Cosmetic use of three topical moisturizers following glycolic acid facial peels.

BACKGROUND: Facial chemical exfoliation (peeling) involves using a chemical agent to insult the skin and damage the cutaneous barrier, to reduce the signs of aging. The use of a moisturizer is advised postprocedure to promote repair of the epidermis. Biomimic moisturizer formulations may be effective treatment options for repair following facial peeling. AIMS: The aim of this study was to assess the local tolerance and cosmetic efficacy of three topical moisturizers (Physiogel® moisturizing creams), used after a 70% glycolic acid facial peel. METHODS: Three randomized, evaluator-blind, parallel group studies were performed. Subjects were healthy females aged 30-60 years with moderate to advanced photoaged skin (Glogau photoaging type II-III). All included a screening visit, a 7-day washout period, a 70% glycolic acid facial peeling procedure, and randomization to a 14-day treatment period with one of the three test products vs control. RESULTS: The primary endpoint was reached in all three studies; all completed subjects in the test groups received a favorable dermatologist global assessment score for tolerance at Day 14 (postchemical peel). Secondary assessments of local tolerance based on dermatologist and subject self-assessment scores demonstrated improvements from baseline. No treatment-related adverse events were reported in any study. Benefits for the test products were also observed in secondary efficacy analyses of transepidermal water loss and moisturization. CONCLUSIONS: These studies have demonstrated the local tolerance and cosmetic efficacy of three moisturizing skin care products, when used for skin recovery after superficial chemical peeling on the face.

Tretinoin peel: a critical view.

The tretinoin peel, also known as retinoic acid peel, is a superficial peeling often performed in dermatological clinics in Brazil. The first study on this was published in 2001, by Cuce et al., as a treatment option for melasma. Since then, other studies have reported its applicability with reasonable methodology, although without a consistent scientific background and consensus. Topical tretinoin is used for the treatment of various dermatoses such as acne, melasma, scars, skin aging and non-melanoma skin cancer. The identification of retinoids cellular receptors was reported in 1987, but a direct cause-effect relation has not been established. This article reviews studies evaluating the use of topical tretinoin as agent for superficial chemical peel. Most of them have shown benefits in the treatment of melasma and skin aging. A better quality methodology in the study design, considering indication and intervention is indispensable regarding concentration, vehicle and treatment regimen (interval and number of applications). Additionally, more controlled and randomized studies comparing the treatment with tretinoin cream versus its use as a peeling agent, mainly for melasma and photoaging, are necessary.

Tretinoin peel: a critical view

Abstract The tretinoin peel, also known as retinoic acid peel, is a superficial peeling often performed in dermatological clinics in Brazil. The first study on this was published in 2001, by Cuce et al., as a treatment option for melasma. Since then, other studies have reported its applicability with reasonable methodology, although without a consistent scientific background and consensus. Topical tretinoin is used for the treatment of various dermatoses such as acne, melasma, scars, skin aging and non-melanoma skin cancer. The identification of retinoids cellular receptors was reported in 1987, but a direct cause-effect relation has not been established. This article reviews studies evaluating the use of topical tretinoin as agent for superficial chemical peel. Most of them have shown benefits in the treatment of melasma and skin aging. A better quality methodology in the study design, considering indication and intervention is indispensable regarding concentration, vehicle and treatment regimen (interval and number of applications). Additionally, more controlled and randomized studies comparing the treatment with tretinoin cream versus its use as a peeling agent, mainly for melasma and photoaging, are necessary.

Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris.

Acne vulgaris is an extremely common condition affecting the pilosebaceous unit of the skin and characterized by presence of comedones, papules, pustules, nodules, cysts, which might result in permanent scars. Acne vulgaris commonly involve adolescents and young age groups. Active acne vulgaris is usually associated with several complications like hyper or hypopigmentation, scar formation and skin disfigurement. Previous studies have targeted the efficiency and safety of local and systemic agents in the treatment of active acne vulgaris. Superficial chemical peeling is a skin-wounding procedure which might cause some potentially undesirable adverse events. This study was conducted to review the efficacy and safety of superficial chemical peeling in the treatment of active acne vulgaris. It is a structured review of an earlier seven articles meeting the inclusion and exclusion criteria. The clinical assessments were based on pretreatment and post-treatment comparisons and the role of superficial chemical peeling in reduction of papules, pustules and comedones in active acne vulgaris. This study showed that almost all patients tolerated well the chemical peeling procedures despite a mild discomfort, burning, irritation and erythema have been reported; also the incidence of major adverse events was very low and easily manageable. In conclusion, chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in active acne vulgaris while salicylic acid peels is a more convenient for treatment of darker skin patients and it showed significant and earlier improvement than glycolic acid.

Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris

Abstract: Acne vulgaris is an extremely common condition affecting the pilosebaceous unit of the skin and characterized by presence of comedones, papules, pustules, nodules, cysts, which might result in permanent scars. Acne vulgaris commonly involve adolescents and young age groups. Active acne vulgaris is usually associated with several complications like hyper or hypopigmentation, scar formation and skin disfigurement. Previous studies have targeted the efficiency and safety of local and systemic agents in the treatment of active acne vulgaris. Superficial chemical peeling is a skin-wounding procedure which might cause some potentially undesirable adverse events. This study was conducted to review the efficacy and safety of superficial chemical peeling in the treatment of active acne vulgaris. It is a structured review of an earlier seven articles meeting the inclusion and exclusion criteria. The clinical assessments were based on pretreatment and post-treatment comparisons and the role of superficial chemical peeling in reduction of papules, pustules and comedones in active acne vulgaris. This study showed that almost all patients tolerated well the chemical peeling procedures despite a mild discomfort, burning, irritation and erythema have been reported; also the incidence of major adverse events was very low and easily manageable. In conclusion, chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in active acne vulgaris while salicylic acid peels is a more convenient for treatment of darker skin patients and it showed significant and earlier improvement than glycolic acid

Tretinoin-based formulations - influence of concentration and vehicles on skin penetration

Tretinoin is used in the management of acne and it is part of a gold standard treatment for photoaging. It has also been reported as an agent for superficial chemical peeling in highly concentrated formulations with few considerations about skin penetration. The aim of this study was to evaluate the influence of drug concentration and vehicles currently used on skin penetration of tretinoin. In vitro permeation tests were carried out using Franz diffusion cells fitted with porcine ear skin and 10% aqueous methanol in the receptor compartment. Formulations studied, cream or hydroalcoholic dispersion, containing 0.25%, 1% and 5% of tretinoin were placed in the donor compartment for six hours. Tretinoin concentration in skin layers was measured by high performance liquid chromatography. The largest amount of tretinoin from both vehicles was detected in stratum corneum with significant differences among the three concentrations. The hydroalcoholic dispersion was the best vehicle. Significant amounts of tretinoin were found even in deep layers of epidermis. The formulation with 0.25% tretinoin showed better results when considered the amount of tretinoin on skin in terms of percentage. Finally, skin penetration of tretinoin was influenced by vehicle and concentration of this drug used in formulation.

A tretinoína é usada no tratamento de acne e é considerada como padrão de ouro para o tratamento do fotoenvelhecimento. Em altas concentrações, é relatada como um agente para peeling químico superficial, com poucas considerações sobre a penetração na pele. O objetivo deste estudo foi avaliar a influência da concentração do fármaco e os veículos comumente usados na penetração cutânea da tretinoína. Testes in vitro de penetração foram realizados com células de difusão de Franz equipados com pele da orelha de porco e 10% de solução aquosa de metanol no compartimento receptor. As formulações estudadas, creme ou dispersão hidroalcoólica, contendo 0,25%, 1% e 5% de tretinoína foram colocadas no compartimento doador, durante seis horas. A concentração da tretinoína foi medida por cromatografia líquida de alta eficiência. A maior quantidade de tretinoína foi detectada no estrato córneo com diferenças significativas entre as três concentrações. A dispersão hidroalcoólica foi o melhor veículo. Quantidades significativas de tretinoína foram encontradas nas camadas profundas da epiderme. A formulação com 0,25% de tretinoína mostrou melhores resultados em termos de porcentagem penetrada na pele. Por fim, a penetração de tretinoína na pele foi influenciada pelo veículo e pela concentração desta utilizada na formulação.

Five percent 5-fluorouracil in a cream or for superficial peels in the treatment of advanced photoaging of the forearms: a randomized comparative study.

BACKGROUND: The antimetabolite 5-fluorouracil (5-FU) is used for topical treatment of actinic keratosis. Overall improvement in the skin is also observed. Additionally, 5-FU was reported to be used for superficial peels. OBJECTIVES: To evaluate the efficacy and safety of 5% 5-FU cream compared with peels for photodamaged forearms. METHODS: This interventional, randomized, comparative, evaluator-blind study included 32 patients with severe photoaging of forearms. The regimens comprised either application of 5% 5-FU cream everyday for 4 weeks on 1 forearm and 4 weekly peels on the other. Efficacy assessment included: clinical photodamage scores, opinion of patients and investigators, and blind photographic evaluation by independent observers. Skin biopsies were performed for histologic and immunohistochemical analysis. Safety evaluation comprised observation of adverse events. RESULTS: Clinical and histologic findings confirmed the benefits of topical 5% 5-FU, in cream or peels, which improved skin appearance and decreased the dermal elastotic material. Immunohistochemistry showed reduced levels of epidermal p53 and increase in the level of procollagen I. Results were maintained after 6 months. Predictable adverse events occurred, with no differences between treatments. Patients reported better tolerability to peels. CONCLUSION: Five percent 5-FU cream or peels was safe and effective for the treatment of photodamaged forearms. Decreased epidermal p53 levels and new dermal collagen were confirmed.

