CHEMICAL PEELS in .NET

Drawer QR Code JIS X 0510 in .NET CHEMICAL PEELS

CHAPTER 20 CHEMICAL PEELS
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FIGURE 20-9 After one modi ed Jessner s peel The solar lentigos are mildly improved, but it will take at least three more peels for the patient to note a signi cant difference in these pigmented lesions such as ultraviolet (UV) light and toxins in the environment Although studies have shown that TEWL is not affected by the use of AHAs, there was still concern that the barrier would be disturbed in skin treated with AHAs In 1999, a study evaluated the barrier integrity of hairless guinea pigs after treatment with 5% and 10% glycolic acid at pH 30 Investigators found no increase in skin penetration of exogenously applied hydroquinone, musk xylol, and 3H water when compared to controls However, they did find that the guinea pigs treated with the glycolic preparations had approximately a two-fold increase in epidermal thickness and almost double the number of nucleated cell layers as compared with the control group21 This suggests that although the SC is thinned by AHAs, the overall epidermis is thicker Another concern with AHAs is that they may increase photosensitivity A study by Tsai et al demonstrated that pretreatment of human skin with 10% glycolic acid caused an increase in UVB-induced skin tanning in Caucasian and Asian subjects and an increase in UVA tanning in Asian subjects (but not Caucasians)22 Many cosmetic companies have also noted that increased numbers of sunburn cells have been seen in patients treated with AHA preparations The FDA is now requiring that all AHA preparations be labeled to inform patients about photosensitivity and to advise using sunscreens EVALUATING AND COMPARING HYDROXY ACID PREPARATIONS The most important aspect of chemical peel strength is the amount of available free acid The amount of free acid itself is affected by the following: concentration of the peel (% hydroxy acid), the pKa of the acid preparation, the pH of the solution (which is also affected by the type of vehicle used), and whether or not the peel is buffered Because of this complex interplay of factors, it is difficult to com-
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use by beginners and nonphysicians, which may account for their popularity Vehicle It is important to remember that the vehicle can also cause irritation to the patient In fact, studies indicate that irritation associated with AHA products is usually related to the formulation of the product and not to the AHA itself7 Also, the difference in vehicles can contribute to variations in the clinical response Some companies add strontium nitrate (eg, Cosmederm7 ) to decrease the sensory irritation of AHA solutions In one study, when strontium nitrate and 70% glycolic acid were applied to the volar arm, patients exhibited less burning and stinging than when 70% glycolic acid was applied alone to the other arm25 There is no evidence that the strontium nitrate decreases redness or epidermolysis, but there is good evidence that it decreases the itching and burning sensations without affecting the efficacy of the glycolic preparations Other agents that increase penetration, such as urea, may affect the efficacy of these topical products; therefore, it is important to know all the ingredients in each topical preparation RESORCINOL Resorcinol has been used as a chemical peeling agent since Unna described its use in 188226 A phenol derivative, resorcinol (m-dihydroxybenzene) exhibits antipruritic, keratolytic, antimycotic, and antiseptic properties It is mainly used as a treatment for pigmentary disorders and acne, but is also a lone peeling agent and a common component of combination chemical peels, including the Jessner s peel (Fig 20-10) In a study of nine patients treated with a 53% concentration of resorcinol once weekly for 10 weeks, all subjects showed an average of 003 mm improvement in thickness of their epidermis and five patients exhibited enhanced elastosis Verhoeff s stain showed an improvement of elastic fibers in all cases27 Care must be taken to limit the surface area treated because systemic toxicity similar to that seen with phenol has been reported Prolonged use has been associated with myxedema because the drug has an antithyroid action and methemoglobinemia in children Resorcinol is a primary irritant and a moderately strong sensitizer that seldom produces allergic contact dermatitis However, contact allergy to resorcinol in topical acne products and in Castellani s paint have been reported28 Although resorcinol is very useful in the treatment
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