Superficial peels indications

This paragraph particularly concerns superficial peels or peels to the Grenz zone . Papillary dermal peels are not really indicated in cases of active acne. 

Aging skin is an excellent indication for EPS. Note, however, that it is still a relatively superficial peel and cannot claim to eliminate folds or wrinkles, which have to be... 

With the development of Easy TCA (ETCA), another possibility for treatment has opened up, however. In many indications, ETCA can produce the results of a medium peel with only the complication risks - usually non-existent - of a superficial peel. ETCA can be applied quite successfully to active acne lesions, and the presence of herpes lesions on the Hps is only a formal contraindication to the peel applied following the basic protocol. It is still advisable to avoid treating patients with active herpes, however. Then again, if herpes were to develop in the course of an... 

The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels, AHA, Jessner s solution, tretinoin, TCA in concentrations of 10-30% and most recently hpo-hydroxy add are used to induce an exfoliation of the epidermis. Medium-depth agents such as TCA (30-50%) cause an epidermal to papillary dermal peel with subsequent regeneration. Deep peels using TCA (>50%) or phenol-based formulations penetrate the reticular dermis to induce dermal regeneration. The success of peeling in darker skin is crudally dependent on the physician s understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedure (see Box 9.1). 

When discussing the approach to chemical peeling off the face, adjectives such as conservative and gradual should come to mind. Common indications are much the same as their facial counterparts and can be grouped into those that would be best treated with superficial peels and those that would benefit from medium-depth peels (see Table 12.1). 

Level 1 Erythema with blotchy or wispy areas of white frosting.This indicates a superficial epidermal peel as can be achieved with TCA concentrations <30%. This peel will result in light flaking lasting 2-4 days. 

Other peels can be used, depending on the case being treated. Unideep is also indicated for the treatment of keratoses on the scalp the Unideep solution produces even frosting more rapidly. Only Touch can be used in combination with a more superficial ETCA peel (cloudy-white frosting instead of even white frosting) on isolated keratoses on the scalp. 

TCA is the most versatile of all the peehng agents and can be effectively used to perform superficial to medium-depth chemical peels in the treatment of a variety conditions ranging from pigmentary dyschromias to moderate photoaging. A proper understanding of the correct techniques, indications, limitations, and complications is... 

The author has never observed a flare of Herpes following a superficial chemical peel. Hence, pretreatment with antiviral therapy is usually not indicated. However, one can prophylactically treat with antiviral therapies including valacyclovir 500 mg bid, famciclovir 500 mg bid, or Acyclovir 400 mg bid for 7-10 days beginning 1 or 2 days prior to the procedure. 

Based on quantifiably reproducible experimental test peel patch studies on the right cheek and, later, left cheek test peel patches (reported below), using 48% phenol with 0.0% croton oil, 35% phenol with 0.4% croton oil, 35% phenol with 2.2% croton oil, and 35% phenol with 0.0% croton oil (see Fig. 8.1), a lowering of the threshold affect to create injury (Fig. 8.2) to between 5 and 20 rubs can be seen when croton oil is added. This is down from the 20 to 50 rubs required when croton oil is excluded. The early appearance of coagulation is not a true indicator of depth of peel, nor is the immediate density of frost as evidenced by the reported superficial results from 88% USP Phenol which can produce an immediate, dense, white frost. The length of time a given formula is applied, the concentration of phenol and croton oil, the volume of acid, the vigor and abrasiveness of the application and... 

These peels are designed to allow fairly consistent peeling into the papillary dermis and into the superficial reticular dermis if performed correctly. Thus, their main indications are for epidermal and upper dermal pathology such as photodamage, actinic keratoses, lentigi-nes, ephelides, fine rhytides, and superficial, non-fibrotic (stretchable) scars. Deeper cutaneous abnormalities such as expression lines, furrows, or scars are somewhat amenable to correction with these peels. However, the risk of subsequent textural change or scarring increases with deeper peels. 

Table 12.1 Indications for superficial and medium-depth peels ...

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