Skin type

Soap as used in personal cleansing products has a long safe history of use. Modem soaps have been specifically formulated to be compatible with skin and to be used on a daily basis with minimal side effects. Excessive use of soap for skin cleansing can dismpt the natural barrier function of skin through the removal of skin oils and dismption of the Hpid bdayer in skin. This can result in imperfect desquamation or a dry appearance to skin and cause an irritation response or erythema, ie, reddening of the skin. Neither of these is a permanent response and the eHcitation of this type of skin reaction depends on the individual s skin type, the product formulation, and the frequency of use. 

Electrotransport technology offers a number of benefits for therapeutic appHcations, including systemic or local adininistration of a wide variety of therapeutic agents with the potential adininistration of peptides and proteins long-term noninvasive administration, improving convenience and compliance controlled release, providing a desired deflvery profile over an extended period with rapid onset of efficacious plasma dmg levels and in some cases reduced side effects and a transport rate relatively independent of skin type or site. Additional benefits include easy inception and discontinuation of treatment, patterned and feedback-controlled deflvery, and avoidance of first-pass hepatic metaboHsm. 

Fig. 37. Dependence of the thermodynamic parameters AH and AS of triple-helix formation on the imino acid content of the peptides (obtained by cleavage of calf skin-type I collagene with cyanogene and subequent isolation by column chromatrography)3) and of the native neutral salt-soluble skin collagene of various animals. The entropy values are denoted by dotted lines...

An established safety profile in patients with skin types i-Vi... 

Unsafe in Fitzpatrick skin type higher than V... 

Patients of varying skin types (1-V) having striae distensae alba on the abdomen or thighs can apply topical 20% glycolic acid daily to the entire treatment area. In addition, these patients apply 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine to half of the treatment area and 0.05% tretinoin emollient cream to the other half of the treatment area. The creams are applied on a daily basis for 12 weeks. Improvement is evaluated at 4 and 12 weeks with increased elastin content within the reticular and papillary dermis [14]. 

Finally, glycolic acid is a member of the alpha-hydroxy acid family, which provides an important adjunctive therapy in a variety of skin disorders. It is widely used in chemical peels in a variety of concentrations, ranging from 20 to 70%. People of almost any skin type and color are candidates and almost any area of the body can be peeled. 

Excellent safety profile Can be used in all skin types... 

Skin type more than V Allergic reaction to resorcinol Pregnancy... 

Unsafe in Fitzpatrick skin type more than V Cannot be used in summer Resorcinol may be a sensitizing agent Additional histological studies are necessary to understand the mechanism of action in facial rejuvenation... 

Bleaching products such as hydroquinone 4-8% are particularly useful in patients with dyschromias and in patients with Fitzpatrick skin types lll-VI... 

In cases of patients with olive skin (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. 

After the procedure, the patient is advised to use water-based lotion creams and potent sunscreens. The erythema gradually resolves over about a 2-month period. During this time, makeup foundation is encouraged. In patients with dark skin (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. Systemic Isotretinoin is required in some patients and can be prescribed as soon as 2-3 weeks after the procedure, if no other surgical intervention is planned in the near future. 

In 2002, Grimes reported the efficacy of combination salicylic acid/TCA 10% peeling [1]. She treated patients with moderate to severe melasma with this combination regimen. In the series, nine patients were classified as Fitzpatrick skin type IV, eleven were skin type V, and seven were skin type VI. Many of the subjects included in the study had not responded to salicylic acid or glycolic acid peels. The concentration of salicylic acid was 20 and 30%, and the TCA concentration was 10%. A series of four peels was performed at 2-week intervals. Thirty percent of the patients experienced moderate improve-... 

The combination of salicylic acid and TCA 15% is also an effective treatment for mild to moderate photodamage, acne and melasma in types 1-111. Moderate to excellent improvement has been observed (Figs. 10.3a, b, 10.4a, b and 10.5a, b). Hence, the combination salicylic acid/TCA peeling protocol can be used in all skin types. 

There are few contraindications to combination salicylic acid/TCA peeling. The combination regimen is tolerated in all skin types and all ra-cial/ethnic groups. General contraindications include salicylate hypersensitivity unrealistic patient expectations active inflammation/der-... 

Fig. 10.4. a Facial melasma in skin type 111. b Note significant improvement after combination salicylic acid/TCA peel... 

Dark skin is a commonly used phrase to describe people of color. Other terms used to describe darker skin types include ethnic skin, brown skin, and pigmented skin. The unifying feature represented is pigmented skin (i.e., shades of tan, olive, brown, and black). Such individuals are often classified as Fitzpatrick s skin types IV through VI. These individuals represent many of the faces of North America, South America, Africa, the Caribbean, Asia, Malaysia, and Australia. 

Peel indications differ between light and dark skin. Key indications in Fitzpatrick s skin types I-III include photodamage, rhytides, acne. 

Lawrence et al. [21] compared the efficacy of Jessner s solution and 70% glycolic acid in a split-face study of 16 patients. Of the total group, five were skin type IV, three were skin type V, and one was skin type VI. There was no statistically significant difference in improvement between the two groups. The investigator did not report an increased frequency of side effects in patients of skin types IV-VI. 

There is minimal published data on the use of combination peeling protocols in deeply pigmented skin (Fitzpatrick skin types IV-Vl). The author has reported the efficacy of combination peeling with salicylic acid 20 and 30% in combination with 10% TCA for recalcitrant melasma patients. This peeling regimen was well tolerated with minimal side effects in darker racial ethnic groups (see Salicylic acid/TCA peel section). 

Melasma is an acquired hyperpigmentation disorder characterized by moth-eaten tan or brownish macules and patches that occur on the sun-exposed areas of the skin (Fig. 14.1) [1]. Melasma is most commonly observed in women, but also in 10% of men. It affects all racial groups but is more prevalent in skin types IV-Vl. When melasma is associated with pregnancy it is called chloasma or mask of pregnancy . 

Indeterminate melasma melasma in patients with skin type VI. 

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