CHEMICAL PEELS in .NET framework

Generation QR Code ISO/IEC18004 in .NET framework CHEMICAL PEELS

CHAPTER 20 CHEMICAL PEELS
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Side Effects of All Types of Super cial Peels
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Although superficial chemical peels are very safe when used properly they can all cause erythema, itching, peeling, increased skin sensitivity, and even
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epidermolysis Allergic contact dermatitis has been reported to occur with resorcinol, salicylic acid, kojic acid, lactic acid, and hydroquinone Irritant contact dermatitis has been linked to glycolic acid Any peel can cause an irritant dermatitis when used with excessive frequency,
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inappropriately high concentrations, or with a vigorous skin preparation using acetone or another degreasing solution Patients with a recent insult to the SC, such as beginning a regimen with tretinoin, facial shaving, use of exfoliating scrubs and Buff-Puffs , or kissing a
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person with a heavy beard for prolonged periods, are more susceptible to chemical peels extending deeper than intended Consequently, it is necessary to closely examine the condition of the skin and get a good history from the patient prior to performing a peel (Box 20-2)
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BOX 20-2 How to Use Chemical Peels Dr Baumann s Perspective There are several brands of super cial chemical peels available on the market In the case of AHAs, one must know the pH and concentration of free acid in the individual products in order to compare strength and ef cacy across products The practitioner must exercise extra caution when treating patients with darker skin types, regardless of the chemical peel selected, to avoid hyperpigmentation For such patients, the practitioner should start with the lowest concentration of free acid and slowly increase the concentration 1 At the rst visit, assess the patient s skin using a UV or Wood s light to determine the extent of pigmentation abnormalities This will help convince the patient of the necessity of sunscreen use Take regular pictures and UV camera photographs if possible Determine the patient s Baumann Skin Type (see 9) Discuss skin care, sunscreen use and the importance of topical retinoid treatments ( 30) and offer product recommendations based on the patient s skin type Also at this juncture, it is imperative to caution patients to refrain from using at-home topical AHAs, BHA, and other irritating ingredients such as vitamin C in order to avoid excessive skin irritation In addition, the physician should make sure that the patient is not using another form of exfoliation such as facial scrubs or Buff-Puffs The practitioner should treat each patient, even those with type I skin, with the lowest strength peel of FIGURE 20-11 Patient on Retin A with retinoid dermatitis Peeling this patient will result in excessive the chosen brand (or the one requiring the redness and scaling It is best to wait 1 week prior to proceeding with chemical peeling shortest duration on the face) on the rst visit to ascertain the patient s level of sensitivity 3 Visit Three and Beyond Manufacturers of 2 At the second visit, the practitioner can go to Explain to patients that they will not notice most super cial chemical peel brands recthe next level in peel strength if the patient much difference in their skin after the rst ommend treatments at 10- to 14-day interexperienced minimal or no peeling after the peel because it is only a low-strength solution vals One may continue the peelings until the initial peel Most patients are started on a used to determine their ability to tolerate the initial presenting symptoms have resolved topical retinoid on the rst visit so care must peel It is important at each visit, but particuand, thereafter, perform peels at 4-week be taken to avoid peeling skin that exhibits larly so at the rst visit, to nd out if the intervals for maintenance One should occa retinoid dermatitis (Fig 20-11) In such a patient has any signi cant forthcoming social sionally inquire about retinoid and sunscreen case, the practitioner should refrain from obligations that might be compromised or use to ensure patient compliance After the performing a peel until the retinoid dermatitis made embarrassing owing to erythema or third peel, patients should be consistently resolves On this visit, it is also important to conspicuous skin aking There is a low inciusing the retinoids with no skin irritation If assess how well the patient tolerates the dence of hypersensitivity reactions (most this is the case, it is a good time to add an social/psychological impact of peeling If the commonly seen with the Jessner s peel) that, at-home AHA or BHA preparation There are patient complains about aking skin or eryaccording to Murphy s law, occur preferenmany brands to choose from and skin care thema, the physician should titrate the peels tially in those patients with an important party product ingredients are discussed at length more slowly If the patient feels that signi or lecture coming up Patients should return throughout this text to help you decide which cant erythema and/or aking are the sine within 10 to 14 days for a follow-up and to products to recommend qua non of an adequate peel, the physician receive the next peel may want to proceed more rapidly
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