Role of Priming the Skin for Peels

Question 1

Skin priming can be divided into 2 phases:

Answer 1

• pretreatment
• preparation
• These two phases are differentiated & determined by timing and the agents used

Question 2

• Pretreatment
• Preparation

Answer 2

• pretreatment phase consists of topical agents applied in the days or weeks preceding the peel
• preparation phase encompasses those steps taken directly before the peel is performed

Question 3

3 major goals of pretreatment

refers to the period before the actual peel

Answer 3

• thinning of the stratum corneum
• reduction of PIH
• faster wound healing

Question 4

minor goal of pretreatment

Answer 4

• assess patient compliance & tolerance to prepeel & postpeel peel regimens
• including sunscreens, moisturizers & other antiaging products

Question 5

Agents commonly used during pretreatment phase

Answer 5

• hydroquinone, retinoids (tretinoin, retinol, adapalene, tazarotene), glycolic acid, Kojic acid
• Aggressive sun protection may be the most important step in reducing the likelihood of postinflammatory pigment deposition & should accompany all agents

Question 6

Duration of pretreatment

Answer 6

• 2 weeks to 3 months before the peel
• with a longer pretreatment time for patients at risk for PIH

Question 7

Kligman and Willis’s original formula

Answer 7

• hydroquinone 5%
• tretinoin 0.1%
• dexamethasone 0.1%

Question 8

modified Kligman’s formula

Answer 8

• hydroquinone 8%
• tretinoin 0.025%
• hydrocortisone 1%

Question 9

Hydroquinone MoA

Answer 9

• tyrosinase inhibitor
• inhibits the enzymatic conversion of tyrosine to DOPA

Question 10

Kojic acid
* MoA
* indications

Answer 10

• tyrosinase inhibitor
• can be used in patients who cannot tolerate hydroquinone or have a sensitivity to it
• most often used in combination with glycolic acid or a retinoid

Question 11

Sun protection in skin priming for peeling

Answer 11

• broad-spectrum UVA/UVB sunscreen with
  a minimum SPF 30 and Heliocare dietary supplement should be used daily
• along with appropriate sun protection measures

Question 12

skin priming for melasma peel

Answer 12

• Kligman’s formula, modified (hydroquinone 8%,
  tretinoin 0.025%, and hydrocortisone 1%), applied
  nightly
• SPF 50+ sunscreen
• Heliocare Dietary Supplement daily
• This regimen begins 4 weeks before the peel, is stopped 1 day before the peel, and then is resumed at full healing for at least 4 weeks after the peel

Question 13

Preparation phase features

Answer 13

• encompasses steps that occur directly before, and sometimes those leading into, the peel itself
• Degreasers; “depth-enhancing” agents such as Jessner’s solution, glycolic acid, and solid CO2, applications of topical anesthetics all fall into this time period

Question 14

MC combination to degrease skin

Answer 14

• First alcohol, then acetone

Question 15

Jessner’s solution

Answer 15

• consisting of lactic acid, salicylic acid, and resorcinol, is a mild peeling agent in its own right
• very safe peel, used primarily for acne treatment and to address light actinic damage
• produces a patchy blanching effect and has a mild postoperative course
• Due to its ability to serve as cleanser, degreaser & peel in one step, it is often combined with TCA in a combination peel, giving an excellent medium-depth peel
• In this instance, the Jessner’s solution is applied to the skin, and once it has penetrated, it is followed by the application of the TCA peel