Superficial peels

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-... 

The skin is usually degreased with alcohol followed by a mild acetone scrub. After cleaning, Jessner s solution is appUed to the face with a sable brush, cotton tipped apphcators, cotton balls, or 2 X 2 gauze sponges. The author prefers the use of cotton tipped applicators. Typically, the cheeks are treated first, working from medial to lateral areas followed by application to the chin and forehead area. For superficial peeling, two coats are usually applied. Additional coats increase the depth of peeling. 

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. 

Stagnone JJ (1989) Superficial peeling. J Derm Surg Oncol 15 924-930... 

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. 

TCA peels were first described by Roberts in 1926. Many consider TCA the gold standard by which other peels are measured. Concentrations of 10-30% are used for superficial peeling. TCA precipitates epidermal proteins, causing sloughing and necrosis of the treated area. The extent of damage is concentration dependent. In contrast to glycolic acid, Jessner s solu-... 

Superficial peeling with 25% salicylic acid in alcoholic solution (Figs. 14.5a, b and 14.6a, b)... 

Patients should undergo a superficial peeling every 2 weeks or a medium peeling every month. With a medium chemical peel, the application of the solution must be reduced in time in order to avoid overpeel. 

Salicylic acid has a keratolytic effect, thus eliminating superficial pigmented keratinocytes and stimulating cells turnover. This superficial peeling allows TCA to act a low concentration to remove pigmented keratinocytes through papillary dermis (see Fig. 14.12). 

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