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Al-Haud AL-Marsud
Junior’s Journal Club




                   AL-HAUD AL-MARSUD




               CHEMICAL PEELING


                                       16 Nov 2011
Al-Haud AL-Marsud
Junior’s Journal Club




    It can simply accelerate the natural processes
   A chemical peel is chemexfoliation intended to
    of exfoliation, but can also completely destroy
   visibly improve the structure of treated tissue
                       Definition
    the epidermisbyand external or less large
                        the a more
    proportion of the of a caustic solution.
            application dermis, essentially by
                  • protein coagulation
                          • lysis.
Definition
Al-Haud AL-Marsud
Junior’s Journal Club




         The effect of any peel reaches the dermis,
                    directly or indirectly
Al-Haud AL-Marsud
Junior’s Journal Club




                  Ultrastructural Changes
Al-Haud AL-Marsud
Junior’s Journal Club   Ultrastructural Changes
Al-Haud AL-Marsud
Junior’s Journal Club   Ultrastructural Changes


          Dermal changes :
   •   Remodelling




                                            2 Weeks
   •   Neocollagenesis
   •   Impaired melanin
       synthesis
   •   Decreased lymphocytic
       infiltration
Al-Haud AL-Marsud
Junior’s Journal Club




                Based upon the American
              Academy of Dermatology Care
                  Classification
                       Guidelines
Classification
Al-Haud AL-Marsud
AAD Guidelines
Junior’s Journal Club




        Superficial                Medium                 Deep




   • Resorcinol: 10% to         • TCA 50% single      • Baker Jordon
       50% pastes                 frost only            Phenol formula
   •   Jessner's solution       • Combinations        • Lithon’s
   •   Tretinoin                  with lower            formula
   •   α-Hydroxy acids
                                  strength TCA
       (glycolic acid, lactic
       acid)                      (35%)
   •   Salicylic acid           • Full-strength
   •   Trichloroacetic acid       phenol, USP
       (TCA) 10% to 35%           88%
Indications


• When to use?
• Which Agent?
• Which Patient?
Al-Haud AL-Marsud
Junior’s Journal Club               Indications

        AAD identified the therapeutic and
       aesthetic indications in which chemical
                  peels can be used
Al-Haud AL-Marsud
Junior’s Journal Club                      Indications




    Committee for the 2001 Guidelines of Care for Chemical
      Peeling of the Japanese Dermatological Association
Al-Haud AL-Marsud
Junior’s Journal Club
                                      Preparation

           Prolonged              Immediate




                                 Alcohol, Acetone,
                                 Combination,
                                 Designated
                                 Cleanser
          H/O Recurrent Herpes
                Retin A,
           Hydroquinone, AHAs
Al-Haud AL-Marsud
Junior’s Journal Club
                        Procedure
Al-Haud AL-Marsud
Junior’s Journal Club
                        Procedure
Al-Haud AL-Marsud
Junior’s Journal Club
                                                          Procedure




   Level 1: Erythema with    Level 2: White frosting   Level 3:Solid Opaque
      blotchy or wispy            with areas of         white, no erythema
   areas of white frosting     erythema showing
                                     through
Al-Haud AL-Marsud
Junior’s Journal Club
                        Combinations and ready made kits


   • Classical Jessner's:Resorcinol (14%)+ lactic acid
     (14%)+ salicylic acid (14%) in alcoholic solution

   • Modified Jessner's: lactic acid (17%)+ salicylic acid
     (17%)+ (8%) in ethanol.

   • Monheit's:17% Jessner's +35% TCA
Al-Haud AL-Marsud
Junior’s Journal Club
                        Combinations and ready made kits




                                Only Touch®
                                  Cosmo Peel®
            Approximately 44% TCA used for AK and lentigenes.
                                   Easy TCA®
                     A Mixture of TCA 15% +AHAs + saponins
                              Needs no preparation
Al-Haud AL-Marsud
Junior’s Journal Club
                        New Advances in Chemical Peeling




   • 50 patients, 25 received Co2 laser, 25 received 30% TCA
     sessions weekly
   to a maximum of 15 sittings
   • Co2 Laser: 100% cure rate
   • TCA 30% : 12/ 25 remission.
Al-Haud AL-Marsud
Junior’s Journal Club




   •   Retrospective review
   •   51 patients, 17 patients reported no recurrence, 22 patients had
       experienced a recurrence, 9 patients had persistence of the lesion and
       3 patients undergone surgical excision
Al-Haud AL-Marsud
Junior’s Journal Club




   • Three strengths of TCA 100%, 70%, 50%
   • 100% or 70% TCA give similar results in flat plaque xanthelasma.
     Hypopigmentation is the commonest side effect, followed by
     hyperpigmentation
   • Macular lesions responded to only one application of 50 %.
Al-Haud AL-Marsud
Junior’s Journal Club
                        New Advances in ChemicalPeeling



   32 Actinic Keratosis
   patients, 29 showed
   complete remission
   14 Bowen’s Disease patients,
   10 showed complete
   remission

   Protocol: Pure Phenol 100%,
   each m, max 8 sessions.
Al-Haud AL-Marsud
Junior’s Journal Club

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Alhaud AlMarsud Junior's Journal Club- Guidelines and New Advances in Chemical Peeling

Notes de l'éditeur

  1. That’s why peels in Hairy areas give much better results than others
  2. Japanese Study2010: Glycolic , Lactic,there was dissociation and vacuolation between the basal cells and increases in vimentin filaments within fibroblasts and endothelial cells were seen. These findings suggest that chemical peeling of the skin with this type of agent directly induces collagen formation within the dermis and thus directly stimulates remodeling of the dermis.Read More: http://informahealthcare.com/doi/abs/10.3109/14764170903376224
  3. Salicylic 50% can be used in paste under occlusion for non facial areas35% TCA may or may not penetrate through the epidermis after a single application and is classified as a superficial peel; with multiple applications it may penetrate into the papillary dermis and is less superficial and more medium in depth.Combinations with lower strength TCA- Glycolic-JessnerFull-strength phenol, USP 88%-penetrates less than diluted
  4. Which type of skin and historyDermatologists have the edge in knoowing the depth of the lesions in the skin
  5. Twice daily 2 days before and 5 days after which also applies for resurfacing techniquesDegreasing is not always required e.g. Easy TCATo avoid pooling of the agent in … apply vaseline
  6. Or custom means of application as sponges
  7. Handouts of postpeel care