Due to the current Corona Virus Crisis, the Private Hospitals and Clinics from where I normally consult have been closed and we are only able to see urgent patients. I apologise for the inconvenience.

If there is anything that you wish to discuss with me, then could you please contact Debbie my private secretary on 07502036457 or at debbiewood147@gmail.com, with your contact details and I will telephone you with advice and if it is necessary I will make arrangements to see you at the nearest private hospital to you.

No-one knows exactly how long this situation is going to continue, but one would estimate it will probably be between three and six months before we get back to normal. I look forward to seeing you at that time and wish you and your families all the very best.

Neil McLean


Skin Lightening Agents

Brown spots that appear on the surface of the skin are known as chloasma (also melasma).These can occur for many reasons. One risk of over exposure to the sun is the discolouration known as solar lentigenes, also known as sun spots or age spots. On lighter skin types, solar lentigenes appear as small brown blotches of freckling that grow over time.

Brown patches of skin can also occur as a result of birth control pills or pregnancy in which cases thediscolouration is referred to as hormone masking.

Regardless of the particulars the essence is the same: hyperpigmentation. Melanin is the chemical that gives skin its color and is created by synthesis procedure in the skin.

When it comes to deciding a treatment one major consideration to take into account is the depth of the discoloration. In the majority of cases thediscolouration is merely superficial. In exceptional cases thediscolouration lies deeper within the dermis (second layer). If the pigment is located within the epidermis it can be controlled with skin-lightening agents. If the pigment is deep rooted laser treatments can be a consideration.


Pigment in the dermis does not react well to lightening agents. Resurfacing procedures like chemical peels and laser treatments may help in some instances but the results are inconsistent and problems may arise. Furthemore laser treatments of this kind are seldom an option for people with darker skins. However when laser treatments are appropriate they are particularly effective in altering the appearance of the skin.

Three main treatments involving skin lightening agents are based on the chemicals hydroquinone, Tretinoin and AHAs.

Over the counter skin lightening agents will often contain around 2% hydroquinone, while physicians can administer 4% concentrations. Hydroquinone is a strong regulator of melanin synthesis meaning that it lightens skin pigment. Hydroquinone does not bleach the skin but rather disrupts the process of melanin hyperpigmentation.

Strict use of a sun block with UVA protecting ingredients is the first line of defense when tackling skin discolorations. Many specialists feel that 2% to 4% hydroquinone concentrated lotions can be more beneficial when combined with Retin-A or Renova and AHAs. Higher concentrations of hydroquinone are only available from a physician and can possibly help deeper causes of pigment discoloration,although again they can pose problems for darker skin. It is also highly recommended to consider chemical peels or laser treatments to lighten skin discolouration.

Some concerns about the safety of hydroquinone have been expressed but the research so far indicates reactions are minor or as a result of using high concentrations

Hydroquinone is an unstable ingredient and must be kept under strict conditions to ensure no exposure to sunlight or air which can have an adverse effect on the already volatile substance. It is essential that when considering a hydroquinone product to ensure it is packaged in a non-transparent container that blocks light and minimises air exposure.

A great body of academic research suggests that the use of Tretinoin (all-trans Retinoic acid) is particularly effective in treating skin discolouration. However, the responsiveness to this treatment is less than with hydroquinone or other agents. Results can also take significantly longer with Tretinoin than with other agents, requiring at least six to eight months or so before the effects can be seen. For this reason, Tretinoin is generally not recommended as the only option for skin discoloration although it can be used effectively as part of a combination. Even though Tretinoin can have less than satisfactory results for skin lightening this should not detract from the value it plays in improving the skin's cell production, collagen production, elasticity, texture, and dermal thickness.

Another agent known as AHAs, or alpha hydroxyl acid are usually found in concentrations of 4% to 10%which are not effective in regulating melanin synthesis or skin discolourations. However there is evidence to suggest that in combination these can be more effective.

Risks Involved

As with all procedures, skin lightening carry some risks. It is normally a safe procedure when performed by a fully qualified, experienced medical professional. However, whilst infrequent, some unpredictable results or complications are possible.

  • Patients in a limited number of cases may suffer from uneven pigmentation or colouration as a result of these chemical processes. They may also have to rely on a combination of these agents to produce effective results.

During your initial consultation process, it is beneficial to discuss your expectations with your physician asking any questions or expressing any concerns you may have about the procedure, its aims or the risks involved. Your surgeon will explain the procedure in depth, covering the risks and benefits of the treament, the recovery period and post- treatment care.

Please also remember chemical peel treatments are usually not covered by health insurance unless they are performed for medically related problems.

By nature, all medical procedures carry an element of risk. Before embarking on any medical procedure, it is advisable to consult fully with the McLean Academy so that our qualified staff can suitably discuss any risk or concerns that your procedure may pose. Skin Lightening Agents area non surgical procedure with minimal risks.


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Contact Information

The McLean Academy

Neil R. McLean ( MD FRCS )

Telephone: 07502036457

Email: debbiewood147@gmail.com

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