Light Chemical Peels Flashcards
1
Q
Very light or very superficial peels
A
- those that lead to a necrosis of the epidermis at the level of stratum corneum
2
Q
light peels or superficial peels
A
- those that penetrate through the epidermis and
lead to necrosis of the entire epidermis down to the level of stratum granulosum or the basal lamina - Light peels cause reduced corneocyte adhesion and increase collagen formation in the dermis
- In this way they improve skin’s radiance & luminosity
3
Q
Agents for Very Light Peels
A
4
Q
Classification of depth of peeling in 5 levels according to Schürer & Wiest
A
5
Q
Agents for Light Peels
A
6
Q
Very superficial peels can be repeated every…?
A
1 to 2 weeks
7
Q
light peels can be repeated every…?
A
2 to 4 weeks
8
Q
Peeling too frequently can result in…?
A
- increased risk for complications, in particular
- persistent erythema
- postinflammatory hyperpigmentation
- infections
- scarring
9
Q
Alpha-hydroxy acids (AHAs)
* derive from ?
* examples
A
- group of organic acids
- often referred to as fruit acids, including:
- glycolic acid from cane sugar
- citric acid from citrus fruits
- malic acid from apples
- lactic & mandelic acid
10
Q
Lactic acid features
A
- decreases corneocyte cohesion, leading to a thinner stratum corneum
- It moisturizes & brightens the skin
- improves superficial acne scarring by improving skin texture & appearance
11
Q
Mandelic acid features
A
- slow skin penetration due to its large molecule size
- Therefore, it is considered a safe, light peeling agent
- In concentrations of 20% to 50% it has a skin-rejuvenation & lightening effect
12
Q
AHAs MoA
A
- considered keratolytic agents because they =>
- cause a superficial exfoliation by breaking bonds between keratinocytes in the different layers of the stratum corneum & stratum granulosum
- help to correct an abnormally thickened stratum corneum of the epidermis
13
Q
how long does the effect of AHA last after the end of therapy?
A
- up to 14 days after the end of the therapy
14
Q
daily use of topical AHA lotion leads to..?
A
- increased dermal thickness by stimulating an increased deposition of collagen & GAGs
15
Q
Beta-Hydroxy Acid features
* examples ?
* properties ?
* neutralization ?
A
- salicylic acid (SA) & beta-lipohydroxy acid (LHA), which is a derivative of SA
- have antibacterial, antiinflammatory, antifungal, anticomedogenic properties
- LHA is more lipophilic than SA
- LHA penetrates well into the sebaceous follicle & through the epidermis, but less deeply into the skin compared with glycolic acids & SA
- Neutralization is neither necessary
nor possible when peeling with LHAs
16
Q
Retinoic Acids features
* examples
* properties
* side effects
A
- all-trans retinal & retinoic acid
- usually used alone or in combination with AHAs or other ingredients
- RAs lead to a thinner & more compact stratum corneum and a thicker epidermis
- can help to improve dyschromias by creating a more consistent distribution of melanin throughout the epidermis
- RAs reverse the number of atypical keratinocytes, thus leading to an improvement or eradication of actinic keratosis
- SEs: increased photosensitivity
17
Q
- AHAs act mainly on…?
- Retinoic acids act mainly on..?
A
- AHA => stratum granulosum
- RAs => stratum corneum
18
Q
Both AHAs and RAs lead to…?
