peels revision Flashcards
why does barrier function need to be considered when doing CP
we want the CP to evenly penetrate
why would you use a superficial light peel?
no down time, increases permeability for actives, removes damaged corneocytes, increases mitotic rate via chemical messengers.
why would you use a superficial peel?
basement membrane is still intact, good for shallow scarring, texture, removes keratotic build up, actinic damage and fine rhytides.
why would you use a medium depth peel?
acne scaring, fine rhytides.
what depth does a medium depth peel reach to?
The paplilary dermis
Can a fitz 4 have a medium depth peel?
yes, but with prepping
what depth peels do you need a sterile environment for?
medium
when would you refer a client to have a deep peel?
deep scarring, skin laxity, deep rhytides.
what fitz can have a deep peel?
only 1 & 2
what depth does a micro usually reach?
superficial light - superficial
what results can a client expect following a micro?
smoother skin, increased hydration, reduction in break outs, finer rhytides.
what is kPa?
Measurement of pressure, kilo-pascals
what are some control variables that effect depth of wounding in micro?
crystal type, velocity of crystals, kPa, rate of movement, number of passes.
when would you turn the kPa down?
around the eyes and mouth & skin conditions that you don’t want to create heat.
what kPa would you have it on around the eyes?
5-15
what is an end point?
either immediate, delayed, desired or un desired.
what are some common topical ingredients applied post micro or peels?
hyalauronic acid, soothing botanical s, azelaic acid, pigment inhibitors, retinol and l-ascorbic.
is some one had mild acne (mostly comedones) what would the micro do?
it would be superficial light and would reduce sebum and corneocytes.
A client with Glogau 4 with concerns of photo aging, what would you advise them?
consult with a doctor in regards to deeper peels.
why can it be hard to see erythema in aged skin?
due to the reduction in blood vessels.
why do older people tend to show a higher pain thresh hold in their skin?
due to the decrease in their sensory function.
what are the main differences in keloid scars and hypertrophic scars?
hypertrophic scars develop soon after injury, keloid scars can be delayed. H can be self resolved, K can’t. H are limited to the wound margins, K aren’t, H are most common in the tension areas, K can occur anywhere.
what type of scars are best suited for treatment with micro?
shallow, non atrophic
what scars will not show much improvement ‘or could worsen with micro?
keloid, hypertrophic, ice pick scars.
what stage are striae most responsive to micro in?
2nd stage (light pink/mauve color)
how can the concentration of a peel affect the treatment?
it can determine the depth
how can the length of time affect the depth?
some peels don’t self neutralize and will keep activated.
how does the site affect the healing time following peels?
the face has more sebaceous follicles and will reepithelialize faster.
client in her 50’s with actinic damage, what depth peel would you recommend?
medium, prepped on an inhibitor for 4 weeks. prep on AHA’s and Niacinamide also to help even out the barrier.
How often can you have a deep peel?
only one per lifetime
what depth does a deep peel reach?
the Reticular dermis
A client with milia, comedones, but no pustules or papules. What grade acne is this? & what kPa would you use with micro?
Grade 1, 20-34 kPa
why are you more likely to turn down the kPa and do more passes on a client with hyper-pigmentation?
so we can exfoliate the epidermis, allowing for deeper penetration of inhibitors
list 3 ‘mechanisms of actions’ of chemical peeling agents. with an example.
metabolic - causes increased slothing of cells (AHA’s and retinoids)
caustic & toxic - causes necrosis and inflammation. (phenol, salicylic & resorcinol)
if a client has excessive sebum with no acne, what active cosmeseutical would you prescribe?
Niacinamide
client concerned with photo aging & she enjoys the outdoors, what products would you recommend for her?
sunblock & vitamins E & C to help aid in collagen production.
adult acne, dull skin, soap base cleanser, no moisturizer. why is her skin dull & why does she think moisturizer makes her break out? how could we improve her skin?
higher fitz can look dull, due to build up of cells, AHA’s would improve this, Niacinamide will help improve her acne & act as a moisturizer.
rosacea client what would you recommend?
vitamin B to help promote a good barrier and helps improves TEWL.
what are the main differences with AHA’s and BHA’s
AHA’s have a smaller molecule compared to BHA’s which limit their depth. AHA’s are considered to be hydrating (metabolic) where as BHA’s are caustic.
what peeling agents have hydrating properties?
Lactic acid and Mandelic acid
why do you ask clients to cease use of retinoids before a peel?
to avoid uneven penetration of peel.
which of the following can be both caustic and metabolic, depending on the percentage used? Salicylic, Glycolic, Lactic or TCA
Glycolic
what peeling agents did Unna pioneer?
Salicylic. resorcinol & TCA
What is the minimum time frame between superficial light peels?
1 Week
what can you apply after UV exposure, that will provide photo protection?
Vitamin E & C
What are 5 main variables with the skin (general)
oil flow, hydration level, vascularity, skin thickness, pigmentation.
what Glogau has visible actinic keratosis, wrinkles all the time, skin discoloration & telangiectasia?
type 3
what Glogau has no lines, and little to no discoloration.
type 1
what Glogau has skin cancers & actinic keratosis?
type 4
what Glogau has early actinic keratosis, wrinkles with motion?
type 2
what is the barrier of the skin comprised of?
acid mantle & stratum corneum
what are the 3 phases of wound healing?
inflammatory, proliferation and maturation
what is an example of superficial light peels?
BHA’s (salicylic acid), TCA 10% Glycolic 30-50% (1-2 mins), Jessner’s 1-3 coats
what is an example of superficial peels?
Glycolic 50-70% 2-10 mins, Jessner’s 4-10 coats, Resorcinol 40-50% (30-60 mins), TCA 20-30% - full epidermis
What is an example of medium peels?
Glycolic 70% 3-30 mins, TCA 35-50%
What is an example of deep peels?
Phenol 88% Baker Gordon Phenol, >50% TCA
what is considered to be low kPa?
15-20
what is considered to be medium kPa
20-35
what is considered to be high kPa
35-40
when would you use high kPa?
spot planning, scar margins, stretch marks
when would you use low kPa?
neck, reactive skin, acne prone skin, telangiectasia.
What is a mixture?
a combination of compounds or elements that are physically blended but not bound by chemical bonds
what peels are considered to be toxic?
phenol, salicylic & resorcinol
how often can you do a medium depth peel?
3-6 monthly
how often can you do superficial peels?
2-4 weekly
what is the retinoid conversion?
retinyl palmitate, retinol, retinaldehyde, all-trans retinoic acid, retinoic acid.
does vitamin C reduce pigment?
yes, it inhibits tyrosinase
what is the least stable form of vitamin C?
L-Ascorbic acid
what is the most stable form of vitamin c?
magnesium ascorbyl Phosphate
how does Niacinamide reduce pigment?
prevents the transfer to k.cyte from m.cyte
what is considered to be a strong acid? pKa of -2 or pKa of 5
pKa of -2 is considered a strong acid
what % of TCA is light superficial, superficial, medium & deep?
10-20, 25-35, 35-50, 50 +
what peel would you use on an acne client with moderate sebum flow?
glycolic
what peel would you use on a acne client with seborrhea skin?
Jessner’s Salicylic or pyruvic
what peel would you use on an acne client with dehydrated skin?
lactic or mandelic (larger molecule)
what are the best peels for PIHP?
Jessner’s, Salicylic, Glycolic & Tretinoin
what percentage of TCA do you use for Cross?
50-100%
