Chemical peeling is a well known method attempting to restore a more youthful appearance and improving dermatologic defects. Over the last years this technique has been marked by constant innovation. This book is the first atlas on chemical peels, representing the state of the art in this field.
It is a fully illustrated text, becoming an ideal reference tool for dermatologists dealing with cosmetology. It is a practical and simple guide: in the first part the peeling techniques are displayed in a step-by-step manner with an exhaustive text supporting the illustrations; in the second part different diseases are discussed in their pathogenesis and treatment options.
Color atlas of chemical peels. In all other facial areas, after the frosting fades, additional application of peeling solution is advisable Fig. The entire peeling procedure should take about 60 min. Immediately after the face is covered with the solution, waterproof zinc oxide non-permeable tape is applied to the skin, anchoring it to the hair line. Taping is made using short strips of 3. Over- lapping allows slight motion and flexibility between the strips; therefore, swelling of the face does not cause separation of the tape from the skin surface.
All the face is covered except for the upper eyelids and neck. At the end of the procedure we cover the face with elastic orthopedic grip, which keeps the mask adhered tightly to the face Fig. Waterproof zinc oxide non-permeable tape is applied to the skin in short strips in overlapping fashion. Following removal of the grid, the mask comes off the face almost with no effort, since the skin exudate lifts the tape. Analgesia is not required, since the procedure is almost painless.
Occasionally some physicians remove the mask at 48 h, but we find it unnecessary and more troublesome for the patients, since while the tape mask is on, the eyelids are frequently swollen shut. We feel that this inconvenient period must be minimized. After the tape mask removal the exudate is cleaned by sterile saline.
Spot peeling and retaping may be done if the skin looks underpeeled, particularly in areas with severe wrinkling. It is usually accompanied by a short-duration burning sensation. The tape is left for an additional 4—6 h and then removed by the patient. We cover the face with bismuth subgalate antiseptic powder for 7 days Fig. Other options include occlusive moisturizers, antibiotic ointments, and biosynthetic occlusive dressings such as Meshed Omiderm. At this stage we recommend using regular pain killers every 4 h for the first 2 days.
Some physicians administer systemic corticoids to reduce the swelling and inflammation after the peel. Neck swelling is expected after deep peel. It disappears within 4—6 days. Bismuth subgalate powder acts as a regenerative mask and absorbs skin exudate and gradually creates a firm and rigid mask. It may crack in some areas, usually around the mouth and eyes.
Some patients experience itching and can be helped by oral antihistamines. On the eighth day wet soaking with tap water while standing in the shower is used to soften the powder mask. After the procedure, the patient is advised to use water-based creams and potent sunscreens. The erythema is extremely intense in the first 2 weeks, and gradually resolves over a period of about 2 months. During this time, the use of makeup with a green foundation is encouraged to assist the patient in resuming daily activities.
Results of phenol-based peels for various indications are shown in Figs. The face is covered by bismuth subgalate powder 81 82 Marina Landau 8 c Fig. The powder hardens on the face, creating a rigid crust which cracks in the mimetic areas. Fifty-eight-year-old woman with premature skin aging before a and 2 weeks after b deep peeling a b Fig. Sixty-three-year-old dark-skinned woman before a and 2 months after b deep peeling. Note the effect on the upper eyelid retraction and dramatic improvement of upper lip wrinkles 83 84 Marina Landau 8 a b Fig.
Phenol is directly toxic to myocardium. Studies in rats have shown a decrease in myocardial contraction and in electrical activity following systemic exposure to phenol [16]. Since fatal doses ranged widely in these studies, it seems that individual sensitivity of myocardium to this chemical exists.
After application of peeling solution, there is a quick absorption of phenol from the skin surface to the circulation [18]. Seventy-five percent of phenol is excreted directly through kidney or detoxified by liver. Application of phenol to one cosmetic unit is equivalent to the application of phenol into a nail matrix for matrixectomy.