A
- increased & accelerated skin turnover from the normal 28 days to 10 to 12 days
19
Q
Salicylic-Mandelic Combination Acid Peels
A
- in concentrations of 20% SA & 10% mandelic acid, are effective in treating acne vulgaris & acne scars
20
Q
Pyruvic Acid
A
- belongs to the α-ketoacids
- also effective in treating acne scars because of its keratolytic, antimicrobial, and sebostatic qualities and collagen-building ability
- used in concentrations of 40% to 70%
- causes desquamation during the treatment
- may cause a transient, intense stinging, burning sensation
21
Q
indications for a superficial peeling
A
- Coarse skin, large pores
- Acne comedonica, papulopustular acne
- acne excoriée
- Papulopustular rosacea
- Keratosis pilaris, including ulerythema
ophryogenes - Photodamaged and photoaged skin
- Actinic keratosis
- Dyschromias of the skin including ephelides, lentigines simplex, senile lentigines, flat seborrheic keratoses, melasma, PIH
- Improvement of the skin appearance
22
Q
Patient preparation for peeling
A
- recommended at least 2 to 4 weeks before the peel
- The more pronounced the pigment and the darker the complexion, the longer the priming or preconditioning should be
- Adequate priming of the skin helps reduce wound healing time, facilitates uniform penetration of the peeling agent, reduces the risk of possible side effects, strengthens patient compliance, and helps detect intolerances at an early stage. In addition
- daily use of broad-spectrum sunscreen (SPF 50+) and sun avoidance are crucial for the treatment
23
Q
patients prone to HSV infections
A
- Prophylactic antiviral therapy is recommended
- acyclovir 200 mg 4 times per day (400 mg two times) or valacyclovir 500 mg one-two times per day, starting 1 day before the peel and for 5 to 14 days, until reepithelialization
is completed - Antiviral therapy is continued for a longer duration for deeper peels than for lighter peels
24
Q
Salicylic Acid Peel & General Instructions
* describe step by step the process
A
- Before starting the chemical peel, it is very important to ensure that the patient performed the skin priming & strict daily sun protection/sun avoidance reliably
- exclude an active viral, mycotic, or bacterial infections
- patient’s face is cleaned with a mild soap & water
- hair is held back by a band or cap
- patient should be positioned lying on the back with the head elevated at 45 degrees or less and is asked to keep the eyes closed throughout the whole procedure
25
which areas should be protected with petroleum jelly before the application of the peel?
* Because of the thinner stratum corneum, xerosis, & an increased sensitivity of certain areas, the acid can be absorbed more quickly in areas like the **nasolabial fold, the lateral canthus of the eye, the oral commissures, and the chin**
* eyes should be covered with 2-inch by 2-inch moist gauze pieces
26
important steps to avoid mistakes before starting peeling
* The required peeling agent is poured into a glass beaker or cup
* The neutralization solution or cream should be placed in a glass cup and a syringe filled with saline
or water, to flush the eyes in case of accidental exposure of the eyes to the peel solution
* It is important to **check the label of the bottle to make sure the correct acid is being used before applying the peel**
* The neutralization solution should also be ready & this should be checked before starting the procedure
* To avoid dripping of the peel solution into the eyes, the opened bottle or soaked applicator should never be passed over the patient’s face/eyes
27
application of SA peels leads to...?
* **crystallization**
* which leads to the **formation of a “pseudofrost"**
* In SA peels, **1-3 layers are usually applied to achieve an even pseudofrost**
28
steps after formation of "pseudofrost"
* **After 3 to 5 minutes, the peel is washed
off with water once the burning has subsided**
* The patient is asked to **continue washing the face with cold water until the burning sensation ceases**
* The face is then dabbed dry with gauze. Rubbing the skin should be avoided
29
Glycolic Acid Peels
* concentrations for daily use vs chemical peels
* **In low concentrations (5% to 15%)**, glycolic acid can be used for **daily skin care**
* Concentrations of **20% to 70%** are used to perform **chemical peels**
* The higher the concentration of the solution & the longer the exposure time, the deeper the penetration depth of the peel
30
Glycolic acid peels steps
* When using a glycolic acid peel, the peeling agent has to be **neutralized after a certain, predetermined time, usually 3 to 5 minutes**
* Once the desired penetration depth has been reached or the predetermined application time is reached, AHA peels must be neutralized to
terminate their effect
31
how can immediate complications of glycolic peels present?
* **If erythema or epidermolysis occurs, which often appears as a greyish white discoloration of the epidermis or small blisters (so-called “frost”)**
* the peeling agent must be **neutralized immediately regardless of the time**
32
how to neutralize a glycolic acid peel?
