Jessner modified

The standard formulation of Jessner s solution is listed in Table 3.1. Modified Jessner s solutions that do not contain resorcinol are also available (Delasco, Council Bluffs, lA) (Table 3.2). 

Resorcinol solutions have been used in combination with glycolic acid, trichloroacetic acid (TCA) and 5-fluorouracil (5-FU). Many modified versions of Jessner s solution have been presented, containing kojic acid, hydroquinone, etc. The effectiveness of these resorcinol solutions depends on skin preparation, skin sensitivity and thickness, the type of applicator and the force of application, the number of coats applied, the type of solution used, the quality of the solution s preparation, etc. Moreover, products with a tyrosinase-inhibiting action (kojic acid, hydroquinone, etc.) only produce their effect in the long term. Single application of these products cannot treat melasma in any way. Only repeated applications, allowing the gradual absorption of products that inhibit melanocyte metabolism, can be considered as an effective treatment. 

Safoury OS, ZaUd NM, El Nabruawy EA, Eaiag EA (2009) A study comparing chemical peeling using modified Jessner s solution and 15% trichloroacetic add versus 15% trichloroacetic acid in the treatment of melasma. Indian J Dermatol 54(l) 41-45... 

Different agents have been studied and depicted effectual in achieving a superficial depth peel. Among these, preferred for use are alpha-hydroxy adds (AHAs), beta-hydroxy acid (BHA), Jessner s original and modified solutions, and trichloroacetic acid (TCA). 

The standard formulation of Jessner s solution contains resorcinol (14 g), salicylic acid (14 g), and lactic acid (85%, 14 g) mixed in a sufficient quantity of ethanol to make 100 ml. Modified Jessner s solution contains 17% lactic acid, 17% salicylic acid, and 8% citric acid mixed in a sufficient quantity of ethanol to make 100 ml. Solutions are available (Delasco, Pubmed). 

For the treatment of melasma (symmetric progressive hyperpigmentation of the facial skin), a study was done comparing modified Jessner s solution and 15 % trichloroacetic acid (TCA) versus 15 % TCA alone [318], Modified Jessner s solution (see above) was found to be useful as an adjuvant treatment with 15 % TCA [318]. 

We understand well the interest in using peeling mixtures of different substances so as to combine caustic, toxic, and metabolic effects. This explains the interest in Jessner s solution (a mixture of resorcinol, lactic acid, and sahcyhc acid) Monheit s formula (a version of a modified Jessner s solution with the resorcinol replaced with citric acid) other secret modified phenol formulas and others (Fintsi,Kakowicz,De Rossi Fattaccioli, etc.). 

In summary, we have discussed the benefits of the modified Jessner peel in combination with TCA and retinoids. It is an old standard that deserves another look. Remember to visit a jjractitioner who is doing these peels to help you develop a feeling for the different levels of rejuvenation before you add these tools to your armamentarium. 

Just as lasers offer the physician a certain level of control and safety, TCA peels have evolved in this direction as well. There have been a number of modified TCA peel combinations that were developed in an attempt to obtain more consistent results while giving the physician more control over the peel. The most common variations are Monheit s Jessner-TCA peel, Coleman s glycolic acid-TCA peel, Obagi s blue peel. 

In an attempt to speed the penetration and depth of TCA peels, two modified peels were created which incorporate the use of a keratolytic agent. Monheit described a Jessner s-TCA peel utilizing a keratolytic acid preparation, Jessner s solution, applied prior to the application of TCA. Jessner s solution is comprised of 14% each of resorcinol, salicylic add, and lactic acid mixed in ethanol. Application of the Jessner s solution allows for faster and deeper penetration of the subsequently applied 35% TCA. A similar mechanism is employed with Coleman s glycolic acid-TCA peel, which uses 70% glycolic acid, also acting as a keratolytic, prior to application of 35% TCA. 

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