These arrhythmias included tachycardia, premature ventricular beats, bigeminy, atrial and ventricular tachycardia [19]. Therefore, full-face phenol-based peel should always be performed under full cardiopulmonary monitoring.
The average lag time for the onset of the arrhythmias was Cardiac arrhythmias are more common while applying the solution on the thin skin of eyelids. In this area skin absorption is maximal; therefore, application should be performed extremely cautiously. If arrhythmia occurs, the application of phenol should be stopped until Chapter 8 normal sinus rhythm returns. To reduce the incidence of arrhythmia, minimal amounts of phenol should be used during the peel.
Hydration and diuresis promote metabolism and excretion of phenol, and thus, reduce arrythmias. Proper pre-peel hydration oral or intravenous is imperative while working with phenol.
Antiarrhythmia medications are needed if any arrythmia occurs. Oral poisoning after accidental phenol ingestion has caused fulminant central nervous system depression, hepatorenal and cardiopulmonary failure [20]. No hepatorenal or central nervous system toxicities with properly performed chemical peels have been reported in the literature [21]. Hypopigmentation after phenol peels is proportional to the depth of the peel, amount of the solution used, inherent skin color, and post-peel sun-related behavior.
Complete avoidance of any sun exposure years after the peel creates ivory skin color. Reactive hyperpigmentation can occur after any depth of chemical peels. Therefore, we recommend introducing bleaching preparation 2—3 weeks after the peel in all patients and continuing until erythema fades.
Demarcation lines can be avoided if the boundaries of the peeling area are hidden under the mandibular line and feathered gradually to the normal skin Fig. Medium-depth neck peel is required in patients with blotchy pigmentation of the neck and in those with no clear mandibular line. Demarcation line due to wrong positioning of the lower margin of the treatment area 8. The contributing factors are not well defined yet.
The most common location of the scars is in the lower part of the face, probably due to more aggressive treatment in this area or due to the greater tissue movement, because of eating and speaking, during the healing process. Thus, special precautions should be taken while peeling lower lateral portions of the face in post-surgical face-lift patients, even years later.
We do not recommend combining deep chemical peels with any other surgical facial procedure, since skin undermining severely compromises the post-peel healing process and increases the risk of scarring. Isotretinoin therapy interferes with normal tissue healing; therefore, deep peels should be postponed 6—12 months after completing acne therapy. Delayed healing and persistent redness are important alarming signs for forthcoming scarring.
Topical antibiotics and potent steroid preparations should be introduced as soon as this diagnosis is made. Patients with positive history of herpes simplex infection can be treated prophylactically with acyclovir or valacyclovir during the healing phase for 10 days.
Electrosurgery is a simple and effective method for treating this post-peel complication. Its etiology is multifactorial and is related to either exacerbation of previously existing acne or is due to over-greasing of newly formed skin.
Short-term systemic antibiotics together with discontinuation of any oily preparations will usually provide satisfactory solution. Deep Chemical Peels for Photoaging 8. Perioral wrinkling is a condition in which deep peel has an obvious advantage over other medical and surgical methods.
Facial scars such as acne scars, especially if of atrophic character, may be significantly improved by deep chemical peel. In general, deep chemical peel is the most powerful and legitimate tool in the hands of a practicing dermatologist for facial skin rejuvenation. In addition, special training is needed for the doctor and the office staff before the implementation of this technique in the daily practice. Chapter 8 4. I acknowledge that during the procedure my face will be covered by masks for 8 days.
Some individuals, because of emotional makeup or low pain threshold, may experience severe pain. Heavy premedication is given to make the procedure as comfortable for the patient as possible.
Special medication may be prescribed for this 87 88 8 Marina Landau and will usually clear the condition completely. Every facial rejuvenation procedure is accompanied by swelling of the tissue of the face and neck. Br J Dermatol 64 : — 2. Bames HO Truth and fallacies of face peeling and face lifting. Med J Record : 86—87 3. Urkov JC Surface defects of the skin: treatment by controlled exfoliation.
