WRINKLED SKIN in Visual Studio .NET

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CHAPTER 19 WRINKLED SKIN
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CHAPTER 20 Chemical Peels
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Leslie Baumann, MD Sogol Saghari, MD
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The use of chemical peels to treat the aging face is well established and poses minimal risk when performed by educated practitioners In addition to improving the texture of the skin and reducing hyperpigmentation and mild wrinkling, peels are also useful in the treatment of acne, rosacea, and melasma In 1999, chemical peels were so popular that they were found to be the most common cosmetic procedure performed in the United States1 In 2006, chemical peels were second only to Botox among the top five minimally invasive cosmetic procedures performed by board-certified members of the American Society of Plastic Surgeons, with 11 million procedures performed2 The introduction of lasers in skin rejuvenation may have some impact on the frequency of chemical peel treatments Although the claims of what chemical peels can do have been frequently overstated, there is actually an abundance of research on the utility of these products, which are used in physicians offices and salons worldwide Chemical peels are categorized based on the depth of the procedure: superficial, medium or deep Superficial peels induce necrosis of all or parts of the epidermis, from the stratum granulosum to the basal cell layer (Figs 20-1 and 20-2) Medium-depth peels create necrosis of the epidermis and part or all of the papillary dermis in the treatment area The necrosis extends into the reticular dermis following deep peels3 Currently, superficial peels are the most frequently performed peels, as intense pulsed light, laser resurfacing and dermabrasion have essentially supplanted medium and deeper-depth peels Superficial- and medium-depth peels do not significantly ameliorate deep wrinkles or sagging skin, but can improve the color and texture of the skin thereby yielding a more youthful appearance This chapter will focus on and differentiate between the most frequently used in-office types of superficial and medium-depth peels, including mechanisms of action, side effects and results obtained with the various acids used in peels Many of the ingredients in these peels are also found in home products; therefore, some skin care products will be mentioned in this chapter as well
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SUPERFICIAL PEELS
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Although a wide variety of agents have been shown to be effective for superficial peeling, alpha hydroxy acids (AHAs), beta hydroxy acid (BHA), Jessner s solution, modified Jessner s solution, resorcinol, and trichloroacetic acid (TCA) are the most commonly used in-office peel compounds All of these compounds produce effects on the skin by inducing desquamation with resultant hastening of the cell cycle These solutions remove the superficial layer of the stratum corneum (SC), yielding skin that is smoother in texture and more evenly pigmented The individual ingredients of these peels will be discussed but, notably, these ingredients are often used in combination Many of these ingredients are found in home products as well
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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AHAs AND BHA
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AHAs and BHA are naturally-occurring organic acids that contribute to inducing exfoliation and accelerating the cell cycle Clearly there are myriad uses for AHAs and BHA in the practice of cosmetic dermatology Authors have reported success using such products in the treatment of photoaging by improving mottled pigmentation, fine lines, surface roughness, freckles, and lentigines AHAs and BHA have also been used with success to treat actinic and seborrheic keratoses4 Research in the 1970s demonstrated that topical preparations that contain AHAs exert profound influence on epidermal keratinization5 AHAs and BHA affect corneocyte cohesiveness at the lower levels of the SC,6 where they alter its pH, thereby acting on the skin7 When AHAs and BHA are applied to the skin in high concentrations, the result is detachment of keratinocytes and epidermolysis; application at lower concentrations reduces intercorneocyte cohesion directly above the granular layer, advancing desquamation and thinning of the SC7 This has two major effects: quickening of the cell cycle (which is slowed in aged skin) and increased desquamation, which results in improvement of hyperpigmentation and a smoother skin surface
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