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well hey guys happy Friday welcome back
to the QA for today's QA I'm going to
answer your questions about dark
discoloration of the elbows and knees
dark discoloration of the elbows and
knees is a common cosmetic skin concern
in many individuals and it has given the
name frictional asymptomatic darkening
of the extensor surfaces or fades this
is a condition in which dark
discoloration presents on what are known
as the extensor surfaces namely the
elbows and the knees dark discoloration
often symmetric so both elbows and or
both knees and as the name implies is
otherwise asymptomatic meaning this skin
condition is not painful it's not itchy
and this skin condition arises in areas
that frequently are again as the name
implies under friction frictional
asymptomatic darkening of the extensor
surfaces and by friction I mean chronic
rubbing this happens in individuals who
may do a lot of housework where they're
on their knees or heard their occupation
perhaps involves a lot of kneeling or
maybe certain cultural practices that
they're involved in in a day to day
basis they are on their knees and this
can result and just chronic friction to
the skin that leads to darkening of the
of the area under that frictional
frictional force in the elbows it's not
uncommon to see this in people who kneel
lean on their elbow a lot maybe in
relation to an office chair it's been
reported so you can see it's it tends to
be areas that are kind of under pressure
and friction but what is important for
you to understand about this is that
that dark color actually is not pigment
okay it's not pigment and by pigment I
mean melanin melanin is a compound made
by melanocytes in our skin that is
respon
for our skin color and skin pigment and
there are met there are certain skin
conditions of abnormal pigmentation
hyper pigmentation like melasma light
post inflammatory hyperpigmentation I
have videos on these conditions of
hyperpigmentation but this particular
condition frictional asymptomatic
darkening of the extensor surfaces is
not hyperpigmentation that is why it's
given the name darkening there is no
melanin involved in fact when you biopsy
the affected skin tissue
you see thickened what's called hyper
Carrick skin you don't see melanin
increased in melanin deposits or
anything suggestive of pigments so
pigment is left out of the name has
nothing to do with pigment and the
reason I'm telling you that this is
because you're coming to this video
wondering what can be done to improve
the appearance of this dark
discoloration and I'm going to tell you
upfront
products treatments aimed at improving
pigmentation products and active
ingredients that target melanin in the
melanocytes and how pigment is made are
not going to work for this they are not
going to work for this pigment has
nothing to do with why this appears it
has to do with frictional forces
thickening the skin
you
there are a few other skin conditions
that can present with darkening of the
elbows and knees a key anthesis
nigricans if you'll recall for my 18th
entire pians video I mentioned that that
rarely could have occur on body sites
like the arms and legs it most often
occurs on the back of the neck and under
the arms and in that condition unlike
fades frictional a symptomatic darkening
of the extensor surfaces 18th OSes
nigricans is most often associated with
an underlying metabolic problem namely
insulin resistance fades has nothing to
do with insulin resistance it's really
just a skin response to chronic friction
sometimes putting things on our skin can
cause irritation that leads to
hyperpigmentation so in phase there's no
history of coming in contact with any
known allergen or irritant such as might
occur with putting on certain perfumes
and fragrances that can lead to
darkening of the skin but that it's a
hypopigmentation problem
fades is not on hyperpigmentation
problems so there won't be any history
of coming in contact with an allergen or
an irritant psoriasis is a skin
condition that I've talked about on here
before as well that I can present when
the dark discoloured patches on the
elbows and knees however that tends to
be very very scaly whereas fades is not
scaly also eczema can sometimes appear
the thick and discolored on the elbows
and knees but eczema is very itchy
whereas fades is asymptomatic so now
that I've told you a little bit about
the distinguishing features of other
conditions from fades giving you some
understanding of why fades occurs how to
go about improving us well the first
step in management is to take a look at
your what you're doing that's putting
friction on the affected area if you're
chronically kneeling maybe modifying
your body position or obtaining some
kind of a cushion to put under your
knees to alleviate pressure and friction
elbow pads if appropriate can also
help to just take some of that pressure
and friction off of the bony prominences
of the elbows that you may be coming in