NY Physician Am Med 56 : 36 5. Br J Plast Surg 13 : 6. Litton C Chemical face lifting. Plast Reconstr Surg 29 : 7. Baker TJ Chemical face peeling and rhytidectomy. Plast Reconstr Surg 29 : 8. J Fla Med Assoc 48 : 9. Clin Facial Plast Surg 9 : — Plast Reconstr Surg 45 : Hetter G An examination of the phenol-croton oil peel: Part I. Dissecting the formula. Plast Reconstr Surg : — Fintsi Y Exoderm—a novel phenol-based peeling method resulting in improved safety. Am J Cosm Surgery 14 : 49—54 Plast Reconstruc Surg 37 : Plast Reconstr Surg 53 : Exoderm: phenol-based peeling in olive and dark skinned patients.
J Dermatol Surg Oncol 13 : — Litton C, Trinidad G Complications of chemical face peeling as evaluated by a questionnaire. Plast Reconstr Surg 67 : — Wexler MR, Halon DA, Teitelbaum A, et al The prevention of cardiac arrhythmias produced in an animal model by topical application of a phenol preparation in common use for face peeling.
Plast Recontsr Surg 73 : — Truppman F, Ellenbery J The major electrocardiographic changes during chemical face peeling. Mosby, pp — Mosby, pp — Chapter 8 89 Chapter 9 Deep Chemical Peels for Post-acne Scarring 9 Marina Landau The author has no financial interest in any of the products or equipment mentioned in this chapter.
Contents 9. Differences in the cell-mediated immune response are involved in the personal tendency to develop post-acne scarring [5].
Acne scars are debilitating and socially disabling for the individual. Treatment of acne scars presents a challenge for a treating physician. Usually they cannot be effectively corrected by a single treatment modality because of their widely varied depth, width and structure.
A few morphologic acne scar classifications have been proposed to assess the efficacy of different therapeutic options based on the scar types. Standard classification includes three basic types of scars: icepick scars, rolling scars, and boxcar scars [6].
Acne scarring treated with combined peel a b Fig. Papulo-pustular acne and scarring treated with combined peel Acne For medium and deep scars other treatments are available Table Systemic therapy for acne includes antibiotics, isotretinoin and hormones Tables Oral treatment is indicated in cases of: 1 moderate and severe acne; 2 acne with tendency to scars development; and 3 psychological distress related to acne. Systemic antibiotics are indicated for moderate-severe inflammatory acne not responding to topical treatments.
Systemic antibiotics act on: 1 suppression of P. Oxytetracycline and its derivatives are the most commonly used oral antibiotics. Second-generation tetracyclines such as minocycline, doxycycline and lymecycline present longer halflives, enhanced bacterial activity and lower Chapter 11 toxicity compared with the first generation ones. Minocycline — mg daily , doxycycline — mg daily and lymecycline — mg daily are equally effective, while lymecyclines seems to have a lower side-effect profile.
Antibiotics have to be given for prolonged periods of time; however, if a good response is not obtained after 3 months of treatment, an alternative therapy has to be kept in consideration. Side effects of tetracyclines include gastrointestinal symptoms, vaginal candidiasis, dizziness, phototoxicity doxycycline and pseudotumor cerebri, autoimmune disorders and pigmentation minocycline. In patients allergic to tetracyclines or in females contemplating pregnancy, erythromycin represents an acceptable alternative.
The third-line treatment is oral trimethoprim. The increasing P. This will avoid further scarring and side effects. Excision [20] Useful with icepick and narrow-deep boxcar scars that are excised with a 1. Nonabsorbable sutures are preferred to avoid inflammation and must be removed within 5 days. Elevation [20] Useful with wide-shallow boxcar scars associated with laser resurfacing.
It is made with different biopsy punch, according to the size of the scar. The scar is first excised and then the punched specimen is elevated higher than the surrounding skin and fixed with a suture.
Subcision [20] Useful for rolling scars to free the fibrous bands that cause the scar. It is performed with a gauge triangular tip needle that reaches the subcutaneous tissue and separates the fibrous cords.