* For neutralization, **10% to 15% sodium bicarbonate solution or neutralization lotion** is used, which is then washed off with water, which causes a fizzing on the face
* **The acid can also be neutralized by washing the face with water**
* Care must be taken to make sure that the
complete acid is neutralized ( **watch the patient while rinsing the face**)
33
glycolic acid solutions is better to have low or high pH & why ?
* Glycolic acid solutions with a **low pH value cause erythema, irritation, stinging, and burning pain and are less tolerated by patients**
* They also do not penetrate the skin evenly
* Therefore it is **recommended to use solutions with a higher pH value**
34
how can we estimate the level of glycolic acid penetration by clinical presentation?
* **skin first turns pink, then red, signifying
intraepidermal wounding**
* **occurrence of frost signifies dermal injury**
35
peculiarity of AHA peels?
* **must be neutralized to terminate their effect**
36
Indications of glycolic peels
* **mottled hyperpigmentation, fine wrinkles, and sun-damaged skin**
* They can also be applied on other sun-damaged areas like the dorsum of the hands, the neck,chest, but the **peel needs to be superficial outside the face to avoid scarring**
37
Jessner’s solution consists of...?
* **SA 14 g, lactic acid (85%) 14 g, resorcinol 14 g with ethanol to make 100 mL**
* used for light peels or as a priming agent before a TCA peel
* The penetration depth of the peeling depends on the number of coats of solution applied
38
Jessner used for **very superficial peel**
* **one to three coats are applied**
* A **slight erythema is formed, which can be ass/w a slightly whitish-powdery appearance of the skin**
* This **white precipitate is caused by the precipitation of SA on the skin and can easily
be wiped off ( pseudofrost)**
* **There is no coagulation (frost)**
* For 1 to 2 days a slight exfoliation of the skin may occur, or none at all
39
Jessner for superficial peel (level B)
* **4 to 10 coats are applied**
* An **erythema is formed and pinpoints of white frost occur**
* For 15 to 30 minutes, mild to moderate burning
and stinging occurs
* **The following 1 to 3 days, the skin turns slightly red-brown and feels very tight**
* For 2 to 4 days there is exfoliation with flaking, but rarely peeling of the skin
40
penetration depth of Jessner depends on...?
* **not only on the number of coats of solution applied, but also on the preparation or priming of the skin, the thickness of the stratum corneum, and the sensitivity of the skin**
* It may therefore vary slightly from patient to patient
* **The solution should be left on the skin for 4 to 6 minutes to assess the full effect of the solution on the skin**
41
Advantages of a Jessner’s peel
* **very superficial effect, that it goes rarely deeper than expected**, and that it is safe and has few side effects
* Because of the low amount of resorcinol and SA, toxicity only plays a role in the treatment of very large areas, such as the simultaneous treatment of face, chest, arms, lower legs
42
Trichloroacetic Acid Peels
* TCA peels with a concentration of **10% to 25% are suitable for intraepidermal peels**
* With concentrations of **30% to 40%, a deeper peel reaching the papillary dermis** can be achieved
* It is recommended to treat the region of the eyebrows and also a little beyond the hairline and jawline
43
effect of light TCA peel
* penetrates the entire epidermis results in **erythema and an “almost” uniform white frost, which heals within 5 days**
44
Post-peeling patient instructions
* After the chemical peel, erythema, mild edema, and desquamation occur. These last for 1 to 3 days in superficial peels. After 3 to 5 days, the epidermis is usually completely reepithelialized
* **To soothe the skin, cold compresses can be used. Patients should be instructed to the daily use of broad-spectrum sunscreen (SPF 50+) and sun avoidance**
45
close postpeel follow-up treatment
* patients should be instructed to immediately report any early signs of complications to initiate a therapy at an early stage
* Patients should be given a contact number for such emergencies
46
Absolute contraindications of superficial chemical peels
* active bacterial, viral, or fungal infections; open
wounds
* pregnancy
* breastfeeding
47
relative contraindications of superficial peels
* use of photosensitizing drugs or the presence of inflammatory skin diseases
* Patients with unrealistic expectations and noncompliant patients
48
Complications of superficial peels
