Superficial Peeling Agents

Given the depth of injury induced by glycolic acid peeling, other investigators have reported no benefit when using a series of four 70% glycolic acid peels to treat moderate photodamage [57]. 

Nineteen women were treated. Of that group, nine were treated with 4% hydroquinone and serial salicylic acid peeling. Both groups showed improvement in photodamage however, there were no significant differences between the two treatments. 

The safety and efficacy of a series of glycolic acid facial peels were investigated in 25 Indian women with melasma [16]. Patients were treated with 50% glycolic acid peels monthly for 3 months. Improvement was noted in 91% of patients with maximal clearing occurring in patients classified with epidermal melasma. Side effects were observed in one patient who developed brow hyperpigmentation. 

In a separate study, the combination of glycolic acid peels with a topical regimen for the 

The author has observed enhanced improvement of oily skin, enlarged pores, and acne vulgaris with the use of salicylic acid peels compared with glycolic acid peels. Possible mechanisms for this observation include salicylic acid s effect on lipid solubility and microcome-odone formation. 

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. 

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. 

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Jessner s Solution has been used for over 100 years as a therapeutic agent to treat hyperkera-totic epidermal lesions [1]. This superficial peeling agent constitutes a mixture of salicylic acid, resorcinol, and lactic acid in 95% ethanol. Jessner s solution causes loss of corneocyte cohesion and induces intercellular and intracellular edema. Jessner s typically induces wounding to the level of the papillary dermis. Historically, resorcinol (a key component of Jessner s peels) was used in concentrations of 10-50% in the early twentieth century. High concentrations of resorcinol were associated with side effects such as allergic contact dermatitis, irritant contact... 

As with other superficial peeling agents, Jessner s peels are well tolerated with few contraindications. However, there is scant pub-... 

Salicylic acid (ortho hydroxybenzoic add) is a beta hydroxy acid agent. It is a lipophilic compound which produces desquamation of the stratum corneum via removal of intercellular lipids [3] (see salicylic acid section). Given its keratolytic effects, it has become an increasingly popular superficial peeling agent. Salicylic acid peels induce injury via thinning or removal of the stratum corneum. In addition, salicylic acid potentially enhances the penetration of TCA. 

As with other superficial peeling agents, Jessner s peels are well tolerated with few contraindications. However, there is scant published information on the use of Jessner s peels in Fitzpatrick s skin types V and VI. One study by Ejaz et al. has reported comparable... 

It is one of the most frequently used superficial peeling agents for epidermal melasma. 

Jessner s solution has been used over several years as a superficial peeling agent. 

Hetter [285] noted that the addition of croton oil converts a 50 % phenol solution from a superficial peeling agent to a deep peeling formula, causing an injury of a wholly different magnitude [285]. In the same patient, he showed that 18 % phenol had a nunimal effect, 35 % phenol caused mild keratosis but no dermal effect, 50 % phenol caused some desquamation and perhaps a mild dermal effect, 88 % phenol caused an obvious upper dermal effect with healing in 4-5 days, and the addition of 0.7-2.1 % croton oil to 50 % phenol caused a profound dermal effect with healing in 7-11 days [285]. 

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