Once it is inserted through the dermal-subcutaneous junction plane, it is turned with the tip parallel to the skin surface. A piston-like motion is then used to release the fibers Laser resurfacing [20] Useful with shallow boxcar and rolling scars.
After the treatment, silicone sheeting, gauze and tube netting are placed over the treated area and maintained for 24 h the silicone sheeting remains for another 48 h. The patient is instructed to soak the treated area every 2—4 h with cold water for 20 min and then apply an occlusive ointment. Re-epithelialization is completed in 10 days. A new treatment can be performed after 6—8 weeks. Laser therapy [21] Laser therapy deals only with superficial scars.
Dermabrasion [22] Gentian violet solution is used to delineate the areas to be treated. Refrigerant topical anesthesia is used to freeze the skin prior to the procedure. Holding the skin taut, the dermabrader treats one anatomic unit at a time. Post-operatively, patients may have an open or closed dressing system, use antiviral agents, antibacterials and corticosteroids.
The re-epithelialization is complete in 5—7 days and residual erythema is common for up to 4 weeks. Table Combining systemic antibiotics with topical retinoids provides more rapid efficacy, while the concurrent use of benzoyl peroxide reduces the risk of resistant P. Oral Isotretinoin cis-retinoic acid efficacy is based on its specific actions against all four factors implicated in acne pathogenesis.
Isotretinoin targets are 1 sebum suppression; 2 comedolysis normalization of follicular epithelial desquamation ; 3 anti-inflammatory effect; and 4 P.
Indications for systemic isotretinoin treatment are a severe nodulo-cystic acne; b acne unresponsive to conventional systemic antibiotic therapy; c acne relapsing during or after conventional therapy; d scarring acne; and e severe psychological disability related to acne.
The drug is usually administered at a daily dosage of 0. A starting dosage lower than 0. Higher doses are associated with faster responses, but also with troublesome side effects. Isotretinoin treatment achieves a complete acne clearing in a large proportion of patients, while a further course is rarely required Figs. Side effects of isotretinoin include first of all teratogenicity, mucocutaneous problems, ocular dryness, muscoloskeletal symptoms, hyperostosis and DISH, headache, elevation in sebum tryglicerides and liver enzymes.
Monitoring of liver function Table This patient has been treated with oral isotretinoin 6 months before peeling procedure. Chapter 11 b c Vincenzo Bettoli et al. Cheilitis during isotretinoin treatment d 11 a b Fig. Hormonal therapy can be an effective treatment in females affected by inflammatory acne. Different varieties of hormonal therapies are available. Oral estrogens are used due to their anti-acne effect by decreasing the level of circulating androgens and increasing sex-hormonebinding protein.
In contraceptive pills estrogens are administered as a combination with Acne c Chapter 11 first-generation progestins. The improvement is usually slow. Cyproterone acetate CPA is a progestational antiandrogen that blocks the androgen receptors. It is combined with ethinyl estradiol in an oral contraceptive formulation, which is indicated in female acne patients with a high level of seborrhea, therapy resistant papulo-pustular acne or acne conglobata not responding to other treatments.
In doses of — mg daily it reduces sebum production and improves inflammatory acne in women. During treatment, birth control measures are required due to the risk of male fetus feminization.
References d Fig. The most used estrogenic component is largely ethinyl estradiol. Second-generation progestins ethynodiol diacetate, norethindrone, levonorgestrel and third-generation progestins desogestrel, norgestimate, gestodene have a lower androgenic activity than 1.
UTET, pp — 2. G Ital Dermatol Venereol : 31—36 3. Medicina estetica. Salus, pp — 4. Grimes PE The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups.
