The peeling or flaking skin to produce the renewal of the surface layers of the skin causing a rapid cell turnover
There are different types of exfoliating:
1) Natural sunlight
2) Biological: tretinoin, isotretinoin
3) Chemistry: Different types of acid, salicylic, glycolic trichloroacetic acid, phenol, phenol capping or different combinations.
4) Physical: Liquid nitrogen, carbon dioxide, electrodesecación.
History
The first to perform peels were Egyptians, who wore animal plasters oil, salt, alabaster or baths of milk using lactic acid.
The Turks used fire to induce a mild exfoliation and India pomex stone mixed with urine to produce light abrasions on the skin
Use in dermatology began in 1882, P. G. Unna (German) starts using the salicylic acid, resorcinol, phenol, a. Trichloroacetic acid (TCA)
In 1903, George Miller Mackee (New York) using phenol in scars, this is popular in the First World War
In the decades of 30 and 40 in Los Angelescomienzan to provide new uses for the peelings
(Wrinkles and scars.)
A decade late 70 Van Scott and Yu initiated studies on alpha hydroxy acids
In 1980, Stegman, makes comparison of different histology exfoliating to see the true comparison of some over others.
Anatomical considerations:
The skin of the face differs from the other regions of the body by the amount of pilo sebaceous units, especially in the nose and forehead.
The dermis of the extensor surfaces is generally thicker than the flexor surfaces.
In the hands of photoaging skin disorders may be higher than in the face and the subcutaneous tissue and dermis are thinner and may mean that the use of a chemical agent for these 2 areas is destructive to the back of hands since the metabolic of substances is decreasing and structures to promote annexial reepitelizacion are less numerous.
The dermis of the dorsum is more dense collagen and although it may be more resilient than other areas of the body can lead to scarring after deep peels
Types of chemical peelings, there are over 100 different types, just highlight the most common
Unna Pasta, Pasta Lassa, resorcinol, phenol peeling, Formula Brown, Phenol Buffer Sperber, mixture of phenol Litton, Formula Dennie, Jessner solution, salicylic acid 15% – 35%, 10% trichloroacetic acid — 70% acid, 30% send a. Phytic
The peelings are classified according to the depth at which she served:
1) Mild Peeling Surface
Exfoliation of the stratum corneum or to the grainy, not serve to improve the changes of the skin
2) Surface Peeling
Exfoliation or basal layer to the superficial papillary dermis, does not serve to improve the skin disorders
10% 35% TCA, resorcinol, Jessner solution, salicylic acid, carbon dioxide, alpha hydroxy acids, tretinoin 0.1%
3) Medium Peeling
Papillary dermis to superficial reticular dermis, although some produce descamative posteriors and discomfort, are the best to solve the problems of the skin, the only reality they serve.
Combination of peelings, carbon dioxide and 35% TCA, Jessner solution and 35% TCA, glycolic acid and TCA 35% TCA 50% application of phenol, pyretic acid
4) Deep Peeling
Reticular dermis layer, are excellent for reversing serious damage but must be done under strict control and half protected, can be very dangerous in inexperienced hands
Baker phenol (occluded or not occluded)
Action on skin:
The chemical peeling produces a controlled reduction of thickness caused by second intention healing
After a chemical peeling occur following processes:
# Coagulation and inflammation proteins are produced by the activation of inflammatory mediators (lamina, fibronectin, growth factor from platelets), neutrophils remain for 3 to 5 days, 10 days remaining macrophages while lymphocytes reach 6 days after the injury.
# Reepitelizacion: is migration of keratinocytes from the margins and attachments from this process occurs within 14 hours, needed for keratinocyte migration on a fibronectin matrix that allows the adherence of collagen and fibrin
# Granulation tissue formation: is the 2nd or 3rd day and is an accumulation of cells (fibronectin, fibroblasts, collagen and glycosaminoglycans)
# Angiogenesis: The restoration of blood flow is critical to tissue oxygenation and nutrition
# Remodeling of collagen is responsible for the texture of the skin after peeling
Indications of peelings:
Actinic keratosis
Wrinkles
Discromias pigment
Scars
Acne
Rosacea
Melasma and post inflammatory hyperpigmentation is used but is not the main choice, as there are specific treatments depigmentation and faster resolution
Lentigo
Patient selection
All patients should be carefully examined to determine the chemical agent that will produce better results for their disease, should take into account what are the social activities of the patients to avoid further changes in their lifestyle.
He questioned the frequency of sun exposure, cosmetic use it, which were dermatologic treatments I perform, if conducted after a cosmetic surgery, what is your type of scarring, if you smoke, use drugs that, if it ever herpes, if you are pregnant and should be given a realistic expectation about the results to be obtained.
After the formulation according to each patient a treatment protocol before peeling and will indicate the frequency and number of treatments performed.
How to choose a peeling
The choice of the depth and type of the peelings will be made according to the type of injury and to treat the affected area for example in a patient with minor injuries photo damage is needed to use a chemical action as a superficial deep produce greater damage, however if the wrinkles are deep enough to be a superficial peeling.
Every day the market new products to exfoliate so the selection and proper application of the same will be the foundation for success
Aftercare:
Avoid sun exposure during treatment and depending on the depth reached up to a month later
You can apply cool compresses and apply moisturizing emulsions often