Vitiligo on the hands (a), camouflaged with application of dihydroxyacetone (b)
Frequent applications of DHA are required to maintain desired effect as the normal epidermal turnover exfoliates the epidermis. The staining usually lasts up to 3–5 days. DHA binds only with the stratum corneum layer, and thus the intensity of the tan correlates with the compactness and thickness of the horny layer. Old, mottled hyperkeratotic, or rougher skin takes up an uneven finish. Lighter skin requires a lower concentration of DHA cream than subjects with dark skin. The advantage of DHA is its high substantivity and water resistance, avoiding discoloration of cloth on staining. Its innate sun protection properties however have little practical application due to its low SPF which decreases after application with each passing day. Obtaining a proper color match is difficult as blending with the surrounding skin is tricky [4, 5].
After the formulation becomes 6–9 months old, it starts to impart a greenish color to the skin; thus, product storage requires special care.
DHA is an economical, effective, and safe therapeutic option for patients with recalcitrant vitiligo. It is advantageous over camouflage cream involving the hands and feet as the cover creams are just waterproof and not rub proof [4, 5, 7].
DHA is applied every alternate night on perfectly dry skin. The lesions are cleaned with water and scales are gently removed with a towel, prior to application. Using a cotton bud, a finger, or a paintbrush, a thin layer of the cream is applied with circular movements to obtain a homogeneous result. Application on the mucosa and areas near the forehead hairline and eyebrows should be avoided. The areas which take to self-tanners quite well such as the face and neck should have sparing application. In case the hairs are short, the application of the product should be behind the ears. Nails and hair may take color, whereas mucous membranes do not. In order to avoid staining, the fingers should be cleaned immediately after application. Contact with textiles is avoided for the first 30 min, and no water contact is allowed over the next 2 h. Bathing, swimming, or any activity that will lead to sweating must be avoided for 1 h; no belts, brassieres, and shoes should be worn for 1 h, if the products have been used on the body. During periods with high UV exposure, sun protection is recommended with potent sunscreens of a high UVA and UVB protection factor [7, 8].
32.6 Camouflage in Melasma
Dyspigmentation of the face caused by melasma is a cosmetic challenge, and camouflage cosmetics are an important part of treating the melasma patient. Not only do they provide additional photoprotection, but they also restore the patient’s self-confidence while dermatologic treatment is under way. The difficulty lies in blending the various brown tones associated with the condition. Topical prescription medications intended to lighten the darkened skin usually take a minimum of 3 months to produce clinically acceptable results, necessitating the need for camouflage techniques in the interim. It is very difficult to completely eliminate the uneven pigmentation, especially in hypermelanotic disorders accompanied by melanophages in the dermis such as dermal and mixed melasma. In such patients camouflaging uneven pigmentation can be achieved with corrective cosmetics such as Dermablend®, Covermark®, or Dermacolor®. These cosmetics provide broad-spectrum sunscreen activity along with good coverage. They are especially useful in hyperpigmented conditions in which sunlight plays an aggravating and perpetuating role .
Most sunscreen products are colorless and get absorbed directly into the skin, leaving no trace. Tinted sunscreen combines the benefits of sun protection with camouflage. Self-tanning lotions that have sunscreen properties and so-called “invisible color” lotions for children are sometimes also described as tinted. Tinted sunscreen products are manufactured by including ultraviolet A (UVA) and ultraviolet B (UVB) protection in makeup foundations.
32.7 Principles of Camouflaging Pigmentation Defects
There are three basic techniques for camouflaging skin defects.
Concealing is hiding discoloration by completely covering them with makeup. Concealers are creamy products, different from regular foundation in being more thick and opaque, and are available in a variety of colors to match the natural shade of the skin.
Color correcting is neutralizing red, blue, or yellow tones to more natural tones of complementary color. Skin color is contributed by underlying tones including hemoglobin producing red, keratin/degenerated elastin producing yellow, and melanin producing brown tone. Application of a complementary green foundation can help to camouflage a red pigmentation defect, yielding a brown tone, easily covered with a conventional facial foundation. Brown tones also result when yellow skin tones are blended with complementary purple-colored foundations. Thicker skin possesses more yellow tones, while thinner skin appears red. For these reasons, only one shade is insufficient to mimic the natural skin tone.
Contouring is creating the illusion of highlights and shadows to disguise the irregular facial surface. It creates dimension by using shadow and light (darker areas recede, while lighter areas appear to come forward). A contour shadow is required which is about two shades darker than the concealer, and a highlighter which is about two shades lighter.
To meet different needs of each defect to be concealed, many formulations of camouflage cosmetics are designed. Makeup bases, facial foundations, lining colors, and rouges are the basic products required to create the desired skin color. Camouflage products contain fillers endowed with optical properties and are different from makeup products as they contain up to 25–50 % more pigment. They impart a normal, natural appearance by concealing skin discoloration. Camouflage cosmetics are designed to mask and cover a problem but must be mixed to match the patient’s skin tone. A good cover cosmetic should be opaque, natural looking, greaseless, easy to apply, waterproof, 100 % fragrance-free, long lasting, applicable to all skin types, non-sensitizing, nonirritating, non-photosensitizing, and noncomedogenic. Sun protection can be an additional benefit. Depending on the requirement of the patient, different types of camouflage cosmetics are available which may provide partial and full concealment or just pigment blending.