Dermatol Surg 25 : 18—22 5. Dermatol Surg 25 : — 6. Monti M Il peeling chimico. Ghersetich I, et al Chemical peeling: how, when, why? JEADV 8 : 1—11 8. Ghersetich I, et al Chemical peeling. Springer, Berlin, Heidelberg, New York 9. Kligman D Technologies for cutaneous exfoliation using salicylic acid. Dermatologic Therapy 14 : — Murad H, et al The use of glycolic acid as a peeling agent. Dermatologic Clinics 13 : — Vincenzo Bettoli et al.
Cutis 43 : — Stagnone JJ Superficial peeling. J Derm Surg Oncol 15 : — Brody HJ Chemical peeling, 1st ed. Mosby Cosmetic Dermatology 10 : 44—47 Cronica Dermatologica 3 : — 11 Dermatologic Therapy 17 : Cotellessa C, et al The use of pyruvic acid in the treatment of acne.
JEADV 18 : Al-Waiz MM, et al Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg 28 : — Jacob CI, et al Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol 45 : — Jemec GBE, et al Acne: treatment of scars.
Clin Dermatol 22 : — Gold MH Dermabrasion in dermatology. Contents Actinic keratosis of the lip is known as actinic cheilitis; it usually affects the lower lip, which is more sun-exposed.
Erythematous maculo-papules localized on the dorsum of the nose Ilaria Ghersetich et al. Erythematous macules with a dry adherent scale localized on the forehead d 12 a Fig.
Actinic keratosis on the face a, b and upper arms c b c Actinic Keratosis Chapter 12 When it expands to more than 3 cm in diameter with non-defined borders it is referred to as proliferative AK. Diffuse scaling, with a blotchy and atrophic appearance. When erosions appear, the occurrence of a squamous cell carcinoma must be considered. Erythematosus patches that range in size Ilaria Ghersetich et al.
Alternating hyperkeratosis and parakeratosis, irregular acanthosis and thinning of the granular layer are commonly seen, with buds of atypical keratinocytes extending downward into the papillary dermis.
Epithelium of the hair follicles is shielded from actinic damage and maintains normal structure, reaching the epidermis and extending over adjacent atypical cells to produce the characteristic umbrella sign.
The dermis reveals solar elastosis and there is often a mild chronic inflammatory infiltrate. Biopsy and histologic examination may be useful when clinical appearance is not typical. Clinical presentation after 15 days of treatment: vesicles on an erythematous base Ilaria Ghersetich et al. A follow-up is necessary every 6 months to evaluate recurrences or development of new AK. References 1. Chiarello SE Cryopeeling extensive cryosurgery for treatment of actinic keratoses: an update and comparison.
Dermatol Surg 26 : — 2. Lasers Surg Med 34 : — 3. Labandeira J Efficacy and irritation in the treatment of actinic keratosis with topical 5-fluorouracil. J Drugs Dermatol 3 : 4. Int J Dermatol 41 : — 5.
Gilchrest BA Retinoids and photodamage. Br J Dermatol [Suppl 41] : 14—20 6. Cutis 47 : — 7. Springer, Berlin, Heidelberg, New York, pp — 8. J Am Acad Dermatol 51 : — 9. Gold MH, Goldman MP 5-aminolevulinic acid photodynamic therapy: where we have been and where we are going. Dermatol Surg 30 : — Other terms used to describe darker skin types include ethnic skin, brown skin, and pigmented skin.
The unifying feature represented is pigmented skin i. Statistical projections suggest continuing major growth of the non-white US population, with Hispanics having the most significant growth rate [1]. People of color comprise a substantial percentage of the global population. Melanosomes are often large and singly dispersed within melanocytes and keratinocytes [2, 3, 4].
Melanosomes are distributed throughout the epidermis in black skin, whereas in whites, they are limited to the basal and lower malphigian layer of the epidermis. Melanosomes in whites and Asians are smaller and often aggregated and membrane bound, whereas in black skin, they are most often singly dispersed within 13 Pearl E.
