Professional Documents
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Peeling
Peeling
Peeling
Superficial peels
Combination peels
Jessners peel
Resorcinol 14 g, salicylic acid 14 g, and lactic acid 14 g
in a sufficient quantity of ethanol (95%) to make l100 cc of solution
Reduce the concentration and toxicity of each of the individual
ingredients while increasing efficacy
Popularly used with other peels because it does not have to be
neutralized
Once the peel frosts, a second type of peel can be applied on top
(+) the depth of the overall peel
Jessners peel
Caution
resorcinol PIH (skin type IV++)
Contact dermatitis
Topical or oral steroids may be used to treat this uncommon s/e
Jessners peel
Prior to treatment, a thin layer of Vaseline or Aquaphor is applied to
the areas not intended for treatment, such as the nasoalar grooves,
where the solution tends to pool, and the lips.
Jessners peel
Excellent for acne patients because resorcinol is a well-known
treatment for acne.
Effective in rosacea because of salicylic acid.
Tretinoin peels
Melasma, acne, KP & photoaging
Induce (+) collagen deposition
Inhibit the MMP responsible for degrading collagen
Not available in US, off-label in Brazil
Orange color solution
0.25-1% tretinoin
Must know the pH and conc. of free acid in the individual products in
order to compare strength and efficacy across products.
Extra caution when treating patients with darker skin types.
Start with the lowest conc. of free acid and slowly (+) the
concentration.
TCA
Low strength TCA (10-15%)
Ameliorate fine wrinkles& dyschromia
Provide smooth& healthy appearance to the skin
Not improves deeper wrinkle/ scars
CAUTION
Higher-strength TCA (35-40%)
Strength : Wt/Vol
Diluted 50%TCA with water 25%TCA
(Get a solution stronger than 25% Wt/Vol TCA)
Healing time
TCA : 5-7 days
TCA + Jessners/ Glycolic acid : 7-10 days
Obagi
blue
TCA
Pyruvic acid
An alpha ketoacid lactic acid
Chemical peeling while providing hydration
Penetrates to the papillary dermis
(+) production of collagen& elastic tissue
Must not be used in high- /full strength conc. (potential for scarring)
Pyruvic acid
Success in Tx of moderate acne, photoaging& melasma
Conc. : 40-60% on facial skin previously prepared with topical
retinoids
2-5 min or when adequate frosting is observed, soak the face in
water. (More comfort than neutralizing by 10% NaHCO3 +water)
Well-ventilated room
Reepithelization in 1-2 wks
Erythema last for up to 2 mo
Warn the patient: lesion like solar lentigos will return (Melanocytes
reside below the level of the peeling)
After peeling
Sunscreen
Sun avoidance
HQ in the patient with darker skin
Antiviral med to Pt. with Hx of HSV