Chemicalpeelsdermatologychemicalpeelsderma

chemical peels

1. Pre-treatment Preparation Procedure of Peeling Post- peel Care Complications Chemical Peels - Procedure

2. Priming : It is done 2–4 weeks in advance. The advantages are as follows: - Decreased chances of PIH. - Uniform and better penetration of the peel. - Decreased wound healing time. - Assess the tolerance of topical agents used for maintenance. - Evaluate patient compliance Kojic acid, azelaic acid, and hydroquinone used in PIH prone patients(MOA :- tyrosinase) GA, retinol, and tretinoin used in acne & photoaging (MOA : : re-epithelization) Sunscreens and moisturizers PRE-TREATMENT PREPARATION

3. Place the patient in a supine position at an angle of 45 degrees. A headband or a surgical cap is used to pull back the hair from the face. A hand towel or an apron should be used to avoid any spillage of water on the clothes while washing the face or neutralizing the peel. The ears are plugged with cotton. The eyes are kept closed the whole time. Peel area is degreased with spirit/acetone/specialized pre-peel cleansers with a cotton ball. Vigorous cleaning in thin dry skin should be avoided. Sensitive areas of the face like the angles of the mouth, perinasal area, and inner canthus of the eyes are protected with petroleum jelly. Take the peel in a glass bowl or a beaker Immediate Prepping

4. Use a cotton earbud/gauze piece or a brush to apply the peel. Regardless of applicator used, it should not be dripping wet and never passed over the eyes. The peel is applied from the forehead going onto the temples, cheeks, chin, nose, and lastly the perioral area. The direction of the strokes is from outside to inside of the face. Strokes have to be smoothand uniform, with no skip areas. Overlapping should be avoided, especially in GA peels. Feathering of the peeling agent along the sides and jawline should be followed to prevent demarcation line. Procedure of Peel

5. In TCA peels, the strokes can be light and unidirectional as in GA peels or bidirectional friction. Superficial peeling of TCA is achieved with light, unidirectional For medium to deeper TCA peel results, vigorous bidirectional strokes are done. The patient would experience a mild stinging sensation in a GA peel and a burning sensation in a TCA peel. Neutralize the peel with water only or with post peel neutralizers (10–15% NaHCO3)

6. The endpoint of each peel is different. Glycolic peels are essentially time dependent. They can be kept from 1 to 5 minutes. In TCA, the endpoint is frosting. For TCA to work more superficially, the endpoint should be pinpoint frosting. For a deeper result, there should be a cloud, or a sheet, of frosting. END POINT

7. Non-soap cleanser to be used for 5-7 days post peel. If there is crusting topical antimicrobials to be used. Broad spectrum sunscreens to be liberally used 2-3 times daily. Peeling/scratching avoided. On re-epithelization pre-peel priming agents restarted. Hypopigmenting agents in 4-6skin type important. Post Procedure Care

8. Post peel Complications • Immediate complications  Pain, burning sensation  Pruritus  Erythema  Epidermal or dermal burns  Edema  Ocular injuries • Delayed complications  Hyper/hypo-pigmentation  Persistent erythema  Infections  Acneiform eruption  Scarring  Skin textural changes  Demarcation lines  Milia  Systemic toxicity

9. Salicylism In case of a body peel, if large quantities of peel are used or a large quantity gets absorbed, then it leads to salicylism. It is characterized by nausea, vomiting, tinnitus, gastrointestinal irritation, deep and rapid breathing, and rarely stroke. Oral aspirin can exacerbate Resorcinism Side effects of resorcinol toxicity include nausea, vomiting, diarrhea, dizziness, drowsiness, severe headache, bradycardia, shortness of breath, diaphoresis, and/or paralysis. Phenol Toxicity Deep phenol peels are best avoided in Indian skin types. If used, large quantities of phenol and a large area of application should be avoided. On absorption it is metabolized through the liver and excreted through the kidney and can cause cardiotoxicity. Patients can have arrhythmias

10. Combination peels are a mixture of different chemical compounds of varying strengths in a single formulation. Advantages : Multiple chemical compounds of lower strength when combined together work synergisticallyand increase the depth and safety of the peel. Disadvantages : Combination should be apt allergic reactions to any one agent cannot be assessed. Combination Peels

11. C hemical peels using different chemicals sequentially as they may not be compatible in the same formulation. Sequential peeling also offers the advantage of deeper penetration of the second agent due to exfoliating action of the first peel applied. Sequiential Peels Spot Peels Spot peels are peels done only on a particular spot on the face or body, sparing the rest of the area. Segmental Peels Segmental peels consist of applying different peels in different cosmetic units of the face

12. First bullet point here Second bullet point here Third bullet point here Two Content Layout with SmartArt