Chemical Peels Research Articles

MELASMA ETIOLOGY AND TREATMENT: A SYSTEMATIC REVIEW

Introduction: Melasma is a common chronic refractory pigmentation disorder that predominantly affects women and individuals with darker skin types. It significantly alters quality of life and self-esteem because of its disfiguring skin appearance. Objective: to detail current information related to melasma, etiology, epidemiology, pathophysiology, histology, presentation, treatment and prognosis. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 19 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: melasma, laser, pigmentation, skin. Results: Females are more affected than males in a 9:1 ratio. Melasma is infrequent prior to puberty and more common in the reproductive years. Melasma is found in 15% and 50% of pregnant women. The prevalence is 1.5% and 33% depending on the population. The most notable factor is exposure to sunlight. Next to pregnancy, direct sun exposure is the most important risk factor for melasma, shown by 27% to 51% of individuals as a trigger and 84% as a clinical deterioration factor. Approximately 83% to 93% of individuals with melasma have modifiable levels of solar elastosis. Conclusions: The treatment of melasma continues to be a challenge, because of the fact that the spots do not disappear completely in most of those affected, in addition to presenting considerable recurrence rates. The first line management is adequate sun protection and the association of sunscreens with color and topical bleaching agents, which may have a different effect on melanogenesis. In case oral medications are needed, tranexamic acid presents the best evidence for treatment. Some procedures support the treatment of melasma, such as microneedling and chemical peels that act through epidermal renewal. Lasers should be used with extreme caution because heat induces post-inflammatory melanogenesis. The combination of topical bleaching agents with medications and oral procedures provides more rapid effects, however more studies are needed regarding the treatment of the condition. KEY WORDS: melasma, laser, pigmentation, skin.

Case Series: Therapeutic Combination of VoluDerm Radiofrequency Microneedling and Glycolic Acid Peel in Scaled-Up Concentrations

Abstract Background Glycolic acid (GA) is an α-hydroxy peeling agent that causes controlled removal of the epidermis, with or without the dermis. Studies have shown the ability of GA to stimulate fibroblast proliferation, induce collagen synthesis, and decrease collagen degradation. The VoluDerm radiofrequency microneedling (RFMN; Pollogen, Tel Aviv, Israel) utilizes an array of microelectrodes to penetrate the epidermis and deliver energy to the skin. The controlled fractional thermal injury promotes neocollagenesis in the correction of skin laxity and wrinkle reduction. It was theorized that GA and VoluDerm could synergistically boost collagen production in combined treatment. Objectives Safety and efficacy of the combination treatment were investigated in patients seeking corrections of the age-related skin deteriorations. Methods Seven female patients (aged 42-70 years, Fitzpatrick II-IV) with photo- and chrono-damaged skin received 5 treatments of VoluDerm followed by the GA peel at increasing 30% to 70% concentrations. Results Clinical photography taken 6 months after the treatment demonstrated improvement in elasticity, wrinkling, roughness, pigmentation, erythema, and pore size across the entire treated group. Efficacy quantified by the physician and patients per 1 to 5 Global Aesthetic Improvement Scale was average 4.3 and 4.5, respectively. The treatments were tolerated well without preprocedural anesthesia. Skin phenomena observed after GA application were suggestive of the acid passing to deeper layers. Conclusions A novel combination of VoluDerm RFMN and GA at increased concentrations provided safe and effective synergy in the treatment of aging facial skin. Visible results demonstrated skin tightening, reduction of rhytidids, and improvement of the skin texture which may be a result of the combination. Level of Evidence: 4

A prospective comparative study of efficacy and safety of 15% trichloroacetic acid peel, 35% glycolic acid peel and Q-switched Nd-YAG laser in patients of macular amyloidosis.