Grimes melanocytes and keratinocytes. Dark skin i. On average, five times as much ultraviolet light reaches the upper dermis of whites than in blacks. Differences in transmission between the stratum corneum of blacks and whites are less striking. The increased epidermal melanin content of black skin serves as a significant filter for blocking ultraviolet light transmission. In addition, other reported differences include increased stratum corneum cell layers, increased desquamation, increased lipid content, decreased ceramide content, and increased recovery time after tape stripping [6].
Dark skin demonstrates significantly greater intrinsic photoprotection because of the increased content of epidermal melanin. Clinical photodamage, actinic keratoses, rhytides, and skin malignancies are less common problems in deeply pigmented skin. However, darker skin types are frequently plagued with dyschromias because of the labile responses of cutaneous melanocytes [7]. In a survey of black patients seeking dermatologic care in a private practice in Washington, DC, the third most commonly cited skin disorders following acne and eczema was pigmentary problems other than vitiligo [8].
Of these patients, the majority had a diagnosis of post-inflammatory hyperpigmentation, followed in frequency by melasma.
In a survey of women of color assessing issues of cosmetic concerns for darker skin types, the most commonly cited problems were dark spots or blotchy skin, texturally rough skin, and increased sensitivity to topical products [9]. Patients surveyed also complained of oily skin.
Wrinkles and photodamage were significantly less frequent issues of cosmetic concern when the data was compared with an agematched Caucasian population of women. In contrast, survey data suggest that key indications in darker skin types include disorders of hyperpigmentation such as melasma and post-inflammatory hyperpigmentation, acne, pseudofolliculitis barbae, textural changes, oily skin, wrinkles, and photodamage.
Despite major concerns regarding peel complications such as post-inflammatory hyperpigmentation, hypopigmentation and scarring in darker racial-ethnic groups, recent studies suggest that peeling procedures, particularly superficial procedures, can be performed safely in darker racial-ethnic groups [10]. These peels induce epidermal and papillary dermal wounding Fig. Superficial peels target the stratum corneum to the papillary dermis Fig.
Deep chemical peels utilize the Baker-Gordon formula and penetrate to the midreticular dermis. Analysis of morphologic, physiologic, and clinical data see Introduction suggests that the benefits of chemical peeling in dark skin can be maximally achieved utilizing superficial peels while simultaneously minimizing risks.
Biopsies were performed at 24 h Fig. Glycolic acid induced the most significant stratum corneum necrosis. Illustration of the depth of wounding caused by peeling agents trates. TCA test sites developed post-inflammatory hyperpigmentation. These findings corroborate our clinical experience using these agents. Note stratum corneum necrosis a Even superficial chemical peeling can cause hyperpigmentation and scarring in susceptible individuals.
Therefore, the author always performs the initial peel with the lowest concentration of the Pearl E. Grimes d b 13 c Fig. Note mild lymphohistiocytic infiltrate. Azelaic acid or kojic acid formulations are used if patients are experiencing irritation or hypersensitivity to hydroquinone. Tretinoin, tazarotene and retinol are often used to treat acne, hyperpigmentation or photodamage in darker skin types. However, these agents should be discontinued 1—2 weeks prior to peeling to avoid post-peel complications in dark skin.
Retinoids increase epidermal turnover and they increase the depth of the peeling agent. This may be a desired effect in skin types I—III; however, in dark skin increasing the depth of the peel may result in excessive erythema, crusting, desquamation, and post-inflammatory hyperpigmentation.
Topical bleaching agents, which do not contain retinoids, lower strength alpha hydroxy acids, polyhydroxy acids, and beta-hydroxy acids can be continued up to 1 or 2 days prior to peeling. These are less aggressive agents compared with retinoids. Superficial peels are performed at 2to 4-week intervals and a series of three to six are routinely performed. Hence, cautious titration is appropriate in darker skin types.
Similar titration methods are used for salicylic acid and TCA. Despite the use of higher concentrations of TCA in some studies [12, 13], it is best to initiate TCA peeling in dark skin with low concentrations i.
