Combined therapies combination peels

International Journal of Dermatology 39 539-544 Kang WH et al 2009 Atrophic acne scar treatment using triple combination therapy dot peeling, subcision and fractional laser. Journal of Cosmetic and Laser Therapy 11 212-215 Luis-Montoya P et al 2005 Evaluation of subcision as a treatment for cutaneous striae. Journal of Drugs in Dermatology 4 346-350... 

Jessner s solution contains 14% resorcinol, 14% salicylic acid and 14% lactic acid. Jessner s solution has been used alone for superficial peeling, or in combination with TCA 35% to achieve a medium-depth peel. Increasing the number of coats applied to the treated area increases the depth and reaction induced by the Jessner s peel. These peels are well tolerated with minimal side effects in the author s practice. As with glycolic acid and salicylic acid peels, Jessner s peels are most commonly used as adjimctive therapy for moderate to severe facial dyschromias, acne, oily skin, texturally rough skin, fine wrinkles, and pseudofolliculitis barbae. 

Done for the right indication and chosen for the correct patient, chemical peeling remains as an alternative modality for patients with melasma. It becomes more effective when combined with medical therapy since the peels mechanically remove (he melanin while topical medications inhibit melanocytes or melanogenesis. 

Combined with topical therapy (5% ascorbic acid), results were superior compared to TC A alone in treating epidermal melasma [136]. TCA 35% applied in conjunction with GA or Jessner s solution achieves a midlevel peel, with healing time between 7 and 10 days [9,25]. 

Adverse events associated with treatment were mild and short lasting and included skin irritation, dryness, burning and erythema. The data could not be statistically pooled because of the heterogeneity of treatments and lack of consistency across study designs. Topical combination therapies were found to be more effective than monotherapy. Triple combination therapy was found to be the most effective, but approximately 40% of patients develop erythema and peeling. 

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