The unappealing appearance of skin in macular amyloidosis (MA) interferes with the patient's quality of life, and treating the condition has been challenging. To compare the efficacy and safety of 15% trichloroacetic acid (TCA) peel, 35% glycolic acid (GA) peel, and Q-switched Nd-YAG Laser in MA. Open, prospective study was conducted over 2 years, where after fulfilling the criteria, randomization was done into three groups. Group A: 15% TCA peel; Group B: 35% GA peel; Group C: Q-switched Nd-YAG Laser. Procedures were repeated at monthly intervals for six sittings. On each visit, patients were scored on the following parameters: color score, visual analog score (VAS), physician global assessment (PGA) scale, subjective improvement, and adverse effects. A total of 75 patients (25 patients in each group) completed the treatment. The mean age of study-population was 35.68 ± 9.8 years, with female to male ratio of 11.5:1. The mean change in color score (1.68) was more by Group A, followed by Group C (1.4), followed by Group B (1.16). Similar results were noted by subjective improvement, VAS, and PGA. Adverse events were more in Group A, followed by Group C, followed by Group B. No patient showed permanent adverse events. TCA-peel showed superior results over Nd-YAG laser and glycolic-acid peel. TCA-peel being cost-effective with excellent acceptability should be considered a treatment modality.

Perceptions, Utilization, and Cost Assessment of Sebaceous Hyperplasia Treatment Modalities: A Pilot Survey.

Sebaceous hyperplasia (SH) is a common, benign but cosmetically bothersome skin condition preferentially affecting older adults. Despite multiple treatment options, there is no universally accepted first-line treatment for SH nor standard pricing for said approaches.  Methods: A survey aimed at evaluating treatment approaches and their respective costs was disseminated on the Orlando Dermatology Aesthetic and Clinical Conference email listserv.  Results: Out of 224 dermatologists who participated in the survey (response rate 9.2%), most treated patients with SH (95.98%). In-office procedures were used more than pharmacologic treatments (P=<0.05). Treatments most used by respondents included electrodesiccation (ED; 83.9%), cryosurgery (35.3%), oral isotretinoin (32.6%), and carbon dioxide (CO2) laser (19.2%). Cryosurgery and ED priced between <$200 to $400. Most reported 1 to 2 sessions to achieve lesion clearance for ED, CO2 laser, and cryosurgery. Twenty-one percent reported 3-4 sessions with cryosurgery. Chemical peels, diode lasers, and photodynamic therapy required between 2-4 sessions. Respondents indicated lesions were most unlikely to recur with ED and CO2 laser. Most dermatologists (86.39%) agreed or strongly agreed that they were exposed to new treatments methods for SH through this survey and 86.49% of dermatologists were interested in learning about treatments employed by others. SH is a common issue that presents in the dermatologist's office. These data highlight the perception that ED is the most common approach employed, associated with lower costs, and requiring fewer sessions to achieve resolution. More data is needed and wanted to better determine best practices for the management of SH.J Drugs Dermatol. 2024;23(2):29-37.  doi:10.36849/JDD.7734.

The Efficacy of the Combination of Microneedling with Jessner’s Plus 35% Trichloroacetic Acid Peel versus the Efficacy of the Combination of Microneedling with Platelet-rich Plasma Therapy for the Treatment of Atrophic Acne Scars: A Comparative Study

Background: Acne is a common skin condition that is prevalent in 90% of the adolescent population. Inflammatory lesions of acne may lead to scarring. Various treatment modalities such as subcision, punch excision, chemical peels, microdermabrasion, and fractional lasers have been tried for acne scars but with unsatisfactory results. Purpose: The aim of the present study is to compare the efficacy of microneedling with Jessner’s plus 35% trichloroacetic acid (TCA) peel versus the efficacy of microneedling with platelet-rich plasma (PRP) therapy for the management of atrophic acne scars. Methods: Sixty patients having atrophic scars due to acne were segregated into two groups each containing 30 patients. On Group A, patients microneedling was performed at weeks 0, 6, and 12 and Jessner’s plus 35% TCA peel was performed at weeks 3, 9, and 15. On Group B, patients microneedling and intradermal PRP were performed sequentially at weeks 0, 3, and 6. Patients were followed at the outset of the procedure and 24 weeks after the procedure using the Echelle d’Evaluation Clinique des Cicatrices d’acne (ECCA) score. Results: The difference in the mean ECCA score at the outset of the procedure and 24 weeks after the procedure was more in Group B as compared to Group A (47.8 ± 13.6 vs. 39.1 ± 11.4). Conclusion: The efficacy of the combination of microneedling with PRP was higher than the combination of microneedling with Jessner’s plus 35%TCA peel for the treatment of atrophic acne scars.

