213: Chemical Peels Flashcards
What are the Fitzpatrick skin phototypes?
I: Always burn, never tan; II: Always burn, sometimes tan; III: Sometimes burn, always tan; IV: Never burn, always tan; V: Moderate pigmented skin; VI: Darkly pigmented skin.
What are the indications for superficial, medium, and deep chemical peels for Fitzpatrick skin phototypes?
Superficial Peel: I, II, III (+); Medium Peel: I, II, III (+); Deep Peel: IV, V, VI (±).
What are the relative contraindications for medium and deep chemical peels?
Active skin disease; Recent facial surgery; History of facial keloids; History of post-inflammatory hyperpigmentation; Radiation to head and neck; Active skin infection.
What are the absolute contraindications for medium and deep chemical peels?
Open wounds, excoriations; Isotretinoin within last 6 months; Pregnancy; Unrealistic expectations; Poor patient-physician relationship; Bacterial and viral infections.
What are the preoperative care steps for chemical peels?
Topical pretreatment with retinoid, glycolic or lactic acid; Consider hydroquinone; Sun avoidance; Consider acyclovir or valacyclovir.
What are the postoperative care steps for chemical peels?
Cleanse skin up to 4 times/day; Use diluted acetic acid as cleansing agent; Pat dry and apply bland emollient; Daily sunscreen use; Avoid excessive sun exposure.
What are the indications for a Superficial Chemical Peel?
Acne (comedonal acne); Enlarged pores; Post-inflammatory hyperpigmentation (PIH); Melasma; Mild photodamage; Fine textural concerns.
What is the recovery time for a Superficial Chemical Peel?
Complete recovery typically occurs in 2 to 4 days.
What are the key characteristics of a Medium Depth Chemical Peel?
Indications: mild to moderate photoaging, pigmentary disorders, lentigines, epidermal growths, rhytides, and actinic keratoses; Penetrates through the papillary dermis to the upper reticular dermis.
What are the stages of healing for Medium-depth and Deep peels?
- Inflammation; 2. Coagulation; 3. Reepithelialization; 4. Fibroplasia.
What are the indications for a Deep Chemical Peel?
Deep rhytides; Severe photoaging (Glogau categories III, IV); Destruction of the entire epidermis.
What is the significance of TCA in Medium Depth Chemical Peels?
TCA (Trichloroacetic Acid) is used in concentrations of 45-60% and can cause white frosting due to keratocoagulation.
What are the potential risks associated with Baker-Gordon phenol in Deep Chemical Peels?
Requires monitoring and IV fluid administration due to potential cardiac, renal, and hepatic toxicities.
Which type of chemical peel is recommended for a patient with comedonal acne and mild photodamage?
A superficial chemical peel is recommended.
What are the key differences in the healing stages between medium-depth and deep chemical peels?
Both heal through inflammation, coagulation, reepithelialization, and fibroplasia, but deep peels involve destruction of the entire epidermis.
Which type of chemical peel is most effective for a patient with severe photoaging (Glogau category IV)?
A deep chemical peel, such as the Baker-Gordon phenol peel, is most effective.
Why is salicylic acid considered the preferred agent for dyschromia in superficial chemical peels?
It is the least inflammatory of peeling agents.
Describe the histological changes observed after a medium-depth chemical peel.
Diminished solar elastosis, fibroblast proliferation, increased collagen formation, and reorganization of elastic fibers.
What is the role of glycolic acid in superficial chemical peels?
Promotes fibroblast proliferation, collagen formation, and melanin dispersion; must be neutralized to prevent overexposure.
Which type of chemical peel is appropriate for actinic keratoses?
A medium-depth chemical peel is appropriate.
What are the indications for using a Monheit peel?
Indicated for mild to moderate photoaging and pigmentary disorders; consists of Jessner solution combined with 35% TCA.
Explain the mechanism of action of alpha-hydroxy acids (AHAs) in chemical peels.
AHAs disrupt keratinocyte cohesion, leading to exfoliation and regeneration.
What are the potential complications of using TCA 50% in medium-depth chemical peels?
High risk of scarring; no longer used.
Why are combination peels preferred over single-agent peels for medium-depth treatments?
Lower risk of postprocedural dyschromias and scarring while enhancing efficacy.
Describe the four stages of healing after medium-depth and deep chemical peels.
1) Inflammation and coagulation; 2) Reepithelialization; 3) Fibroplasia.
