Chemical Peels

Question 1

Medium depth peels penetrate the epidermis to upper papillary dermis

Answer 1

F - upper reticular dermis (however JAAD article states to papillary dermis)

Question 2

Deep peels reach the mid-reticular dermis

Answer 2

T

Question 3

70% Glycolic acid + 35% TCA =Coleman Peel

Answer 3

T

Question 4

Pre-treatment with tretinoin and/or AHA’s for at least 4-6wk before procedure is very important for success of a chemical peel

Answer 4

True

Question 5

Even after re epithelialisation has occurred following a peel, tretinoin should be avoided for a further 2-4 weeks

Answer 5

False - can restart with low concentration

Question 6

Glycolic acid cruises epidermolysis though lysis of desmosomes

Answer 6

True

Question 7

Hydroquinone inhibits conversion of DOPA to melanin by inhibiting the tyrosinase enzyme

Answer 7

True

Question 8

Hydroquinone causes depigmentation of surrounding skin

Answer 8

True

Question 9

Superficial peels can eliminate fine lines and actinic keratoses

Answer 9

False = not usually , need medium depth

Question 10

Medium depth but not superficial peels helpful in treating acne and may improve malasma

Answer 10

False - superficial helpful

Question 11

Wood lamp can help reliably predict response to superficial peel

Answer 11

False - dermal melasma can be masked by more superficial melasma

Question 12

Acetone is preferred agent for degreasing prior to a peel

Answer 12

False - due to flammability. Other agents preferred -= Septisol , alcohol

Question 13

Always treat infraorbital region with saturated cotton tipped applicators regardless of agent

Answer 13

True

Question 14

TCA has systemic toxicity at high concentrations

Answer 14

False - no known systemic toxicity

Question 15

TCA is stable for 1-2 years in amber bottles at room temperature

Answer 15

False 23 weeks

Question 16

TCA needs to be refrigerated in a dark room

Answer 16

False - not heat or light sensitive

Question 17

Salicylism is unlikely even with a peel of large area

Answer 17

True, though possible

Question 18

Rubbing and pressure do not determine response to the peel

Answer 18

False

Question 19

The number of coats further determine response of peel

Answer 19

True

Question 20

Isotretinoin produces atrophy of the pilosebaceous gland

Answer 20

True

Question 21

Light peels can be performed fortnightly and not more frequently

Answer 21

True - biweekly

Question 22

Salicylic acid is an alpha hydroxy acid

Answer 22

False beta hydroxy acid

Question 23

There is significant discomfort immediately following sal acid procedures

Answer 23

False - due to anaesthetic property of salicylic acid

Question 24

Salicylic acid peels have a strong comedolytic effect

Answer 24

True

Question 25

Factors affecting penetration of AHA’s?

Answer 25

- acid concentration pH - bioavailability - degree of buffering - volume of agent applied - duration of time acid remains on skin - condition of epidermal barrier - extent of degreasing

Question 26

Tretinoin is not UV sensitive

Answer 26

False - decomposes on UV exposure thus should be applied late int he day

Question 27

Topical tretinoin imparts a pinkish discolouration after application - makes it easier to visualise treatment

Answer 27

False - yellowish

Question 28

Course, more sun damaged skin reacts faster and requires more heavily applied acid

Answer 28

False - reacts slower

Question 29

Chemical peels are very effective in mx of melasma and can be used as first treatment for mild, mod , severe or resistant melasma

Answer 29

False - should NEVER be the first treatment although it is effective

Question 30

Phytic acid is a component of plant seed

Answer 30

True

Question 31

Disadvantage of phytic acid is when acting at low pH , there is stinging and irritation

Answer 31

False - advantageous as no stinging or irritation at low pH

Question 32

If frosting is patchy , do not retreat

Answer 32

False. - can retreat with a minimally saturated cotton-tipped applicator.

Question 33

Jessner’s + TCA —> TCA is applied first followed by Jessner’s solution

Answer 33

False other way around

Question 34

Make up can be worn 2-3 days after chemical peel

Answer 34

False 7-10 days

Question 35

Erythema fades between 5-7 days after peel

Answer 35

False 2-4 weeks

Question 36

Using botox pre peel reduces the result of the peel

Answer 36

False - enhances —> new collagen is formed over stationary areas

Question 37

What is the Baker Gordon formula

Answer 37

Baker Gordon (3 pigs and 2 dogs ate septisol soap and 3 croutons) 3mL Phenol and 2mL Distilled water 8 drops Septisol and 3 drops croutons - phenol 88% 3mL - distilled water 2mL - septisol liquid soap 8 drops - croton oil 3 drops

Question 38

Medium depth peels - desquamation usually complete within 5-7days

Answer 38

True

Question 39

Medium depth oedema occurs within the first 2 hours

Answer 39

False first 24 hr

Question 40

Most important complications of phenol based peels is cardio toxicity

Answer 40

True

Question 41

Phenol is directly toxic to myocardium

Answer 41

True

Question 42

Hypopigmentation can be a complication of any peel

Answer 42

False - only deep peels.

Question 43

Intradermal naevi hypopigment not hyperpigment after a deep peel

Answer 43

False , can hyperpigment

Question 44

Bacteria and fungal complications in chemical peels are common

Answer 44

False - rare

Question 45

Chemical peels can cause toxic shock syndrome

Answer 45

True

Question 46

Milia occur in a negligible number of patients after chemical peels

Answer 46

False up to 20%

Question 47

Milia occur rapidly within 2-3 weeks post peel

Answer 47

False, 2-4 months

Question 48

Scarring is the worst complication of chemical peels

Answer 48

True

Question 49

Acneiform dermatitis after chemical peels is not rare

Answer 49

True