Update on Melasma Treatments.

Melasma is a prevalent hyperpigmentation condition known for its challenging treatment due to its resemblance to photoaged skin disorders. Numerous studies have shed light on the intricate nature of melasma, which often bears similarity to photoaging disorders. Various therapeutic approaches, encompassing topical and systemic treatments, chemical peeling, and laser therapy, have exhibited efficacy in managing melasma in previous research. However, melasma often reoccurs despite successful treatment, primarily due to its inherent photoaged properties. Given that melasma shares features with photoaging disorders, including disruptions in the basement membrane, solar elastosis, angiogenesis, and mast cell infiltration in the dermal layer, a comprehensive treatment strategy is imperative. Such an approach might involve addressing epidermal hyperpigmentation while concurrently restoring dermal components. In this article, we provide a comprehensive review of conventional treatment methods frequently employed in clinical practice, as well as innovative treatments currently under development for melasma management. Additionally, we offer an extensive overview of the pathogenesis of melasma.

The Impact of Carboxytherapy and Treatments Combining Carboxytherapy and Selected Chemical Peels on Vascular and Pigmentary Components of the Dark Circles.

Particular attention is given to the enhancement of melanin-related pigmentation (dark circles, photoaging) and vascular circles, which are commonly located in the tear trough. The objective of the study is to provide an objective evaluation of the impact of carboxytherapy and the treatment regimen combining carboxytherapy with lactobionic acid (20%, pH 2.1) or ferulic acid (14%, pH 4.0-5.0) and ascorbic acid (12%) on skin defects in the eye area. A group of 39 Caucasian people were subjected to a series of five carboxytherapy treatments (right eye area) and five treatments combining carboxytherapy with a selected chemical peel for the skin around the eyes (left eye area). The efficacy of therapy was assessed based on parameters (MI and EI) measured with the Mexameter probe. Measurements were made in the tear trough and the middle of the lower eyelid. We demonstrated that a series of carboxytherapy (right side) significantly statistically influenced the EI parameter (in different measurement points: P <0.0001, P = 0.015, P = 0.002), which reflects the intensity of vascular circles under the eyes. Improvement of this parameter by 7.2 units was also shown in the tear trough in 82.1% of participants after the application of carboxytherapy combined with acids (left side) on the valley of tears for this parameter (EI). Lactobionic acid and carboxytherapy were associated with a statistically significant improvement (P = 0.011) in the tear trough. In this study, a reduction in the combined pigmentation (MI plus EI) for both the right and left sides (p = 0.001 and p = 0.015, respectively) was observed. The study provides objective evidence for the effectiveness of sole carboxytherapy and carboxytherapy combined with acids in the reduction of dark circles, in particular vascular circles in the tear trough. Lactobionic acid, ferulic acid, and ascorbic acid can be used as safe supplements to enhance carboxytherapy.