contact with chronically and then the
other thing to think about is sometimes
people see the dark discoloration and
they think the skin is dirty or soiled
and it's not and their response to to
try and remedy the situation is to scrub
the skin with like a loofah and that is
absolutely the worst thing that you
could do this is a response to friction
the last thing you want to do is rub the
skin rubbing the skin is only going to
make it worse and more persistent and
more stubborn to respond to you to the
treatment fades takes a really long time
to fade after you have addressed the
frictional component and you're doing
your best to avoid undue frictional
stress on the affected area the
treatment that has been shown to be most
effective albian it takes a very long
time to begin to notice any improvement
is the application twice a day of a
cream that contains either 12% lactic
acid or 40% urea lactic acid is an alpha
hydroxy acid that can help you begin to
the lightly and gently exfoliate some of
that thick built-up discolored skin it
also hydrates the skin and helps as a
moisturizer to improve the integrity of
the skin barrier and begins to improve
the appearance of that affected skin
urea is the other ingredient that can be
included in the cream and it's
specifically been examined and shown to
be effective at a concentration of 40%
that's because that is what is in
prescription of prescription creams
twice daily application of either a 40%
urea cream or a 12% lactic acid cream
are those interventions that have been
shown to be most helpful they can take
up to two to three months sometimes
years to begin to work to show
improvement so you have to be really
page
and really consistent while also
avoiding undue frictional stress to the
affected area in terms of stuff that is
available over-the-counter with these
active ingredients you will find
numerous products over the counter I'll
list many down below that contain lactic
acid in a cream form that could be tried
twice daily to the affected area in
terms of urea I have a whole video on
urea urea is you know as I said in that
video a wonderful humectant and it is
dry skin ingredient it too can improve
the appearance of this and the studies
the case series specifically report the
use of 40% you won't find 40% urea
over-the-counter you can buy like one
product on Amazon that has 40% URI on it
I don't recommend that though because
that particular product also has tea
tree leaf oil in it which if you've seen
my videos on tea tree leaf oil you know
that bad boy can be really problematic
and lead to irritation it might take you
several steps back in your journey to
improving the skin tone of your knees
and elbows so I don't recommend that and
I wish that particular product did not
put that in there but there are a
variety of over-the-counter urea creams
that can be tried and will likely help
to improve the appearance of this one
product all this many down below
including those that are available
outside the u.s. to those of you who
watch me from other countries but what
product newer product is used on it
makes these has this new roughness
relief series they have a lotion and the
spot treatment I love this spot
treatment I think it is a fantastic
option for somebody aiming to improve
the appearance of fades it has lactic
acid in it I can't tell you the
percentage strength they don't disclose
out on the site it also has urea and in
addition to that it also has some skin
barrier restoring ingredients like
ceramide so it is a wonderful moisture
and it's pretty easy to just pipe right
on to the skin and you know just target
treat that affected area it's gentle
it's hydrating it is a wonderful spa
treatment the body lotion likewise could
be used to the area as well so I'll list
both of those down below but the key to
know going into this is a it takes from
removing the frictional force to get
better and B it takes consistence
consistent use with these products to
get better and C it takes a lot of
patience because it can take a very long
time so I hope this video is helpful to
you guys and addressing this skin
condition because I do get a lot of
questions about it and you know these
are the treatments that I've been shown
to be helpful do you be aware that there
are some other conditions out there that
look a little bit similar but are
slightly different but for the most part
as the name implies these there are this
darkening of the skin is asymptomatic
it's not itchy it's not painful there's
no scale like in psoriasis and it has
nothing to do with insulin resistance as
in a campus it's nigricans
it is simply related to chronic rubbing
of the skin in those areas whether it be
from kneeling or you know mopping the
floor on your hands and knees or
what-have-you
so try it hopefully this clarifies that
to you all and if you like this video
give it a thumbs up share it with your
friends and as always don't forget
sunscreen and subscribe
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