What is the primary advantage of the Baker-Gordon phenol peel in deep chemical peels?
Provides the most permanent skin rejuvenation.
What are the risks associated with the Baker-Gordon phenol peel?
Cardiac, renal, and hepatic toxicities; managed through monitoring and IV fluid administration.
How does the TCA CROSS technique work for treating atrophic scars?
Involves applying high-concentration TCA to scars, promoting dermal expansion and collagen proliferation.
What are the key differences between Jessner solution and glycolic acid in chemical peels?
Jessner solution contains multiple acids; glycolic acid is a single-agent AHA.
Which chemical peel is recommended for a patient with melasma?
A superficial chemical peel, such as one with salicylic acid.
Why is it important to neutralize glycolic acid during a chemical peel?
To prevent overexposure.
What are the histological changes observed after a deep chemical peel?
Dermal expansion, increased collagen proliferation, and elevation of atrophic scars.
How does the lipophilic nature of salicylic acid enhance its effectiveness in chemical peels?
Allows penetration and dissolution of the stratum corneum.
What are the contraindications for using a deep chemical peel?
Cardiac, renal, or hepatic conditions.
Which type of chemical peel is recommended for lentigines?
A medium-depth chemical peel.
How does the healing process differ between superficial and medium-depth chemical peels?
Superficial peels heal within 2-4 days; medium-depth peels take longer.
What are the key features of the Coleman peel?
Combines 70% glycolic acid with 35% TCA for medium-depth treatments.
Why is the Baker-Gordon phenol peel considered the most aggressive chemical peel?
Destroys the entire epidermis.
How does the Monheit peel differ from the Brody peel in medium-depth treatments?
Monheit uses Jessner solution with 35% TCA; Brody combines solid CO2 with 35% TCA.
What are the benefits of using alpha-hydroxy acids (AHAs) in chemical peels?
Promote exfoliation, fibroblast proliferation, and collagen formation.
Which chemical peel is recommended for a patient with fine textural concerns?
A superficial chemical peel.
What are the key differences in the indications for superficial and deep chemical peels?
Superficial peels target acne and mild photodamage; deep peels target severe photoaging.
How does the reepithelialization stage contribute to the healing process after a chemical peel?
Involves formation of new epithelial cells.
What is microdermabrasion and what are its indications?
A closed-system mechanical resurfacing procedure for enlarged pores, fine rhytides, mild photodamage, and acne scarring.
What is the purpose of manual dermasanding?
Uses sterile sandpaper to ablate the epidermis; rinse thoroughly to prevent complications.
What is motorized dermabrasion and what are its indications?
A mechanical resurfacing technique for moderate to severe photodamage, textural changes, rhinophyma, and scar revision.
What are the surgical landmarks for motorized dermabrasion?
Papillary dermis, upper reticular dermis, mid-deep reticular dermis.
How do surgical landmarks guide motorized dermabrasion?
Help determine the depth of abrasion.
Which mechanical resurfacing procedure is most suitable for rhinophyma?
Motorized dermabrasion.
What precautions should be taken during manual dermasanding?
Thoroughly rinse the abraded skin.
How does microdermabrasion differ from other mechanical resurfacing techniques?
Ablates only the superficial epidermis.
Which procedure is recommended for a patient with acne scarring?
Microdermabrasion.
How does microdermabrasion differ from other mechanical resurfacing techniques?
Microdermabrasion is a closed-system procedure that ablates only the superficial epidermis, making it suitable for mild conditions like enlarged pores and fine rhytides, unlike deeper techniques like motorized dermabrasion.
What procedure is recommended for a patient with mild acne scarring?
Microdermabrasion is recommended for mild acne scarring as it gently ablates the superficial epidermis, improving skin texture.
What are the indications for using motorized dermabrasion?
Motorized dermabrasion is indicated for moderate to severe photodamage and scar revision. It uses handheld devices with burrs, unlike manual dermasanding, which uses sterile sandpaper.
What are the potential complications of silica-carbide crystals in manual dermasanding?
Silica-carbide crystals can embed in the skin, causing granulomas or tattoos if not thoroughly rinsed off.
What are the indications for microdermabrasion?
Microdermabrasion is indicated for enlarged pores, fine rhytides, and mild photodamage. It uses abrasive aluminum oxide crystals to ablate the superficial epidermis.
