ABSTRACT
BACKGROUND: Treatment of acne scarring in darker skin types is fraught with challenges. Highly purified liquid injectable silicone (LIS) is effective in the treatment of acne scars, although its use in darker skin types has yet to be evaluated. OBJECTIVE: Retrospective evaluation of the safety and efficacy of highly purified LIS for the treatment of acne scars in lighter and darker skin types. MATERIALS AND METHODS: A retrospective chart review of patients who received highly purified LIS for acne scars between July 2010 and March 2021. RESULTS: Two hundred six total treatments in 96 patients, 32.29% ( n = 31) of whom were Fitzpatrick skin type IV ( n = 20, 20.83%) and V ( n = 11, 11.46%), with depressed and both broad-based and shallow acne scarring were reviewed. Mean age was 50.77 years (SD 16.77), and 83% were female. Complications such as granuloma formation, migration, extrusion of silicone, hyperpigmentation, hematoma, or infection were not observed. The average follow-up time was 6.31 years (SD 3.02). CONCLUSION: Highly purified LIS is a safe and effective permanent treatment for acne scars in all skin types. Injection of highly purified LIS using small volume microdroplet technique at 6- to 8-week intervals did not yield any complications, including in patients with darker skin types.
Subject(s)
Acne Vulgaris , Cicatrix , Humans , Female , Middle Aged , Male , Cicatrix/etiology , Cicatrix/therapy , Cicatrix/pathology , Retrospective Studies , Silicones , Acne Vulgaris/complications , Treatment OutcomeABSTRACT
BACKGROUND: Constitutional periorbital dark circles (PDC) are common in skin of color and represent a therapeutic challenge. OBJECTIVE: To summarize the experience of the International Peeling Society on the safety and effectiveness of deep chemical peeling in the treatment of constitutional PDC. MATERIALS AND METHODS: Multi-institutional, retrospective case series (1990-2020) of constitutional PDC treated by deep chemical peeling. Descriptive analysis by age, sex, Fitzpatrick phototype, phenol-croton formula, degree and durability of improvement, and complications. RESULTS: Fifty-five phenol-croton oil peels were performed in 52 patients: 3 patients received a second peel for periorbital rhytids 72 to 84 months after the first peel. 92% (48/52) of patients were women; the median age was 46 years (range, 23-68 years). 89% (46/52) of patients were Fitzpatrick III-IV. Most common formula included phenol 60% to 65% and croton oil 0.6% to 0.7%. 89% (49/55) of peels demonstrated >50% clinical improvement. The median duration of improvement was 24 months (range, 1.5-168 months), and 69% (36/52) of patients demonstrated ongoing improvement at the last follow-up. 4% (2/55) of peels exhibited complications of persistent erythema that resolved without scarring. CONCLUSION: Based on its safety and effectiveness, deep chemical peels are a treatment of choice for constitutional PDC.
Subject(s)
Chemexfoliation , Croton , Humans , Female , Middle Aged , Male , Croton Oil , Retrospective Studies , PhenolsABSTRACT
BACKGROUND: Actinic keratoses (AKs) are a common premalignant cutaneous neoplasm and can progress to squamous cell carcinoma. A variety of treatment options are available for field therapy of diffuse AKs. OBJECTIVE: This review systematically analyzes the use of chemical peels for treatment of AKs. MATERIALS AND METHODS: A systematic review of PubMed was performed searching from 1946 to March 2020 to identify the literature on chemical peels for AKs. RESULTS: Of the 151 articles identified, 5 met inclusion criteria for review. Four of the reviewed articles demonstrated the efficacy of chemical peels in reducing AK count and minimal adverse effects. In some studies, chemical peels exhibited potential to prevent additional AK formation and development of keratinocyte carcinomas. CONCLUSION: Chemical peels are an efficacious and affordable treatment option for field treatment of AKs. With improved patient tolerance and adherence, chemical peels are an attractive option for field therapy of AKs for both dermatologists and patients.
Subject(s)
Caustics/administration & dosage , Chemexfoliation/statistics & numerical data , Keratosis, Actinic/surgery , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/prevention & control , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/prevention & control , Caustics/adverse effects , Chemexfoliation/adverse effects , Humans , Keratosis, Actinic/pathology , Recurrence , Secondary Prevention/methods , Secondary Prevention/statistics & numerical data , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Skin Neoplasms/prevention & control , Treatment OutcomeABSTRACT
BACKGROUND: Chemical peels are applied to the face and neck to improve rhytides and the photoaged appearance of the skin. Peels can be applied to different skin depths depending on the types of chemicals, the volume of solution, and the amount of pressure or friction applied. If a peel is applied too superficially, rhytides will not be removed. If a peel is applied too deeply, scarring or hypopigmentation could occur. OBJECTIVE: To create face and neck depth maps for chemical peeling, which can guide safety when removing rhytides and improving the skin's appearance. MATERIALS AND METHODS: A multicenter retrospective review of records was conducted of patients who underwent phenol-croton oil peeling, from January 1, 2018, to December 31, 2018. Information was collected on facial and neck cosmetic units peeled, peel formula and strength used, outcomes, and complications. RESULTS: A total of 410 patients received deep peels. Two depth maps were created that corresponded to the most common patterns of deep chemical peel applications. CONCLUSION: Different areas of the face and neck are treated with different chemical peel application depths to safely improve rhytides and appearance. Depth maps are created to balance safety and efficacy.
