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Treatment of Acne Scars With a Combination of Chemical Peels and Microneedling

Introduction Postacne scarring is the most important sequelae for acne and can be psychologically traumatic to the patient. It can occur even in patients with milder degrees of acne. The pathogenesis of atrophic acne scarring is most likely related to inflammatory mediators and enzymatic degradation of collagen fibers and subcutaneous fat. Picking at acne lesions adds to scarring. Postacne pigmentation and pigmented scars are very common…

Combination Therapy in Acne: Peels as Adjuvant Therapy

Introduction Acne vulgaris is an exceedingly common inflammatory condition with a lifetime prevalence approaching 80%. Acne has been associated with depression, anxiety, and low self-esteem; untreated or poorly managed acne often has major effects on patient quality of life and has significant associated socioeconomic and healthcare costs. This underscores the importance of an effective and cost-conscious approach to acne treatment. An accurate understanding of the disease…

Peels in Men: Special Considerations

Introduction The low cost and reliable results of chemical peeling have made it a staple procedure in aesthetic medicine. The American Society of Plastic Surgeons ranked chemical peels as the third most popular cosmetic minimally invasive procedure in 2018, with an annual total of 1,384,327 chemical peel procedures performed. Based on estimates by the American Society for Aesthetic Plastic Surgery, consumers spent over $64.5 million on…

Deep Chemical Peels

The results of phenol–croton oil peeling, also known as deep chemical peeling, are considered the gold standard in the treatment of the aged face. Historically, in the “pre–energy-based devices era,” it was almost the only option for radical facial skin rejuvenation. The main advantages of a deep peeling procedure are its efficacy, predictability, and longevity of results. The dissection of phenol–croton oil formulas discloses that more…

Phenol-Croton Oil Peels

Introduction The history of phenol–croton oil peels dates back to the 1920s, when they were introduced into the United States by “lay peelers” coming from Europe. The formulas involved boiling crystals to obtain liquid phenol, to which were added drops of the caustic acid croton oil, among other ingredients. How these original formulas came to be is unknown, but what is clear is that the treatments…

Trichloroacetic Acid Peels of the Neck, Chest, and Arms and Hands

Introduction The face is frequently the focus of antiaging and skin rejuvenation interventions. It is important to remember, however, that there are other areas that should be targeted for rejuvenation efforts to avoid a discordant appearance between the face and other visible areas. As we age, both intrinsic and extrinsic factors affect the appearance of the dorsal hands, neck, and décolletage and can “give away” a…

Medium-Depth Peels and Trichloroacetic Acid Blue Peel

Introduction Medium-depth chemical peels remain very important and highly versatile tools for skin resurfacing and rejuvenation. Although newer laser technology has added to the arsenal of tools for skin resurfacing, these lasers are either cost-prohibitive for certain patients, not advisable for certain skin types, or, most importantly, not as flexible for the physicians who like to tailor their skin-resurfacing approach for each patient. When performed correctly,…

Light Chemical Peels

Introduction Chemical peels are classified by their level of injury to the skin as very light/very superficial, light/superficial, medium-depth, or deep peels. They can also be classified by their mechanism of action as caustic, metabolic, or toxic peels. They induce a controlled destruction of parts or the whole epidermis with or without the dermis, producing exfoliation with ablation of superficial lesions. The ablation is followed by…

The Role of Priming the Skin for Peels

Introduction Foundation: That upon which anything is founded; that on which anything stands, and by which it is supported; the lowest and supporting layer of a superstructure; groundwork; basis Webster’s Revised Unabridged Dictionary 1998. The art of chemical peeling has been a constant in dermatologic surgery for many years. From the use of phenol in the treatment of acne scars in the early 1950s through the…

Choosing the Correct Peel for the Appropriate Patient

Introduction Chemical peels are a method of resurfacing the skin to address a variety of skin conditions. The benefits of understanding the peel–tissue interaction gives the physician the ability to selectively resurface various parts of the skin, thus allowing for control and artistry in the resurfacing process. By inducing a controlled wound to the skin, chemical peels can resurface part or all of the epidermis (very…

