Chemical peels peeling preparation

Monheit GD (1996) Skin preparation an essential step before chemical peeling or laser resurfacing. Cosmet Dermatol 9 9-14... 

It is still debatable whether preparation of the skin is required for deep chemical peeling. We feel that topical retin A preparations used daily for 3-6 weeks prior to the procedure may create better and more even penetration of the peeling solution in sebaceous and hyperkeratotic skins. We did not find any benefit of this regimen in thin-skinned patients. 

Acneiform eruption after deep chemical peel is a common phenomenon appearing immediately after reepithelialization. Its etiology is multifactorial and is related to either exacerbation of previously existing acne or is due to over-greasing of newly formed skin. Short-term systemic antibiotics together with discontinuation of any oily preparations will usually provide satisfactory solution. 

Glogau RG, Matarasso SL. Chemical peels trichloracetic acid and phenol. Dermatol Clin 1995 13 263-76. Ruedemann R, Deichmann WR. Blood phenol level after topical application of phenol-containing preparations. JAMA 1953 152 506-9. 

This is the definitive reference for all engaged in chemical peels in cosmetic practice, based on one author s extensive experience in research, practice and teaching. It contains the results of over fifteen years of work with peels and coxers all tyjDcs of treatment and all t qaes of peel, paying attention to the science underlying their use, as well as to preparation, application and... 

Hunter D, Frumkin A. Adverse reactions to vitamin E and aloe vera preparations after dermabrasion and chemical peel. Cutis 1991 47 193-6. 

Since deep chemical peels are based on phenol-containing solutions, it seems that the history of this procedure starts at the moment of carbolic acid discovery in 1834 by the German chemist Friedlieb Ferdinand Runge. The name phenol had been coined in 1841 by Charles Frederick Gerhardt. Nowadays, phenol is prepared synthetically in a process that utilizes chlorobenzene as a starting point. 

Preparing the skin for a peel, or priming, is one of the most important components in chemical peeling. The prepeeling agents are used for at least 2-4 weeks prior to chemical peeling. 

Litton [284], one of the pioneer physicians in chemical skin peeling, ranaiked that almost all the scarring he had seen following chemical peels was due to TCA [284], A full-thickness injury and hypertrophic scarring may occur wheu the 50 % TCA solution is incorrectly prepared (50 g TCA in 50 mL distilled watCT rather than the correct 50 g TCA in 1(X) mL distilled water), resulting in a concentration much higher than 50 % [337]. 

The foundation of an effective chemical peel is skin preparation. This begins in the weeks leading up to the peel, and also includes the actual preoperative steps before the peel. With adequate priming, the skin will frost rapidly and more uniformly than unprimed skin. TCA in particular is usually applied expeditiously to rninirnize discomfort a more rapid and complete frost will enhance the patient s experience. Although relatively uncommon, adverse effects such as hypo- or hyperpigmentation, delayed reepitheUaUzation and prolonged erythema may also be minimized because skip areas are usually minimized as well. Finally, the postoperative phase can be shortened as a result of more rapid healing in primed skin. 

Preparation of the skin before peel is very important to improve results and reduce the risk of complications. The darker the skin, the longer the duration of the preconditioning should be prior to the chemical peel. A minimum period of 2 weeks is recommended to prepare the skin. 

As might be expected, preparing the skin of the body is similar to what is done to the face pnior to chemical peeling. For the sake of ease, only specific differences will be highlighted in the text while common jjreparations are listed in Table 12.2. 

Cosmeceutical pharmaceutical agents are commonly combined with chemical peels to enhance exfohative and regenerative effects. Retinoic acid preparations are prescribed as daily home care to accelerate epidermal proliferation, so there is an increase in epidermal thickness despite the stratum corneum being shed. The application of retinoic acid enhances the effectiveness of light and even medium-depth chemical peeling to texture, tone, and smooth the skin. Used in combination with alpha-hydroxy acids (AHAs) retinoic acid prepares the skin for the peel procedure. 

Glycolic acid creams, cleansers, and exfoliating preparations are used to boost epidermal exfoliation, reduce stratum corneum thickness and augment the peel penetration, thus enhancing the uniformity of the light chemical peel. Pretreatment is also essential for combination medium-depth peels. 

---