Alhaud AlMarsud Junior's Journal Club- Guidelines and New Advances in Chemical Peeling
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Al-Haud Al-Marsud (Cairo Dermatology Hospital) conducts 2 weekly CME sessions. This is Nov 16th junior residents journal club.
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Alhaud AlMarsud Junior's Journal Club- Guidelines and New Advances in Chemical Peeling
- 1. Al-Haud AL-Marsud Junior’s Journal Club AL-HAUD AL-MARSUD CHEMICAL PEELING 16 Nov 2011
- 2. Al-Haud AL-Marsud Junior’s Journal Club It can simply accelerate the natural processes A chemical peel is chemexfoliation intended to of exfoliation, but can also completely destroy visibly improve the structure of treated tissue Definition the epidermisbyand external or less large the a more proportion of the of a caustic solution. application dermis, essentially by • protein coagulation • lysis.
- 3. Definition Al-Haud AL-Marsud Junior’s Journal Club The effect of any peel reaches the dermis, directly or indirectly
- 4. Al-Haud AL-Marsud Junior’s Journal Club Ultrastructural Changes
- 5. Al-Haud AL-Marsud Junior’s Journal Club Ultrastructural Changes
- 6. Al-Haud AL-Marsud Junior’s Journal Club Ultrastructural Changes Dermal changes : • Remodelling 2 Weeks • Neocollagenesis • Impaired melanin synthesis • Decreased lymphocytic infiltration
- 7. Al-Haud AL-Marsud Junior’s Journal Club Based upon the American Academy of Dermatology Care Classification Guidelines
- 8. Classification Al-Haud AL-Marsud AAD Guidelines Junior’s Journal Club Superficial Medium Deep • Resorcinol: 10% to • TCA 50% single • Baker Jordon 50% pastes frost only Phenol formula • Jessner's solution • Combinations • Lithon’s • Tretinoin with lower formula • α-Hydroxy acids strength TCA (glycolic acid, lactic acid) (35%) • Salicylic acid • Full-strength • Trichloroacetic acid phenol, USP (TCA) 10% to 35% 88%
- 9. Indications • When to use? • Which Agent? • Which Patient?
- 10. Al-Haud AL-Marsud Junior’s Journal Club Indications AAD identified the therapeutic and aesthetic indications in which chemical peels can be used
- 11. Al-Haud AL-Marsud Junior’s Journal Club Indications Committee for the 2001 Guidelines of Care for Chemical Peeling of the Japanese Dermatological Association
- 12. Al-Haud AL-Marsud Junior’s Journal Club Preparation Prolonged Immediate Alcohol, Acetone, Combination, Designated Cleanser H/O Recurrent Herpes Retin A, Hydroquinone, AHAs
- 13. Al-Haud AL-Marsud Junior’s Journal Club Procedure
- 14. Al-Haud AL-Marsud Junior’s Journal Club Procedure
- 15. Al-Haud AL-Marsud Junior’s Journal Club Procedure Level 1: Erythema with Level 2: White frosting Level 3:Solid Opaque blotchy or wispy with areas of white, no erythema areas of white frosting erythema showing through
- 16. Al-Haud AL-Marsud Junior’s Journal Club Combinations and ready made kits • Classical Jessner's:Resorcinol (14%)+ lactic acid (14%)+ salicylic acid (14%) in alcoholic solution • Modified Jessner's: lactic acid (17%)+ salicylic acid (17%)+ (8%) in ethanol. • Monheit's:17% Jessner's +35% TCA
- 17. Al-Haud AL-Marsud Junior’s Journal Club Combinations and ready made kits Only Touch® Cosmo Peel® Approximately 44% TCA used for AK and lentigenes. Easy TCA® A Mixture of TCA 15% +AHAs + saponins Needs no preparation
- 18. Al-Haud AL-Marsud Junior’s Journal Club New Advances in Chemical Peeling • 50 patients, 25 received Co2 laser, 25 received 30% TCA sessions weekly to a maximum of 15 sittings • Co2 Laser: 100% cure rate • TCA 30% : 12/ 25 remission.
- 19. Al-Haud AL-Marsud Junior’s Journal Club • Retrospective review • 51 patients, 17 patients reported no recurrence, 22 patients had experienced a recurrence, 9 patients had persistence of the lesion and 3 patients undergone surgical excision
- 20. Al-Haud AL-Marsud Junior’s Journal Club • Three strengths of TCA 100%, 70%, 50% • 100% or 70% TCA give similar results in flat plaque xanthelasma. Hypopigmentation is the commonest side effect, followed by hyperpigmentation • Macular lesions responded to only one application of 50 %.
- 21. Al-Haud AL-Marsud Junior’s Journal Club New Advances in ChemicalPeeling 32 Actinic Keratosis patients, 29 showed complete remission 14 Bowen’s Disease patients, 10 showed complete remission Protocol: Pure Phenol 100%, each m, max 8 sessions.
- 22. Al-Haud AL-Marsud Junior’s Journal Club
Editor's Notes
- That’s why peels in Hairy areas give much better results than others
- Japanese Study2010: Glycolic , Lactic,there was dissociation and vacuolation between the basal cells and increases in vimentin filaments within fibroblasts and endothelial cells were seen. These findings suggest that chemical peeling of the skin with this type of agent directly induces collagen formation within the dermis and thus directly stimulates remodeling of the dermis.Read More: http://informahealthcare.com/doi/abs/10.3109/14764170903376224
- Salicylic 50% can be used in paste under occlusion for non facial areas35% TCA may or may not penetrate through the epidermis after a single application and is classified as a superficial peel; with multiple applications it may penetrate into the papillary dermis and is less superficial and more medium in depth.Combinations with lower strength TCA- Glycolic-JessnerFull-strength phenol, USP 88%-penetrates less than diluted
- Which type of skin and historyDermatologists have the edge in knoowing the depth of the lesions in the skin
- Twice daily 2 days before and 5 days after which also applies for resurfacing techniquesDegreasing is not always required e.g. Easy TCATo avoid pooling of the agent in … apply vaseline
- Or custom means of application as sponges
- Handouts of postpeel care