The Chemistry of Peels: A Hypothesis of Mechanism of Action and Classification of Peels

A chemical peel is a treatment technique used to improve and smooth the facial and/or body skin’s texture using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother, healthier, and less wrinkled than the old skin. It is advised to seek training with a specialist such as a dermatologist, plastic surgeon, otorhinolaryngologist (facial plastic…

Medical and Legal Aspects of Skin Cancer Patients

Key Points When practicing innovative therapy for skin cancer treatment, consider which reputable similarly situated skin cancer specialists would support that particular treatment as expert witnesses. When a complication occurs during skin cancer treatment, maintaining the patient's trust is the key to successful patient care and is helped by availability and close communication between the dermatologist, the patient, and significant others. Enhanced communication between skin cancer…

Psychological Responses and Coping Strategies in Skin Cancer Patients

Key Points Approximately 30% of all patients diagnosed with melanoma report levels of psychological distress indicative of the need for clinical intervention. Psychological distress has been associated with: patient delay in seeking medical advice; decreased adherence to treatment regimens; increased rates of cancer recurrence, morbidity and mortality; lower quality of life; greater medical costs; and reduced engagement in post-treatment screening and preventive behaviors. Screening for symptoms…

Photography in Skin Cancer Treatment

Key Points Photographic documentation is an important adjunct to the care of patients at risk for melanoma. The evolution of pigmented lesions can be monitored using standardized procedures of whole body integumentary imaging. Individual lesions can be documented using macro-photographic and dermoscopic techniques. Photo documentation services can be provided within the practice or through the use of outside services. Introduction As with most dermatological conditions, visual…

Vitamin D and UV: Risks and Benefits

Key Points Vitamin D is important in bone metabolism. Studies have suggested that vitamin D may lower the risk of developing certain cancers and provide benefit in several diseases, although a causal relationship has yet to be established through clinical trials. Adequate vitamin D levels can be maintained with oral supplementation. Because of known side effects of unprotected exposure to natural and artificial UV radiation, using…

Indoor Tanning

Key Points Indoor tanning is a US$5 billion a year industry, utilized daily by 1 million Americans. It is increasing in popularity. Indoor tanning utilizes bulbs that contain UVB amounts similar to the sun and UVA content several multiples higher. It is convincingly linked to the development of skin cancer and photoaging. Introduction The development of indoor tanning over the last 20 years has allowed the…

Management of Skin Cancer in the Immunocompromised Patient

Key Points Solid organ transplant recipients have an increased risk of developing squamous cell carcinomas. Immunocompromised patients can develop aggressive skin cancers with an increased risk for recurrence and metastasis. HIV/AIDS patients have an increased risk of human papillomavirus-associated neoplasms, sebaceous carcinoma and Merkel carcinoma. Patient education, photoprotection and close surveillance are important aspects of treatment. Introduction The immune system has the important task of mounting…

Treatment of Disseminated Melanoma

Key Points Surgical resection should be considered for all patients with limited numbers of metastatic sites. Standard cytotoxic chemotherapy has limited efficacy in metastatic melanoma, with response rates in the 10–20% range and short-lived response durations. High-dose IL-2 is associated with a small percentage of complete and durable responses, but is limited to a subgroup of patients with good performance status owing to its toxicity. CNS…

Imaging Work-up of the Patient with Melanoma

Key Points Imaging is heavily utilized in the diagnosis and management of melanoma patients but the utility of imaging depends upon the goal in the context of the clinical disease setting. For staging purposes, little evidence supports comprehensive body imaging assessment in asymptomatic early-stage melanoma patients. High-frequency ultrasound can augment the sensitivity of sentinel lymph node biopsy assessment of regional nodal disease. Routine follow-up of melanoma…

Targeted Therapy for Melanoma

Key Points A number of targets in melanoma cells and the melanoma tumor microenvironment exist. Early targeted clinical studies against the oncogenic form of B-Raf (V600E) using PLX-4032 have shown promising results. Rational drug combinations will prevent inevitable drug resistance using single-agent therapies. Introduction Conventional systemic chemotherapies and immunotherapies have not translated into clinically significant benefit for the treatment of melanoma and other skin cancers over…