Pre-peel preparation

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. 

The products usually used to prepare the skin are sunscreens, tretinoin, AHAs and tyrosinase inhibitors. Jess-ner s solution is sometimes used as a pre-peel preparation. It is often necessary to take measures to prevent infection, especially herpes. 

Areas of hyperkeratosis (senile keratoses, and flat and seborrheic warts) are a perfect example of this difference in the level of penetration. Keratoses, which are characterized by a localized thickening of the stratum corneum, are less permeable to the acids. Pre-peel preparation with tretinoin evens out the thickness of the stratum corneum and hence the overall permeability of the epidermis. 

Tyrosinase inhibitors should be used in post-peel treatment as well as in pre-peel preparation (1 month before the peel when there is a risk of pigmentary change, i.e. when TCA-SAS or AHA peels are used). 

Monitoring the preparation process can give an idea of how reactive and sensitive the skin is. Thus, a patient who cannot tolerate hydroquinone during pre-peel preparation will tolerate it even less in the days following the treatment as the skin becomes more sensitive to any irritant. Similarly, if the patient develops an allergy to one of the products used in the preparation, it can be isolated and avoided after the peel. 

For example Easy TCA and Easy Phytic need no pre-peel preparation. 

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. 

With EPS, the AHAs penetrate far more evenly because of the type of vehicle used and the slow-release mechanism, which eliminates the need for pre-peel preparation. The different types of AHAs used in EPS are important the three AHAs in the solution actually penetrate at different speeds. Small molecules penetrate the skin more rapidly than larger molecules the glycolic acid is therefore the first to penetrate, followed by the lactic acid and finally the mandelic acid, the largest molecule, which relies on the lytic action of the other acids on the corneodesmosomes to help it penetrate the skin more easily. 

This is likely to increase the penetration of the acids unnecessarily. EPS was designed to avoid any pre-peel treatment. Application of EPS should be delayed for 2 weeks if there has been any pre-peel preparation EPS uses the stratum corneum as a reservoir for the slow release of the acids, and if it has been damaged, it can no longer fulfil this role and the acids will penetrate too rapidly through the thirmed layer of skin. Body skin is much less permeable than face skin. This is why an abrasive technique has been described earlier in this chapter. 

Pre-peel preparation (see also Chapter 2) involves the following ... 

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). 

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). 

Unideep was designed to make pre-peel preparation as easy as possible, at the same time as maintaining rapid re-epithelialization and limiting the risks of post-peel complications. Unideep is a by-product of Easy TCA (ETCA) technology and is a medium-depth peel that reaches the papillary dermis. 

Lack of pre-peel preparation, proper cleansing and/or degreasing the skin... 

Skin preparation must be even, suitable to the skin type and not excessive. Some peels are only really effective after several weeks of skin preparation (TCA-SAS), whereas for other products (Exoderm , Easy TCA and Lip Eye-Hd ) pre-peel preparation is pointless, and in some cases any pre-peel preparation is contraindicated (Easy Phytic ). 

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