213: Chemical Peels

Question 1

What are the Fitzpatrick skin phototypes?

Answer 1

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.

Question 2

What are the indications for superficial, medium, and deep chemical peels for Fitzpatrick skin phototypes?

Answer 2

Superficial Peel: I, II, III (+); Medium Peel: I, II, III (+); Deep Peel: IV, V, VI (±).

Question 3

What are the relative contraindications for medium and deep chemical peels?

Answer 3

Active skin disease; Recent facial surgery; History of facial keloids; History of post-inflammatory hyperpigmentation; Radiation to head and neck; Active skin infection.

Question 4

What are the absolute contraindications for medium and deep chemical peels?

Answer 4

Open wounds, excoriations; Isotretinoin within last 6 months; Pregnancy; Unrealistic expectations; Poor patient-physician relationship; Bacterial and viral infections.

Question 5

What are the preoperative care steps for chemical peels?

Answer 5

Topical pretreatment with retinoid, glycolic or lactic acid; Consider hydroquinone; Sun avoidance; Consider acyclovir or valacyclovir.

Question 6

What are the postoperative care steps for chemical peels?

Answer 6

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.

Question 7

What are the indications for a Superficial Chemical Peel?

Answer 7

Acne (comedonal acne); Enlarged pores; Post-inflammatory hyperpigmentation (PIH); Melasma; Mild photodamage; Fine textural concerns.

Question 8

What is the recovery time for a Superficial Chemical Peel?

Answer 8

Complete recovery typically occurs in 2 to 4 days.

Question 9

What are the key characteristics of a Medium Depth Chemical Peel?

Answer 9

Indications: mild to moderate photoaging, pigmentary disorders, lentigines, epidermal growths, rhytides, and actinic keratoses; Penetrates through the papillary dermis to the upper reticular dermis.

Question 10

What are the stages of healing for Medium-depth and Deep peels?

Answer 10

1. Inflammation; 2. Coagulation; 3. Reepithelialization; 4. Fibroplasia.

Question 11

What are the indications for a Deep Chemical Peel?

Answer 11

Deep rhytides; Severe photoaging (Glogau categories III, IV); Destruction of the entire epidermis.

Question 12

What is the significance of TCA in Medium Depth Chemical Peels?

Answer 12

TCA (Trichloroacetic Acid) is used in concentrations of 45-60% and can cause white frosting due to keratocoagulation.

Question 13

What are the potential risks associated with Baker-Gordon phenol in Deep Chemical Peels?

Answer 13

Requires monitoring and IV fluid administration due to potential cardiac, renal, and hepatic toxicities.

Question 14

Which type of chemical peel is recommended for a patient with comedonal acne and mild photodamage?

Answer 14

A superficial chemical peel is recommended.

Question 15

What are the key differences in the healing stages between medium-depth and deep chemical peels?

Answer 15

Both heal through inflammation, coagulation, reepithelialization, and fibroplasia, but deep peels involve destruction of the entire epidermis.

Question 16

Which type of chemical peel is most effective for a patient with severe photoaging (Glogau category IV)?

Answer 16

A deep chemical peel, such as the Baker-Gordon phenol peel, is most effective.

Question 17

Why is salicylic acid considered the preferred agent for dyschromia in superficial chemical peels?

Answer 17

It is the least inflammatory of peeling agents.

Question 18

Describe the histological changes observed after a medium-depth chemical peel.

Answer 18

Diminished solar elastosis, fibroblast proliferation, increased collagen formation, and reorganization of elastic fibers.

Question 19

What is the role of glycolic acid in superficial chemical peels?

Answer 19

Promotes fibroblast proliferation, collagen formation, and melanin dispersion; must be neutralized to prevent overexposure.

Question 20

Which type of chemical peel is appropriate for actinic keratoses?

Answer 20

A medium-depth chemical peel is appropriate.

Question 21

What are the indications for using a Monheit peel?

Answer 21

Indicated for mild to moderate photoaging and pigmentary disorders; consists of Jessner solution combined with 35% TCA.

Question 22

Explain the mechanism of action of alpha-hydroxy acids (AHAs) in chemical peels.

Answer 22

AHAs disrupt keratinocyte cohesion, leading to exfoliation and regeneration.

Question 23

What are the potential complications of using TCA 50% in medium-depth chemical peels?

Answer 23

High risk of scarring; no longer used.

Question 24

Why are combination peels preferred over single-agent peels for medium-depth treatments?

Answer 24

Lower risk of postprocedural dyschromias and scarring while enhancing efficacy.

Question 25

Describe the four stages of healing after medium-depth and deep chemical peels.

Answer 25

1) Inflammation and coagulation; 2) Reepithelialization; 3) Fibroplasia.

Question 26

What is the primary advantage of the Baker-Gordon phenol peel in deep chemical peels?