TCA chemical peel as facial anti-aging therapy for postmenopausal women: a randomised clinical study

TCA chemical peel as facial anti-aging therapy for postmenopausal women: a randomised clinical study

Investigation of inflammatory mechanisms induced by croton oil in mouse ear

Croton oil is liquid at room temperature, with a pale-yellow color and spicy odor. It is commonly used in combination with phenol as a chemical peeling agent in dermatology, which reveals its caustic exfoliating effects. Topical use of croton oil at a high dose produces skin irritation, inflammation, swelling, pain, and even tumors. Therefore, croton oil has been widely used for inflammation, pain, and tumor related research, with different animal models having been established. However, mechanistic studies through which croton oil induces skin swelling, injury and activates tissue repair/regeneration are limited. The present study used croton oil to induce mouse ear edema and examined tissue responses 4 h after exposure. To this end, croton oil was applied to the ventral side of mouse ears, followed by tissue collection. Samples were analyzed by hematoxylin and eosin (H&E) staining, toluidine blue staining, and immunohistochemistry staining for myeloperoxidase (MPO) and matrix metalloproteinase-9 (MMP-9). Western blotting and ELISA were also carried out for MMP-9 together with unbiased proteomic analysis using mass-spectrometry. Results from our study demonstrated that as soon as 4 h of exposure to 2.5 % croton oil, the expression levels of MPO and MMP-9 in the dermis significantly increased compared to acetone-treated (vehicle) control ears, as did other inflammatory reactions such as swelling and neutrophil aggregation and infiltration. Subsequently, proteomic analysis confirmed that croton oil treatment resulted in significant upregulation of proteins such as myeloperoxidase (MPO), matrix metalloproteinase-9 (MMP-9), and matrix metalloproteinase-8 (MMP-8) in the ear skin. Interestingly, mouse ears treated with acetone vehicle showed differential expression of 2,478 proteins relative to naïve tissues; among those differentially expressed in acetone-treated samples were members of the phosphatidylinositol-glycan biosynthesis class N, T and U proteins (PIGN, PIGT, and PIGU). Overall, this work confirms the presence of neutrophil-derived MPO and MMP-9 and extends the body of knowledge to show that MMP-8 is also present during croton oil-mediated skin inflammation in the mouse ear; moreover, we find that acetone vehicle is not inert and has effects on the skin that should be considered moving forward.

Application of integrated skincare in medical aesthetics: A literature review.

Integrated skincare combines clinically proven skincare products with professional medical aesthetics to provide a comprehensive solution for beauty pursuers. Studies have demonstrated that a combination of medical aesthetic procedures and maintenance therapies is more effective than either treatment alone. This review outlines the current applications of integrated skincare, including different regimens of energy-based aesthetic devices and active ingredients in cosmeceuticals or chemical peels. Additionally, the benefits and limitations of integrated skincare are discussed. Lastly, this review highlights the potential for improved satisfaction and long-term maintenance of the desired outcomes through appropriate integrated skincare procedures.

Evaluation of Cassava Peeling Machine using Dimensional Analysis Technique

Cassava processing for various products requires an efficient peeling process. However, peeling – the first step in its processing – has been considered laborious and time-consuming; hence, the need for full mechanization. Several mechanical peeling approaches have been exploited by researchers toward achieving ideal peeling. In this study, an innovative abrasive cassava peeling machine, combining chemical and mechanical peeling methods, was used for the experiment using TMS 30572 and TME 419 cassava cultivars. The physical and technological characteristics of the motion of the roots within the peeling compartment were subjected to analysis. Model equations based on dimensional analysis were adopted to predict the functionalities between cassava and the peeler variables. The following cassava roots properties were established: distal diameter (TME 419: 15.20-26.50 mm; TME 30572: 10.20-35.10 mm), peel thickness (TME 419: 1.60-4 mm; TME 30572: 1.80-4 mm) and moisture content (TME 419: 59.20-61.18%; TME 30572: 58.40-60.40%). The machine’s peeling efficiency (μ), mechanical damage (λ), peel retention (P) and throughput capacity (η) were 62.02-86.45%, 1.26-2.90%, 8.26-11.63%, 900-1,210.5 kg/h, respectively, for both cultivars. A linear relationship was found between the machine speed, velocity of conveyance and peeling time. The study revealed that the machine resulted in the careful removal of the cassava peels achieving good peeling efficiency at a speed of 1,600 rpm &lt; Nt &lt; 2,600 rpm depending on the variety. It is recommended for peeling operations in cassava processing factories.

