more precipitously than estrogen levels and this can lead to a problem of estrogen dominance which can be associated with hyperpigmentation. So using progesterone creams, progesterone serums, I, I don't know about the progesterone troches or the internal progesterone as much because they'll spike your progesterone and then the estrogen levels will drop where you get a steady state of progesterone with a topical progesterone. Pregnenolone. Have you ever heard of pregnenolone? Pregnenolone can help balance out estrogen for problems with melanogenesis. And then there's also the whole cortisol issue which is associated with psychological stress, physiologic stress, as well as interestingly, hypoglycemia, low blood sugar. So cortisol can be handled by use by stabilizing blood sugar. That's one strategy. Also using nutritional, reducing stress. Of course psychological stress is also important. And then there are nutrients that you could use to balance out cortisol, vitamin A, vitamin E and they also have vitamin A. And E will also help you with your estrogen too. Pregnenolone for anti cortisol and all your sugar supporting sugar metabolizing supporting nutrients will also help with cortisol. Oxygenation or deep breathing. Slow deep breathing techniques is a great way to lower cortisol also. So for melanogenesis you're not going to be able to really control it by hacking into the pathways because they're so tied in with the stress response. In fact, the production of adrenaline and the production of cortisol are linked in to what's called the melanocortin system. And the melanocortin system not only produces melanin but it also produces stress hormones. So it's very difficult to hack into the melanogenesis biochemical pathway because it's so tied in with the body stress response, which the body considers a survival threat. However, by hacking into insulin and by not, I don't wanna say hacking into insulin, but by manipulating insulin through dietary strategies, manipulating estrogen through improving detoxification and elimination and balancing it out. And then also by working with stress, with psychological stresses as well as physiologic stresses, and using supplements, you can help stabilize cortisol and that will also help with melanization. Topically, you're going to be stuck with the really retinol or hydroquinone, Vitamin C will have some skin lightening effects. You know, it's really lame and I don't know why people still use these things. The tyrosinase inhibitors, you know, the herbal. I've never seen anybody get rid of hyperpigmentate. Have you ever? Never. And Kojic acid and these kinds of things. And they'll tell you, companies will tell you, oh, it's a tyrosinase inhibitor. It tyrosine by the way, is an enzyme whose conversion is important for the production of melanin. And there's an enzyme called tyrosinase that's important for that conversion. Tyrosinase inhibitors, the thinking goes, will inhibit the conversion for of tyro tyrosine, the amino acid tyrosine into pigment. So that's where the logic of tyrosinase inhibition comes from. But in all the years that I've been doing skincare and 40 plus years I've yet to see anybody use herbal tyrosinase inhibitor or a phytochemical that has tyrosinase inhibition properties and have their skin lightening improved. So you're really going to be using retinol, hydroquinone, even transamic acid, I don't know if you've heard of that one, doesn't really work very effectively. But retinol and hydroquinone will work. And then peeling the skin is also a strategy, but you just got to be careful because the skin's already destabilized. You can cause more hyper melanization if.
- [13:10]
A
Somebody is dealing with hyperpigmentation, whatever the cause, if they are then using like as you're saying, say retinol, they have to consistently use the retinol to treat and suppress the melanin topically.
- [13:24]
B
Absolutely.
- [13:25]
A
But let's say they determine the cause internally of that hyperpigmentation treat it, heal it. All the things they'll see that go away 100%.
- [13:36]
B
But. But that's easier said than done.
- [13:38]
A
Yeah.
- [13:38]
B
And then also retinol has other benefits, too. So you pre. You want to. Retinol is one of those. And to me, the big three or even the big four of skincare ingredients for anti aging that everybody wants to use all the time are retinol. And not the fake retinol either. Not the, not the faux stuff, vitamin C. And again, fat soluble, the water soluble is problematic. And then hydroxy acids, whether it's beta or alpha hydroxy acids, and then ionic minerals, which I don't know if we talked about ionic minerals. We should talk about that. You've heard about mitochondria, obviously, right? The mito mitochondrial issues. I don't want to digress here, but I will Mitochondrial issues are behind a lot of health and skin problems. We're frying out our mitochondria by our lifestyle habits, particularly excess calories and sugar. And stabilizing mitochondria is very important for overall health, but also for hyperpigmentation, because defects at the mitochondrial level in a cell will cause cellular stress that can lead to pigmentation. So keeping mitochondria healthy are very important. And vitamin C is. A lot of folks don't realize this, but vitamin C plays a very important role in mitochondrial health. And that's another reason why vitamin C is so important. But also ionic minerals, electrical minerals are very important for keeping mitochondrial healthy. So maybe that's. We can talk about that on another podcast.
- [14:53]
A
That concludes our show for today, and we thank you for listening. But if you just can't get enough of Ben Fuchs, the ASCP's rogue pharmacist, you can find him@truthtreatments.com for more information on this episode or for ways to connect with Ben Fuchs or to learn more about ascp, check out the show notes.