The document discusses hyperpigmentation and melasma, outlining the causes and types of hyperpigmentation as well as protocols for treating it using a Yellow Peel chemical peel approach with combinations of retinol, salicylic acid, phytic acid, kojic acid, azelaic acid, and other ingredients over multiple treatments tailored to a patient's skin type and level of hyperpigmentation. The Yellow Peel protocols provide guidance on application times and endpoints based on a patient's phototype and hyperpigmentation severity to safely and effectively treat conditions like melasma, sun damage, and other causes of dark patches and spots on the skin

1. Understanding
Hyperpigmentation and
treating it with combined
strategies

2. MELANOCYTES
The pigment-producing cells of the skin
are called melanocytes and their activity is the
major determinant of the color of the hair and
skin.
Within the epidermis, melanocytes reside
in the basal layer in a ratio of about 10
keratinocytes to 1 melanocyte. However, each
melanocyte via its dendrites supplies melanin to
about 30 nearby keratinocytes.
www.skinpedia.org

3. www.skinpedia.org

4. When ultraviolet rays penetrate the skin it
triggers the production of melanin as a defense
mechanism. Melanin moves along arm-like
structures called dendrites in a special container
called a melanosome.
After the complete synthesis of melanin,
melanosomes filled with this pigment are injected in
the interior of keratinocytes. Once inside
keratinocytes, melanosomes tend to spread through
the cytoplasm, over the upper part of the nucleus,
so as to protect it from ultraviolet radiations.
.
www.wikipedia.org/wiki/Melanocyte

5. www.google.com

6. Inflammation is the cause of
Hyperpigmentation
• External Causes
– Sun Exposure
– Skin trauma, burn, cosmetic treatment,
surgery
– Acne wound, psoriaisis, eczema.

7. Inflammation is the cause of
Hyperpigmentation
• Internal Causes
– Inflammatory hormones
• Pregnancy, Oral Hormone Therapy,
Menopause, other hormones—primarily
the sex steroids progesterone and
estrogen
– High amounts of Omega 6, low amounts of
Omega 3

8. What is Melasma?
Melasma is a skin condition
presenting as brown patches on
the face of adults. Both sides of the
face are usually affected. The most
common sites of involvement are
the cheeks, bridge of nose,
forehead, and upper lip.
www.add.org

9. Who gets Melasma?
Melasma mostly occurs in women.
Only 10% of those affected are
men. Dark-skinned races,
particularly Hispanics, Asians,
Indians, people from the Middle
East, and Northern Africa, tend to
have melasma more than others.
www.add.org

10. What causes Melasma?
The precise cause of melasma is unknown. People
with a family history of melasma are more likely to
develop melasma themselves. A change in
hormonal status may trigger melasma. It is
commonly associated with pregnancy and called
chloasma, or the "mask of pregnancy." Birth control
pills may also cause melasma, however, hormone
replacement therapy used after menopause has not
been shown to cause the condition.
The most influencing factor seems to be estrogen
and ultraviolet light.
www.add.org, Baumann

11. What are the types of Melasma?
Epidermal •Brown color
•Light brown color
•Appears more obvious under
black light
•Responds well to treatment
Dermal •Blue gray color
•Dark brown color
•Unchanged under black light
•Responds poorly to treatment
Mixed •Combination of light and brown
patches
•Partial improvement with
treatment

12. MELASMA / CHLOASMA
IMPORTANT INFORMATION
• UNDERSTANDING THE PHYSIOPATHOLOGY
• UNDERSTANDING THE MECHANISM OF
ACTION OF THE CHEMICAL AGENTS TO BE
USED
• CORRECT DIAGNOSTIC OF THE LESION TO BE
TREATED (MIXED, SUPERFICIAL OR DEEP?)
• PLAN THE TREATMENT WITH YOUR PATIENT
AND A TREATMENT PROGNOSTIC .
Romulo Mene, MD - Rio de Janeiro - Brazil

13. YELLOW PEEL
Protocol
This new Yellow Peel Protocol was created to suit the
Spa/Skin Care Setting. This protocol will allow
professionals to perform the Yellow Peel within a 2
hours time frame. In order to achieve results similar
to Dr. Romulo Mene original protocol a series of
treatment will be required.

