Chemical and mechanical skin resurfacing Flashcards
What Fitzpatrick skin types can safely receive microneedling for acne scars?
This has been studied with all Fitzpatrick skin types and has been shown to be safe
What things has microneedling been used to treat in skin of color?
Melasma, acne vulgaris, primary hyperhidrosis, and scarring
What peels can be used to safely treat acne in skin of color?
Salicyclic acid (up to 30% concentration), glycolic acid (up to 50%)
While TCA peels up to 10-30% would be a deeper superficial peel, and can be used cautiously in the skin of color, it is not used for acne treatments
Which chemical peel is a beta-hydroxy acid?
Salicylic acid
What is the depth of a salicylic acid peel?
Superficial (papillary dermis)
What are the uses of a salicylic acid peel?
Acne, photoaging
Does salicylic acid peels require neutralization?
No
What frost level is generated from a salicylic acid peel?
minimal
Are salicylic acid peels safe in Fitzpatrick V and VI skin?
Yes
What is the mechanism of salicylic acid peels?
They are keratolytic and comedolytic (hence why good for acne)
What is a potential side effect of salicylic acid peels?
Tinnitus
Pregnancy class C
Which chemical peel is an alpha-hydroxy acid?
Glycolic acid
What is the depth of a glycolic acid peel?
Superficial (papillary dermis)
What things are glycolic acid peels used for?
Fine wrinkles, melasma, dyspigmentation
Do glycolic acid peels require neutralization?
Yes, with sodium bicarbonate
What is used to neutralize glycolic acid peels?
Sodium bicarbonate
What level of frosting is generated from a glycolic acid peel?
None, no peeling
To what depth do the different concentrations so TCA peel affect?
TCA 10-25% = Superficial (Papillary dermis)
TCA 35-50% = Medium (Upper reticular dermis)
TCA >50% = Deep (Mid–reticular dermis)
What things can a TCA 10-25% peel be used for?
Fine wrinkles, dyspigmentation, melasma, and acne
What level of frosting occurs with TCA 10-25% peels?
Frosting usually only occurs w/ concentrations >25%
What chemical peels can be used for melasma/dyspigmentation?
Glycolic acid, TCA 10-25%, Jessner’s peel, and TCA 35-50%
What chemical peels are superficial (go to the papillary dermis)?
Salicylic acid, glycolic acid, TCA 10-25%, Jessner’s Peel
What are the medium depth chemical peels?
TCA 35-50%
Which chemical peels are deep chemical peels?
TCA >50%, Baker-Gordon peel (Phenol, septisol, tap water, croton oil)
What peels can be used for acne?
Salicylic acid and TCA 10-25%
What is in Jessner’s Peel?
Salicylic acid, lactic acid, and resorcinol ethanol
To what depth does Jessner’s peel affect?
Superficial (papillary dermis)
What side effects can occur in Jessner’s peel and what causes them?
Tinnitus = Salicylic acid
Syncope and hypothyroidism = Resorcinol
What peels can be used to treat actinic keratoses?
Jessner’s peel + TCA 35-50% or TCA 35-50% by itself
To what depth does TCA 25-50% peels affect?
Medium depth, to the upper reticular dermis
What things can TCA 35-50% peels be used for?
Fine to medium wrinkles, actinic keratoses, dyspigmentation, seborrheic keratoses
Does frosting occur with TCA 25-50% peels?
Yes, usually within 2-3 minutes and self resolves in 15-20 minutes
How long can post-peel erythema last after TCA 25-50% peels?
1 month
To what depth does the TCA >50% peel affect?
Deep (mid-reticular dermis)
What things do TCA 50% peels address?
Fine to dep wrinkles, warts
What is the most common side effect of TCA >50% peels?
Depigmentation
What is the most serious side effect of >50% TCA peels?
Scaring (common!)
High concentration TCA peels are not usually recommended, phenol peels are more recommended for deep peels
What is in the Baker-Gordon peel?
Phenol, septisol, tap water, croton oil
To what depth does the Baker-Gordon peel affect?
Deep (mid-reticular dermis)
What types of things are Baker-Gordon peels used for?
Fine to deep wrinkles
What are some contraindications to Baker-Gordon peels?
Dark skin types, history of cardiac arrhythmias, history of renal or liver disease
What are some common side effects of a Baker-Gordon peel?
Hypopigmentation, scarring/milia formation
What types of monitoring must be had for Baker-Gordon peels?
Cardiac monitoring required during and 1 hr postop due to arrhythmia risk
What can be done to decrease arrhythmia risk?
Wait 15 minutes between treatments of each cosmetic unit to decrease systemic absorption
How can renal toxicity be avoided when performing a Baker-Gordon peel?
IV fluids –> adequate hydration reduces risk
How long does post-operative erythema last after a Baker-Gordon peel?
3 months
What component is most important for the Baker-Gordon peel (most related to efficacy)?
Croton oil
Why is it important to ask about radiation therapy to the head and neck when performing a chemical peel/
Because radiation therapy reduces the number of pilosebaceous units –> can worsen healing or increase the risk of scarring