Optimization of durable superhydrophobic wood with superstrong ultraviolet resistance and chemical stability

The less UV durability and weak chemical stability of superhydrophobic wood limited its wide application. Cu2(OH)3Cl nano particles, epoxy (EP), vinyltriethoxysilane (VTES), and room temperature vulcanized silicone rubber (RTV) were combined together to modify both soft and hard wood with function of superhydrophobic at once successfully. The modified wood was endowed not only superhydrophobicity as expected, such as CA more than 150°, along with anti-fouling and self-cleaning properties, but also excellent durability, including well chemical, sandpaper abrasion, water impact and tape peeling stability. Most prominently, there was almost no color changing being observed on the modified samples. Furthermore, the best UV resistance, 3168 h consistently against UV irradiation, was achieved in the field of wood superhydrophobic modification. The proposed synergistic protective mechanism by synthesizing silicon dioxide and siloxane has potential to extend the service life and improve the high value utilization of wood product.

Evidence-based management of cutaneous scarring in dermatology part 2: atrophic acne scarring.

Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner's solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.

Virtual mesotherapy cocktails, chemical peels and professional cosmetics

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Expert Consensus on the Clinical Application of Chemical Peels in China (2022) #

Chemical peels are widely used to treat various skin diseases and photoaging. Their rational, effective, and safe use has become an important issue in clinical practice. To standardize the clinical use of chemical peels, a group of experts developed this consensus based on the latest research and discussions. This consensus provides specific guidance to clinicians on chemical peels with respect to their classification, peeling agents, mechanisms, indications, contraindications, peeling techniques, and complications.

Cystic acne treatment: A comprehensive review

AbstractAcne, a common skin condition, is primarily seen in teenagers and young adults and is characterised by large pus‐filled bumps beneath the skin. Cystic acne is a common form and is linked to a high incidence of acne‐related skin diseases. Causes include age, sex, and lifestyle changes. Treatment options for severe acne include medications, laser therapy, chemical peels, and microneedling patches. This review focuses on cystic acne treatment options and discusses their advantages and disadvantages. Medications like isotretinoin reduce inflammation but have side effects. Laser therapy targets bacteria without medication but may require multiple sessions for optimal results.

Optimized Patient Outcomes With the Novel Modality of Corrective Chemical Peel and Neurotoxin on Same-Day Treatment.

This study was conducted to improve standards of care in the cosmetic treatment of sun damage, fine lines, and wrinkles. Chemical Peels and Neurotoxins have been traditionally used cosmetically as monotherapies. This study aimed to confirm that the same-day combination created no additional side effects while also improving outcomes. The multi-generational study enrolled 30 patients with Fitzpatrick I-VI representation. The Roberts Skin Type Classification System was used to establish baseline patient information. Patients were treated with a VI Peel&reg;, followed by Botox&reg;. Objectively, photographic matching, Wrinkle Severity Scale, Uniformity of Pigment Scale, and Skin Tone Scales were used to evaluate skin improvement. Patient questionnaires were issued to assess satisfaction. Safety of the same-day combination was established with no adverse events reported. Improvements on the Wrinkle Severity Scale showed an average rating dropping from 1.46 to 0.59 representing a 60% improvement. Improvements on the Uniformity of Pigment Scale showed an average rating dropping from 2.27 to 0.92 representing a 59% improvement. Improvements on the Skin Tone Scale showed an average rating dropping from 2.35 to 0.71 representing a 70% improvement. Questionnaires correlated with objective findings with high satisfaction.&nbsp; Conclusion: This study confirmed the safety of the same-day combination. The efficacy of VI Peel &amp; Botox same-day treatment was clinically proven by the improvements to Wrinkle Severity, Uniformity of Pigment, and Skin Tone via photographic matching. While perception studies indicated strong patient satisfaction with the combination.&nbsp;J Drugs Dermatol. 2024;23(1):1349-1354. &nbsp; doi:10.36849/JDD.7194R1.