14. YELLOW PEEL
Protocol
The slide show will explain the new protocol based on
skin classification and condition. The graphs will
guide you to choose the appropriate professional
treatment and home care for you client.

15. YELLOW PEEL
Retinol / Salicylic Acid /
Phytic Acid
Kojic Acid / Azelaic Acid
Emu Oil/ Alantoin

16. YELLOW PEEL
Protocol
1. Photo Documentation
2. Skin Analysis
3. Check Up Peel - Glycolic Acid Soap 20%
4. Apha Beta Complex Gel (ABC)
or 30% Glycolic Gel
3. Yellow Peel Balm
4. Post Peel Recovery Formula

17. YELLOW PEEL
Protocol
Check Up Peel
1. APPLY CHECK UP PEEL TO ENTIRE FACE. LEAVE ON THE
SKIN FROM 5-20 MINUTES. THE MORE OILY AND/OR DAMAGED
THE SKIN THE LONGER TO LEAVE ON.
2. WASH SKIN WITH FRESH WATER.
3. Evaluate the sensitive points of the skin, as detected by CHECK UP
PEEL
4. CHOOSE HOW TO PROCEED WITH TREATMENT

18. A B C OR 30% GLYCOLIC PEEL
VERY SUPERFICIAL PEEL (MELASMA, ASIAN, AFROAMERICAN)
PHOTOTYPES V & VI
•APPLY ACID GEL ON THE SKIN AND REMOVE WITH WATER AS
SOON AS THE PATIENT REPORTS FEELING A HOT SENSATION ON
THE SKIN

19. YELLOW PEEL
ABC or 30% Glycolic Peel
• SUPERFICIAL PEEL (INICIAL PHOTOAGING) PHOTOTYPE III & IV
APPLY ACID GEL ON THE SKIN AND REMOVE WITH WATER WHEN
THE SKIN DEVELOPS A PINK COLOR ERITHEMA
• MEDIUM PEEL (MIDLE PHOTOAGING) PHOTOTYPE I, II & III
APPLY ACID GEL ON THE SKIN AND REMOVE WITH WATER WHEN
THE SKIN DEVELOPS AN ERITHEMA OF MEDIUM RED COLOR
• DEEP PEEL (SEVERE PHOTOAGING) PHOTOTYPE I & II
APPLY ACID GEL ON THE SKIN AND REMOVE WITH WATER WHEN
THE SKIN DEVELOPS AN SHOWS A INTENSE RED ERYTHEMA IN THE
TREATED AREA.
POST PEEL PHASE: MOISTURIZE THE SKIN FOR THE NEXT 3 DAYS WITH
POST PEEL RECOVERY FORMULA

20. YELLOW PEEL
VERY SUPERFICIAL PEEL (MELASMA, ASIAN, AFROAMERICAN)
PHOTOTYPES V & VI

21. Very Superficial Peeling Protocol
• Indicated for: EPIDERMAL MELASMA, ASIAN SKINS,
DARK SKIN, SKINS HYPERPIGMENTATION
DISORDERS.
• PHOTOTYPES V & VI
• Apply the yellow cream to the facial skin, and leave to work
for 20-30 minutes.
• Remove the inactive cream with a SkinRenu Micro-Bead
Cleanser and reapply a new layer of yellow cream, leaving it
to act for another 20-30 minutes.
• Repeat these steps 1 to 3 times (1-3 applications), until the
skin become HOT, BUT WITHOUT SIGNS OF ERYTHEMA.
• Apply Post Peel Recovery Formula for the next 8-10 days;
use SkinRenu Micro-bead Cleanser soap for washing or
plain water.

22. Professional Treatment

23. Home Treatment
Very Sensitive Skin/Epidermal
Melasma/Phototypes V & VI

24. COMPLEX MELASMA
PHOTOS WITH
UV EFFECT Rômulo Mêne, MD -
Rio de Janeiro - Brazil

25. PHOTO WITH EFECT UV
BEFORE
Rômulo Mêne, MD - Rio de Janeiro - Brasil BEFORE PHOTO WITH EFECT UV

26. Superficial Peeling Protocol
• Indicated for INICIAL HYPERPIGMENTATION and
Sensitive Skins.
• PHOTOTYPE III & IV
• Apply the yellow cream to the facial skin, and leave to
work for 20-30 minutes.
• Remove the inactive cream with a SkinRenu Micro-Bead
Cleanser and reapply a new layer of yellow cream,
leaving it to act for another 20-30 minutes.
• Repeat these steps 3 times (1-3 applications) until AN
INTENSE, PINK COLORED ERYTHEMA appears on
the skin.
• Apply Post Peel Recovery Formula for the next 8-10
days; use SkinRenu Micro-bead Cleanser soap for
washing or plain water.