Post-peel care includes the use of bland cleansers and emollients until irritation and peeling subsides. The patient then resumes the use of topical skin care products and bleaching agents. Post-peel reactions such as excessive erythema, desquamation, and irritation are treated with low- to Chapter 13 high-potency topical steroids. Clearing usually occurs in 5—7 days.
Glycolic acid formulations include buffered, partially neutralized, and esterified products. Several published studies have assessed the efficacy of glycolic acid peels in darker-skinned racial-ethnic groups.
Greater improvement with minimal side effects was noted on the side treated with the series of glycolic acid peels. The investigators noted significant improvement in skin texture and acne.
Side effects were reported in 5. Nineteen black patients with post-inflammatory hyperpigmentation were treated with glycolic acid peeling [15]. Although not statistically significant, greater improvement was noted in the chemical peel group.
The safety and efficacy of a series of glycolic acid facial peels were investigated in 25 Indian women with melasma [16]. Side effects were observed in one patient who developed brow hyperpigmentation. In a separate study, the combination of glycolic acid peels with a topical regimen for the Pearl E.
Grimes treatment of melasma was assessed in a series of dark-skinned patients with melasma [17]. Forty women were included in each group. However, maximal improvement occurred in the group treated with the series of glycolic acid peels in combination with the topical bleaching regimen.
Glycolic acid peels are well tolerated in darker skinned racial-ethnic groups Figs. Glycolic acid peels are most advantageous when treating darker skin types with sensitive skin. It is a lipophilic agent that produces desquamation of the upper lipophilic layers of the stratum corneum. Grimes [19] treated 25 patients with skin types V and VI with salicylic acid peels. Conditions treated included acne vulgaris, post-inflammatory hyperpigmentation, oily skin, with textural changes, and melasma.
Peels were performed biweekly. Three patients experienced hyperpigmentation that resolved in 7—14 days. The author has observed enhanced improvement of oily skin, enlarged pores, and acne vulgaris with the use of salicylic acid peels compared with glycolic acid peels.
Lawrence et al. There was no statistically significant difference in improvement between the two groups. The investigator did not report an increased frequency of side effects in patients of skin types IV—VI. The efficacy of tretinoin peels was compared with glycolic acid peels in the treatment of melasma in dark skinned patients [23].
Peels were performed weekly. However, there were no significant differences between the tretinoin peeled side and the glycolic acid treated areas. Side effects despite the weekly frequency of peel applications were minimal throughout the week study.
Many consider TCA the gold standard by which other peels are measured. TCA precipitates epidermal proteins, causing sloughing and necrosis of the treated area. The extent of damage is concentration dependent. The frequency of post-peel hyperpigmentation is significantly more common in dark skin. TCA peels are cautiously used in darker-skinned patients. Indications include wrinkles, photodamage, stubborn pigmentation, and scarring. Both procedures induced increasing amounts of types I and III collagen.
However, 13 a b Fig. There is minimal published data on the use of combination peeling protocols in deeply pigmented skin Fitzpatrick skin types IV—VI. Combination medium-depth peels are often used to treat moderate to severe photodamage. All patients were of light brown to dark brown complexion. Nine patients Patients with light brown complexions did not develop hyperpigmentation. Skip to main content Skip to table of contents.
Advertisement Hide. This service is more advanced with JavaScript available. Color Atlas of Chemical Peels. Editors view affiliations Antonella Tosti Pearl E. Grimes Maria Pia De Padova. Fully updated since the first edition Presents the different peeling techniques with the aid of informative illustrations Describes the treatment options appropriate for a variety of diseases and conditions, such as acne, rosacea, melasma, photoaging, postinflammatory hyperpigmentation, actinic keratosis, and dark skin An ideal reference tool for all who perform, or wish to start performing, chemical peels.
Front Matter Pages i-x. Front Matter Pages Pages Glycolic Acid. Salicylic Acid. Pyruvic Acid. Trichloroacetic Acid. Christopher B. Harmon, Michael Hadley, Payam Tristani. Deep Chemical Peels Phenol. Home Peeling: A Combined Technique.
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