Selected treatments and active ingredients influencing collagen synthesis

Collagen makes up 30% of all proteins in the body. There are 28 types of this protein discovered and types I and III are the most important for cosmetology. The entire process of collagen formation is a complex series of steps, beginning with transcription and culminating in enzyme reactions that determine the type, structure, and function of collagen. The decrease of collagen synthesis by the body occurs with advancing age, manifesting as skin dryness and the formation of wrinkles. This study aimed to present selected treatments affecting collagen synthesis, including needlefree and micro-needle radiofrequency, chemical peels, needle and micro-needle mesotherapy, platelet-rich plasma, and massages. Active ingredients such as retinol, vitamin C, or phytoestrogens are also effective against the signs of aging. There is no single treatment that specifically promotes the production of collagen. Optimal outcomes are achieved by employing combination therapies and implementing suitable home care regimens that are founded on active ingredients.

Characterisation of Allium sativum bulb and its component for high end applications

This paper covers selective characterisation of garlic bulb, clove, and tunic based on phyico-chemical, nutritional, phytochemical, optical, electrical, structural, and antimicrobial characteristics of the selected promising variety, Haryana Garlic–17 (HG-17). Organosulphur and phenolic compounds are major phytochemicals attributed to have therapeutic effects. Five organosulphur and fourteen phenolic compounds were identified and qualified using High-Performance Liquid Chromatography (HPLC). These were identified to have antimicrobial capabilities against Staphylococcus aureus, Escherichia coli and Aspergillus niger. The antimicrobial characteristics of garlic extract further revealed its potential for antimicrobial and biomedical applications. The tunic or peel of garlic must be removed before its utilisation for edible purposes. Manual removal of the tunic is a cumbersome process. Therefore, the effect of sodium hydroxide (lye) as a chemical peeling agent on the characteristics of the tunic was further assessed. Treatment of tunics with lye solution improved the recovery of cellulose and hemicelluloses. The prepared garlic peel powder was found to have least one dimension in the nano range, confirmed through Field Emission-Scanning Electron Microscopic. The electrical characterisation of garlic pulp reflected a positive for ohmic heating. On the other hand, treated garlic peel behaved as a potential candidate to be used in the fabrication of paper capacitors as having the capacitance peak found to a maximum near 50Hz frequency.

Recent Fluctuations in Public Searches for Cosmetic Procedures as Shown by Google Trends.

The goal of this study is to understand the dynamic trends of 20 cosmetic procedures in the United States using Google Trends. This was a descriptive cross-sectional study using Google Trends to measure changes in search volumes for 20 cosmetic procedures from a 5-year period (2018 to 2023) in the United States. Outcome measures included total and weekly changes in relative search volumes and variance levels for the following 20 search terms related to cosmetic surgeries: blepharoplasty, botox, breast augmentation, breast lift, brow lift, buccal fat removal, chemical peel, dermal filler, face lift, hair removal, hair transplant, lip filler, liposuction, masseter botox, microneedling, otoplasty, photofacial, rhinoplasty, tear trough filler, and tummy tuck. Search terms were divided into 3 categories, a) those with a change of public interest over a single week of 25% or less, b) 26%-50%, and c) greater than 50%. There was an overall 5-year increase of public interest in all but 5 search terms: breast augmentation, breast lift, liposuction, photofacial, and tummy tuck. Within a single week, lip filler, masseter botox, buccal fat removal, and tear trough filler exhibited greater than 50% change in public interest, while public interest in microneedling, hair removal, rhinoplasty, tummy tuck, liposuction, breast lift, and augmentation were more stable with less than 26% change. While certain procedures may experience rapid accelerations in public interest, not all procedures will consistently increase in popularity. Physicians must recognize the shifting popularity of cosmetic procedures to provide informed cosmetic care to patients.