Answer 26

Provides the most permanent skin rejuvenation.

Question 27

What are the risks associated with the Baker-Gordon phenol peel?

Answer 27

Cardiac, renal, and hepatic toxicities; managed through monitoring and IV fluid administration.

Question 28

How does the TCA CROSS technique work for treating atrophic scars?

Answer 28

Involves applying high-concentration TCA to scars, promoting dermal expansion and collagen proliferation.

Question 29

What are the key differences between Jessner solution and glycolic acid in chemical peels?

Answer 29

Jessner solution contains multiple acids; glycolic acid is a single-agent AHA.

Question 30

Which chemical peel is recommended for a patient with melasma?

Answer 30

A superficial chemical peel, such as one with salicylic acid.

Question 31

Why is it important to neutralize glycolic acid during a chemical peel?

Answer 31

To prevent overexposure.

Question 32

What are the histological changes observed after a deep chemical peel?

Answer 32

Dermal expansion, increased collagen proliferation, and elevation of atrophic scars.

Question 33

How does the lipophilic nature of salicylic acid enhance its effectiveness in chemical peels?

Answer 33

Allows penetration and dissolution of the stratum corneum.

Question 34

What are the contraindications for using a deep chemical peel?

Answer 34

Cardiac, renal, or hepatic conditions.

Question 35

Which type of chemical peel is recommended for lentigines?

Answer 35

A medium-depth chemical peel.

Question 36

How does the healing process differ between superficial and medium-depth chemical peels?

Answer 36

Superficial peels heal within 2-4 days; medium-depth peels take longer.

Question 37

What are the key features of the Coleman peel?

Answer 37

Combines 70% glycolic acid with 35% TCA for medium-depth treatments.

Question 38

Why is the Baker-Gordon phenol peel considered the most aggressive chemical peel?

Answer 38

Destroys the entire epidermis.

Question 39

How does the Monheit peel differ from the Brody peel in medium-depth treatments?

Answer 39

Monheit uses Jessner solution with 35% TCA; Brody combines solid CO2 with 35% TCA.

Question 40

What are the benefits of using alpha-hydroxy acids (AHAs) in chemical peels?

Answer 40

Promote exfoliation, fibroblast proliferation, and collagen formation.

Question 41

Which chemical peel is recommended for a patient with fine textural concerns?

Answer 41

A superficial chemical peel.

Question 42

What are the key differences in the indications for superficial and deep chemical peels?

Answer 42

Superficial peels target acne and mild photodamage; deep peels target severe photoaging.

Question 43

How does the reepithelialization stage contribute to the healing process after a chemical peel?

Answer 43

Involves formation of new epithelial cells.

Question 44

What is microdermabrasion and what are its indications?

Answer 44

A closed-system mechanical resurfacing procedure for enlarged pores, fine rhytides, mild photodamage, and acne scarring.

Question 45

What is the purpose of manual dermasanding?

Answer 45

Uses sterile sandpaper to ablate the epidermis; rinse thoroughly to prevent complications.

Question 46

What is motorized dermabrasion and what are its indications?

Answer 46

A mechanical resurfacing technique for moderate to severe photodamage, textural changes, rhinophyma, and scar revision.

Question 47

What are the surgical landmarks for motorized dermabrasion?

Answer 47

Papillary dermis, upper reticular dermis, mid-deep reticular dermis.

Question 48

How do surgical landmarks guide motorized dermabrasion?

Answer 48

Help determine the depth of abrasion.

Question 49

Which mechanical resurfacing procedure is most suitable for rhinophyma?

Answer 49

Motorized dermabrasion.

Question 50

What precautions should be taken during manual dermasanding?

Answer 50

Thoroughly rinse the abraded skin.

Question 51

How does microdermabrasion differ from other mechanical resurfacing techniques?

Answer 51

Ablates only the superficial epidermis.

Question 52

Which procedure is recommended for a patient with acne scarring?

Answer 52

Microdermabrasion.

Question 53

How does microdermabrasion differ from other mechanical resurfacing techniques?

Answer 53

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.

Question 54

What procedure is recommended for a patient with mild acne scarring?

Answer 54

Microdermabrasion is recommended for mild acne scarring as it gently ablates the superficial epidermis, improving skin texture.

Question 55

What are the indications for using motorized dermabrasion?

Answer 55

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.

Question 56

What are the potential complications of silica-carbide crystals in manual dermasanding?

Answer 56

Silica-carbide crystals can embed in the skin, causing granulomas or tattoos if not thoroughly rinsed off.

Question 57

What are the indications for microdermabrasion?

Answer 57

Microdermabrasion is indicated for enlarged pores, fine rhytides, and mild photodamage. It uses abrasive aluminum oxide crystals to ablate the superficial epidermis.