Subject(s)
Chemexfoliation/methods , Dermabrasion/methods , Keratolytic Agents/administration & dosage , Administration, Cutaneous , Adult , Aged , Aged, 80 and over , Chemexfoliation/adverse effects , Croton Oil/administration & dosage , Croton Oil/adverse effects , Dermabrasion/adverse effects , Face/anatomy & histology , Female , Humans , Keratolytic Agents/adverse effects , Male , Middle Aged , Neck/anatomy & histology , Phenol/administration & dosage , Phenol/adverse effects , Retrospective Studies , Skin/anatomy & histology , Skin/drug effects , Skin Aging , Treatment OutcomeABSTRACT
Once considered the standard for deep facial resurfacing, the classical Baker-Gordon phenol-croton oil peel has largely been replaced by formulas with lower concentrations of phenol and croton oil. The improved safety profile of deep peels has ushered in a new era in chemical peeling. Wrinkles can be improved and skin can be tightened with more subtle and natural results. No longer does a deep peel denote "alabaster white" facial depigmentation with complete effacement of wrinkles. Gregory Hetter's research showed that the strength and corresponding depth of penetration of the phenol-croton oil peel can be modified by varying the concentration of croton oil. This second article in this continuing medical education series focuses on the main historical, scientific, and procedural considerations in phenol-croton oil peels.
Subject(s)
Chemexfoliation/methods , Croton Oil/therapeutic use , Dermatologic Agents/therapeutic use , Phenol/therapeutic use , Chemexfoliation/adverse effects , Drug Combinations , Humans , Patient Selection , Skin/pathology , Skin AgingABSTRACT
Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.
Subject(s)
Caustics/therapeutic use , Chemexfoliation/methods , Keratolytic Agents/therapeutic use , Skin Diseases/therapy , Chemexfoliation/adverse effects , Drug Combinations , Ethanol/therapeutic use , Glycolates/therapeutic use , Humans , Lactic Acid/therapeutic use , Phenol/therapeutic use , Resorcinols/therapeutic use , Salicylates/therapeutic use , Salicylic Acid/therapeutic use , Tretinoin/therapeutic use , Trichloroacetic Acid/therapeutic useABSTRACT
BACKGROUND: Highly purified liquid-injectable silicone (LIS) has been established as a permanent agent for off-label correction of HIV-associated facial lipoatrophy (HIV-FLA). However, controversy exists about long-term safety. OBJECTIVE: To establish the safety and efficacy at 10 years or greater of LIS for HIV-FLA. METHODS: Patients from 3 practices with 10-year or greater in-person office follow-up were analyzed to determine the number of LIS treatments and total volume required to achieve optimal correction. The nature of any treated adverse events was noted. RESULTS: One hundred sixty-four patients had 10-year or greater in-office follow-up. All subjects maintained long-term correction with an average of 9 treatments, average of 1.56 mL per treatment, and an average total of 14.1 mL. Two patients had severe adverse events manifesting as temporary facial edema. Four patients experienced mild-to-moderate excess fibroplasia presenting as perceived overcorrection, and 6 patients had nondisfiguring subcutaneous firmness. All adverse events were successfully treatable, mostly with intralesional 5-fluorouracil and triamcinolone. CONCLUSION: Liquid-injectable silicone is an effective long-term treatment option for HIV-FLA. When injected in small quantities with the microdroplet serial puncture technique at monthly or greater intervals, optimal correction appears durable for more than 10 years. Adverse events consisted mostly of excess fibroplasia and were treatable.
Subject(s)
Cosmetic Techniques , Dimethylpolysiloxanes/administration & dosage , Facial Dermatoses/therapy , HIV-Associated Lipodystrophy Syndrome/therapy , Silicones/administration & dosage , Biocompatible Materials/administration & dosage , Cohort Studies , Follow-Up Studies , Humans , Injections, Subcutaneous , Male , Time FactorsSubject(s)
Chemexfoliation , Trichloroacetic Acid , Basement Membrane , Dermabrasion , Humans , Reference StandardsABSTRACT
BACKGROUND: Cosmetic dermatologic procedures offer the promise of visible aesthetic enhancement with minimal risk. While in recent years the number of available procedures has proliferated, there are few objective methods for evaluating the relative quality of these procedures for particular indications or specific patients. OBJECTIVE: (A) To develop a simple, easy-to-use numerical rating scale to assess the quality of cosmetic surgical procedures on a range of parameters pertaining to clinical efficacy and patient satisfaction; (B) to statistically validate the discriminative value of this rating scale. METHODS: (A) Patient and physician interviews were performed to elicit a list of factors that may collectively characterize the clinical efficacy and patient tolerability of cosmetic dermatologic procedures. A 0-100 point rating scale was developed based on these factors, with the face-validity of this scale checked by a group of patients and physicians; (B) Statistical analysis of the questionnaire was performed by asking 15 expert cosmetic dermatologic surgeons to use it to rate 23 common cosmetic dermatologic procedures, and analyzing the results. RESULTS: (A) An easy-to-use scale was constructed to assess the quality of cosmetic dermatologic procedures by rating the associated cost, risk, time (procedure and recovery), discomfort, results, and longevity of benefit. A "physician adjustment factor" was used to further increase the relevance of this 0-100 point scale for specific patients; (B) Repeated-measures analysis of variations (ANOVAs) performed on the data from the survey of experts demonstrated that this scale can be used to discriminate between common dermatologic procedures. The differences in mean subscores and total scores among procedures grouped by anatomic site and target lesion-type were significant at the level of P < .05. LIMITATIONS: Patient preferences exogenous to the rating scale may increase or decrease the suitability of specific procedures. CONCLUSIONS: Common cosmetic dermatologic procedures are of uniformly high quality, as per expert ratings on a systematic measure. This quality rating scale appears statistically valid and robust, given that expert raters assigned similar ratings to the same procedures but mean ratings were different across procedures. In the future, this quality rating scale can be used to assess novel interventions, and to help dermatologic surgeons faced with patient concern to optimally select among alternative procedures for a given indication.