27. Professional Treatment

28. Home Treatment
Sensitive Skin/ Initial
Hyperpigmentation/ Phototypes III & IV

29. Professional Treatment

30. Home Treatment
Sensitive Skin/ Moderate
Hyperpigmentation/ Phototypes III & IV

31. Professional Treatment

32. Home Treatment
Sensitive Skin/ Severe
Hyperpigmentation/ Phototypes III & IV

33. PHOTOS WITH EFECT UV AFTER 14 DAYS WITH PHOTOS WITH EFECT UV
BEFORE
YELLOW PEEL
Rômulo Mêne, MD - Rio de Janeiro - Brazil

34. BEFORE BEFORE PHOTO WITH EFECT UV
Rômulo M êne, MD - Rio de Janeiro - Brazil
Mê
AFTER TREATMENT WITH SUPERFICIAL CHEMICHAL PEEL
AND SKIN BLEACHING GEL

35. Medium Peeling Protocol
• Indicated for MODERATE and SEVERE
HYPERPIGMENTATION in PHOTOTYPES I, II & III
• Apply the yellow cream to the facial skin, and leave to
work for 15-20 minutes.
• Remove the inactive cream with Check Up Peel soap
and reapply a new layer of yellow cream, leaving it to act
for another 15-20 minutes.
• Repeat these steps 3 times, until the SKIN SHOW A
STRONG ERYTHEMA (similar to intense sunburn).
• Apply Post Peel Recovery Formula for the next 8-10
days; use SkinRenu Micro-bead Cleanser soap for
washing or plain water.

36. End Point of Medium Peel

37. Professional Treatment

38. Home Treatment
Initial Hyperpigmentation / Phototypes I,
II, & III

39. Professional Treatment

40. Home Treatment
Moderate Hyperpigmentation /
Phototypes I, II, & III

41. BEFORE 15 DAYS AFTER YELLOW PEEL
Rômulo Mêne, MD - Rio de Janeiro, Brazil

42. Rômulo Mêne, MD – Rio de Janeiro - Brasil
BEFORE 1996 AFTER 4 DAYS AFTER 2 YEARS
YELLOW PEEL 2001 YELLOW PEEL 2004
AFTER 2 YEARS
BEFORE 2001 YELLOW PEEL

43. Fig. 1 Fig. 2
Fig 1. Pre-treatment.
Fig 2. Patient showing
crusts on the 4th day after
the application of YELLOW
PEEL
Fig 3. 30 days after the
initial peeling with YELLOW
PEEL and maintenance with
Fig. 3 Phytic Acid

44. PHOTOS WITH EFECT UV
BEFORE AFTER 6 YEARS
(YELLOW PEEL/LIGHTENING GEL)
BEFORE Rômulo Mêne, MD - Rio de Janeiro - Brazil

45. HIPERPIGMENTATION AND 10 DAYS AFTER THE 1TH
HIDROQUINONE SEQUELES YELLOW PEEL

46. AFTER 2 YEARS
BEFORE ALPHA BETA, NUTRI CREAM, LIGHT. GEL, FADE SHADE
BLEPHAROPLASTY (2007)
Rômulo Mêne, MD - Rio de Janeiro, Brazil

47. PHOTO WITH EFECT UV
AFTER 2 YEARS
BEFORE ALPHA BETA, NUTRI CREAM, LIGHT. GEL, FADE SHADE
BLEPHAROPLASTY (2007)
Rômulo Mêne, MD - Rio de Janeiro, Brazil

48. Professional Treatment

49. Home Treatment
Severe Hyperpigmentation/Phototypes I,
II& III

50. Jordana Lewis
Florida/Caribbean Distributor
Trainer
305-335-8719
877-646-RENU