COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE in .NET

Encoding QR Code in .NET COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE

COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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FIGURE 20-8 Prior to a super cial modi ed Jessner s peel Note the solar lentigos Any areas that have been inadequately peeled can be easily identified and then treated by reapplying the BHA solution Also, timing of the peel is unnecessary, and the risk of overpeeling is remote because once the vehicle becomes volatile, which occurs in approximately 2 minutes, there is very little penetration of the active agent It is important to immediately use the chemical peel liquid once the cap has been taken off the bottle, otherwise it will evaporate and change the efficacy In addition, do not use a fan when you use this peel because it will increase the rate at which the vehicle becomes volatile and will lessen the effect of the peel Because neutralization of the BHA peel is unnecessary, it is easier to apply to larger areas of the body such as the back and chest that are difficult to adequately neutralize However, it is unwise to peel large surface areas of the body with SA in one office visit Although toxic levels of salicylates have not been reported in association with the concentrations currently used for SA peels,3 there have been case reports of children with multiple excoriations and elderly patients with ichthyosis treated with topicals containing SA that developed salicylism20 Therefore, large body surfaces should be treated with care and the physician should watch for the signs of salicylism, which include nausea, disorientation, and tinnitus Of course, BHA, whether in concentrations developed for in-office peels or in at-home products, is contraindicated in patients who are pregnant, breast-feeding, or allergic to aspirin Many home care product formulations contain SA Typically, they are labeled as acne washes and contain 05% to 2% SA These products are an excellent addition to a home care regimen for acne, rosacea, photoaging, and pigmentation disorders Notably, irritation and skin dryness can result from such products, especially since patients tend to use higher and higher concentrations of home products to maintain exfoliation Patients should use an
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pare one brand of chemical peel to another For example, a 30% glycolic acid peel from one company is not necessarily the same strength as a 30% glycolic peel from another company The acid percentage is only a small part of the story It is necessary to consider the pH, the amount of free acid, the additive ingredients, and whether or not the peel is buffered before comparing different peeling brands The Signi cance of the pKa In order to use AHAs and BHA properly, one must understand the pKa and how the pH of a peel affects its efficacy The pKa of a substance measures its capacity to donate protons The pKa is the pH at which the level of free acid is the same as the level of the salt form of the acid When the pH is less than the pKa, the free acid form, the one responsible for exfoliation of the skin, predominates; when the pH is greater than the pKa, the salt form predominates The acid form is the active form in the peel because it causes exfoliation It is necessary to have the proper balance of the salt and acid forms to have an efficacious peel with minimal irritation The pKa for salicylic acid is 297 while 383 is the pKa for the AHAs23,24 Because the pKa of BHA differs from that of the AHA family, it is difficult to formulate a combination product containing both that reaches an optimal pH For example, in a combination AHA BHA product with a pH of 35, the AHA acid form would predominate but the BHA salt form would predominate The effects of BHA would be rendered suboptimal then Signi cance of the pH The higher the pH, the more basic the solution is; the lower the pH, the more acidic the solution is The irritation induced by a product is often directly related to how low the pH is Lower pH equates to increased irritation, as well as efficacy Buffered solutions Some chemical peel formulations are buffered Many companies claim that this increases the tolerability of these agents A product is buffered when a base such as sodium bicarbonate or sodium hydroxide is added to the solution This produces an increased amount of the salt form, which results in less free acid and a higher pH Buffered solutions are resistant to pH changes when a salt or an acid is added to the preparation Because these solutions have a lower pH and less free acid, there is a decrease in side effects; however, there may also be a decrease in efficacy These formulations are safer for
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