Pre-peel care

Depending on the type of peel, preparing the skin can be essential, completely pointless or even dangerous. The chapters devoted to the dilferent types of peels give details of the preparation recommended in each particular case. This chapter deals with the generalities of pre-peel care. 

Alpha-hydroxy add (AHA) peels produce the best results if they are preceded by careful preparation and followed by long-term daily cosmetic care. Easy Phytic solution, on the other hand, does not allow any pre-peel preparation that is likely to accelerate penetration of the acids, as the stratum corneum must be intact for the peel to be safe. 

Resorcinol produces far better results and fewer complications if the skin is well prepared. 

Phenol does not usually require any specific preparation, but needs careful post-peel care. 

As a general rule, it is worthwhile preparing the skin carefully with tyrosinase inhibitors if there is any risk of post-peel pigmentary changes or to optimize results when treating melasma. Retinoic acid and sometimes glycolic acid are used to make transepidermal penetration more even or to deepen the action of the acid solution. 

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Although EPS does not require any specific pre-peel care. 

Pre-peel care is discussed in Chapter 2. Further information can be found in Chapter 12. The safety of peels employing trichloroacetic acid in simple aqueous solution (TCA-SAS) has been greatly improved by systematic preparation of the skin before peeling. Preparing the skin helps improve microcirculation, increase glycosaminogly-can synthesis, increase the number of mitoses in the basal layer keratinocytes, stimulate production of epidermal growth factors, deactivate melanocytes and even out and deepen the effect of the TCA. 

Trichloroacetic acid in simple aqueous solution (TCA-SAS) involves pre-peel preparation, application of the TCA-SAS solution to the required depth (usually the papillary dermis), flaking, natural skin regeneration and post-peel care. 

A glycolic acid peel should never be considered as an end in itself, but as part of an overall care plan for the past and future of a patient s skin. Pre- and post-peel care plays a large part in the final outcome, for the follow-up, there... 

As a general rule, no skin preparation is necessary during the weeks preceding the peel or even immediately before the procedure itself It is not necessary to clean or degrease the skin, or to remove any make-up (except for impermeable make-up with a silicone base). If the doctor wants, the skin can of course be cleaned carefully, without irritating it or increasing its permeabihty. Skin Tech s pre-peel cleansing mousse is recommended, as it is not acidic and does not increase skin permeability. 

The histological features of melasma and chloasma are discussed elsewhere in this book. The standard recommendations for treatment often only mention topical applications of tretinoin, hydroquinone and other tyrosinase inhibitors corticosteroids and peels are considered as a last resort because of their potential to turn melasma into post-inflammatory hyperpigmentation (PIH). Conventional peels require conscientious pre-peel preparation to avoid this danger. Easy TCA (ETCA), in combination with appropriate post-peel care, can be used to treat melasma without the constraints of pre-peel preparation (Eigures 16.1-16.5). 

Wearing gloves, the doctor rolls a sheet of sandpaper around a round object (e.g. a bottle of pre-peel cleanser). The skin is held taut with one hand, and intersecting, careful, gentle and repeated passes are made with the sandpaper. Pressure must be firm and even. If the pressure is too light, the skin will not be abraded properly. On the other hand, if the pressure is too firm, it will take off more skin and make it too permeable. 

Trichloroacetic acid (TCA) in a simple aqueous solution (TCA-SAS) is the peel most widely used to partially or completely remove the papillary dermis. Strict pre-peel preparation is required to even out penetration, reduce melanocyte activity and accelerate post-peel re-epithelial-ization. The main purpose of post-peel care is to coimter complications (see Chapter 14). 

The application technique and pre-peel and post-peel care have very important roles. The latest formulations are therefore tamed and adjuvanted. 

Face cleansing Face care Shaving materials washing lotions, peeling, eye make up remover, face water, cleaning wipes and pads, day and night creams, lotions, masks, pre- and after-shaves, shaving soaps. 

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