Escolar Documentos
Profissional Documentos
Cultura Documentos
Review article
Authors:
Vania Marta Figueiredo Yokomizo
Tania Maria Henneberg Benemond
Chinobu Chisaki
Paula Henneberg Benemond
ABSTRACT
Cosmetic-driven research currently yields an avalanche of products and treatments for all dermatological sub-segments. Many treatments aimed at rejuvenating skin have been developed. Although chemical peels have now been used for more than a centuryand despite the availability of new technologiesthe treatment is still widely known and employed due to its practicality, low cost, and excellent results. The present study offers a review of all types of peelings recognized by the scientific literature from the most superficial to the deepest compiling the practical experience of the authors
and detailed descriptions of the application technique, results, and complications.
Keywords: chemexfoliation;phenol; skin.
RESUMO
A pesquisa atual em funo da cosmtica desenvolve uma avalancha de produtos e tratamentos para todas as reas dermatolgicas a cada dia. Muitos tratamentos visando ao rejuvenescimento cutneo tm sido desenvolvidos. Embora os peelings qumicos sejam usados
h mais de um sculo e apesar das novas tecnologias existentes, continuam amplamente
usados e divulgados por sua praticidade, baixo custo e timos resultados. Os autores apresentam uma reviso de todos os tipos de peelings reconhecidos pela literatura cientfica
desde o mais superficial at o mais profundo, acrescentando experincia prtica com detalhada descrio da tcnica de aplicao, resultados e complicaes.
Palavras-chave: abraso qumica; fenol; pele.
Correspondence:
Dr. Vania Marta F. Yokomizo
Av. Brigadeiro Faria Lima, 1597conj. 403
Cep: 01452-917So Paulo (SP), Brazil
E-mail: vaniamfy@yahoo.com.br
INTRODUCTION
An ever-growing number of peelings have continued
toarise,improving on or being associated with existing ones, or
innovating with new formulas.The controlled therapeutic
desquamation caused by these procedures is a powerful weapon
in the treatment of various diseases and aesthetic disorders.Their
main indications are the treatment of spots, and scars and fine
wrinkles, and can be performed on the face and body areas.
The term peeling originates from the English to peel = to
come off in sheets or scales, to lose an outer layer,or to strip off.
It refers to the application of a chemical agent to the skin that
may cause the controlled destruction of part or all of the epidermis, leading to the removal of the lesions with exfoliation,
and followed by the regeneration of new tissues.1,2
Chemical peelings
HISTORY
Chemical peelings were first described in Egyptian medicine in 1550 BC, in the Ebers papyrus. Reports are also found
in ancient Greek and Roman literature .In previous centuries,
some formulas were passed on by peoples of Gypsy origin.
Dermatologists began to show an interest in peelings in the
nineteenth century. In 1874, in Vienna, the dermatologist
Ferdinand Von Hebra used the technique to treat melasma,
Addisons disease, and ephelides. In 1882, in Hamburg, Paul G.
Unna described the actions of salicylic acid, resorcinol,
trichloroacetic acid (TCA) and phenol on the skin. His early
work was followed by a prolific academic production.3
The use of phenol was developed after the First World
War, in France. In England, Mac Kee had already used phenol to
treat scars, but did not publish his results until 1952. Meanwhile,
in the United States during the 1940s, Eller and Wolff provided
the first systematic description of the use of phenol, salicylic
acid, resorcinol, and dry ice for the treatment of scars.
Themodern era of peelings began in the 1960s, with the development of modified solutions of phenol (addition of croton oil,
septisol and water) by Baker and Gordon, and with the histological evaluation of results, comparing effects between phenol and
TCA. The scientific basis for TCA-based treatments was
expanded in the 1970s and early 1980s through the comparison of histological effects caused by three different TCA concentrations. Concomitantly, alpha-hydroxy acids (AHA) were
developed by Van Scott and Yu for more superficial peelings,
which were indicated for the treatment of hyperkeratosis. The
glycolic acid-based peeling was developed later on.The combination of two substances aimed at achieving medium depth
effects, described by Brody and Hailey, and subsequently by
Monheit, lent further progress in the use of peelings. The most
recent development is the use of lipohydroxy acid (LHA).4,5
CLASSIFICATION
Peelings can be classified according to depth into:
- Very superficial:removing the stratum corneum (depth
= 0.06 mm);
- Superficial: causingepidermal exfoliation of the granular layer up until the basal layer (depth = 0.45 mm);
- Medium: reaching the papillary dermis (depth = 0.6 mm)
- Deep: reaching the midreticular dermis (depth = 0.8 mm).
The deeper the peelings, the more apparent the results
however risks and discomfort in the period after the procedure
will also increase.
The criteria used in the indication of each peeling type
include age, skin phototype, body area to be treated, degree of
photoaging, results sought, and the skill fulness of the applicator
physician, in addition to factors intrinsic to each patient.2
The absorption of the medications varies according to:
- Characteristics of the skin: thickness of the epidermis,
density of the follicles, degree of photo-aggression, gender (male
skin is oilier, hampering penetration), skin phototype (the lower
the phototype, the greater the penetration), integrity of the epidermal barrier, previous preparation, cleansing prior to the
59
60
FIGURE 1:
Immediatepostpee
ling: frosting.
61
Chemical peelings
Before
After Tca
62
Before
Chemical peelings
63
64
FIGURE 6:
60% resorcinol peeling
65
Chemical peelings
Before
Application
66
48h
Immediate PostPeeling
48h
48h
Before
After
67
Chemical peelings
7 Days After
2 Months After
4 Months After
68
- textural alterations
- persistent erythema: erythema lasting for more than
three weeks is indicative of hypertrophic scarring and must be
treated with potent topical corticosteroids (Figure 11)
toxicity:it may occur with salicylic acid, resorcinol and
phenol2
Peelings are contraindicated in cases of pregnancy, lactation, active herpes lesions, bacterial or fungal infection, facial
dermatitis, use of photosensitizing medications, allergies to
components of the peeling formula, and unrealisticexpectations.30,31
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Kadunc BV. cido pirvico: tcnica de padronizao para uso em esfoliaes qumicas atravs de estudo experimental. [Tese]. So Paulo:
Universidade de So Paulo; 1998.
Berardesca E, Cameli N, Primavera G, Carrera M. Clinical and
Instrumental Evaluation of Skin Improvement afterTreatment with a
New 50% Pyruvic Acid Peel. Dermatol Surg. 2006;32:52631.
Grimes PE. The safety and efficacy of salicylic acid chemical peels in
darker racial-ethnic groups.Dermatol Surg. 1999;25(1):1822.
Uhoda E, Pierard-Franchimont C, Pierard GE. Comedolysis by a lipohydroxyacid formulation in acne-prone subjects. Eur J Dermatol.
2003;13(1):658.
Garg VK, Sinha S, Sarkar R. Glycolic acidpeels versus salicylic-mandelicacid peels in active acne vulgaris and post-acne scarring and hyperpigmentation: A comparative study. Dermatol Surg.2009;35(1):5965.
Costa A, Basile AV, Medeiros VLS, Moiss TA, Ota FS, Palandi JAC. Peeling
de gel de cido tiogliclico 10%: opo segura e eficiente na pigmentao infraorbicular constitucional. Surg Cosmet Dermatol.
2010;2(1):29-33.
Obagi ZE, Obagi S, Alaiti S, Stevens MB. TCA-based blue peel: a standardized procedure with depth control. Dermatol Surg. 1999;25(10):773-80.
Steiner D, Feola C, Bialeski N, Silva FAM, Antiori ACP, Addor FAZ, Folino BB.
Estudo de avaliao da eficcia do cido tranexmico tpico e injetvel
no tratamento do melasma. Surg Cosmet Dermatol. 2009;1(4):174-7.
Kanechorn Na, Ayuthaya P, Niumphradit N, Manosroi A,
NakakesA.Topical 5% tranexamic acid for the treatment of melasma in
Asians: a double-blind randomized controlled clinical trial. J Cosmet
Laser Ther. 2012;14(3):150-4.
Lee JH, Park JG, Lim SH, Kim JY, Ahn KY, et al. Localized intradermal
microinjection of tranexamic acid for treatment of melasma in Asian
patients: a preliminary clinical trial. Dermatol Surg. 2006;32(5):626-31.
Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A study comparing
chemicalpeeling using modified Jessner's solution and 15% trichloroacetic Acid versus 15% trichloroacetic acid in the treatment of
melasma. Indian J Dermatol. 2009;54(1):415.
Hong SP, Han SS, Choi SJ, Kim MS, Won CH, Lee MW, et al. Split-face comparative study of 1550 nm fractional photothermolysis and trichloroacetic acid 15% chemical peeling for facial melasma in Asian skin. J
Cosmet Laser Ther. 2012;14(2):81-6.
Mendona MC, Aarestrup FM, Aarestrup BJ. Clinical protocol for punctuated 88% phenol peels in the treatment of photoaging: a histopathological study of three cases. Dermatol Surg. 2012;38(12):2011-5.
Berson DS, Cohen JL, Rendon MI, Roberts WE, Starker I, Wang B. Clinical
role and application of superficial chemical peels in today's practice. J
Drugs Dermatol. 2009;8(9):803-11.