Randomized clinical efficacy of superficial peeling with 85% lactic acid versus 70% glycolic acid / Estudo randomizado da eficacia clinica dos peelings superficiais de acido lactico 85% versus acido glicolico 70%

BACKGROUND: Peeling is a procedure which aims to accelerate the process of skin exfoliation. OBJECTIVES: Development of formulations containing lactic acid at 85% or glycolic acid at 70% and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles. METHODS: Preliminary stability tests were carried out and an in vivo study was performed with three groups with 9 representatives each. One was the control group, which used only sunscreen; another one used lactic acid+sunscreen, and the last group used acid glycolic+sunscreen. Clinical efficacy was assessed with a CCD color microscope, through the digitization of images before and after treatment. The applications were carried out by a dermatologist, once a mont h every 30 days, during 3 months. The area with wrinkles was calculated by planimetry point counting, in accordance with Mandarin-de-Lacerda. RESULTS: The formulations were stable in the visual and Ph evaluation. There was no improvement in the control group; for lactic acid, there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye. For the glycolic acid group, there was significant improvement in the outer lateral area of the left eye after the first application, and of the right eye region, after three applications. The formulations used must be kept under refrigeration and should be manipulated every 30 days. CONCLUSIONS: Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications (p≤0.05%). It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye, relative to the speed of skin improvement. .

FUNDAMENTOS: Peeling visa a acelerar o processo de esfoliação da pele. OBJETIVOS: Desenvolver formulações contendo ácido láctico a 85% ou ácido glicólico a 70% e avaliar sua eficácia clínica na redução de rugas finas. MÉTODOS: Testes preliminares foram efetuados e estudo in vivo foi realizado em três grupos com nove representantes cada, separados de forma randomizada. Um grupo foi controle, utilizando apenas fotoprotetor; outro utilizou ácido láctico e fotoprotetor; o último usou ácido glicólico e fotoprotetor. Para eficácia clínica, empregou-se microscópio CCD color, digitalizando-se as imagens do pré e do pós-tratamento. As aplicações foram realizadas por médica dermatologista uma vez por mês, a cada 30 dias, durante três meses. A área com traços de ruga foi calculada pela planimetria por contagem de pontos. RESULTADOS: As formulações foram estáveis na avaliação visual e de pH. Não houve melhora no grupo controle; para o grupo do ácido láctico, houve melhora significativa após a segunda aplicação do peeling na região lateral externa do olho direito e após a terceira aplicação na região lateral externa olho esquerdo. Para o grupo do ácido glicólico, houve melhora significativa na região lateral externa olho esquerdo após a primeira aplicação e, depois de três aplicações, na região lateral externa do olho direito. As formulações magistrais empregadas no estudo devem ser mantidas sob refrigeração e manipuladas a cada 30 dias. CONCLUSÕES: Tanto o peeling de ácido láctico quanto o de ácido glicólico foram eficazes na diminuição de rugas finas da região lateral externa dos olhos após ...

Randomized clinical efficacy of superficial peeling with 85% lactic acid versus 70% glycolic acid.

BACKGROUND: Peeling is a procedure which aims to accelerate the process of skin exfoliation. OBJECTIVES: Development of formulations containing lactic acid at 85% or glycolic acid at 70% and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles. METHODS: Preliminary stability tests were carried out and an in vivo study was performed with three groups with 9 representatives each. One was the control group, which used only sunscreen; another one used lactic acid+sunscreen, and the last group used acid glycolic+sunscreen. Clinical efficacy was assessed with a CCD color microscope, through the digitization of images before and after treatment. The applications were carried out by a dermatologist, once a mont h every 30 days, during 3 months. The area with wrinkles was calculated by planimetry point counting, in accordance with Mandarin-de-Lacerda. RESULTS: The formulations were stable in the visual and Ph evaluation. There was no improvement in the control group; for lactic acid, there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye. For the glycolic acid group, there was significant improvement in the outer lateral area of the left eye after the first application, and of the right eye region, after three applications. The formulations used must be kept under refrigeration and should be manipulated every 30 days. CONCLUSIONS: Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications (p ≤ 0.05%). It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye, relative to the speed of skin improvement.

Observations on estrus as monitored by receptivity to mating activity and pattern of vaginal exfoliates in trypanosoma brucei ­ infected WAD goat does synchronized with Estrumate® / Observaciones sobre el estro monitorizado por la receptividad a la actividad de apareamiento y el patrón de exfoliación vaginal en cabras WAD infectadas por trypanosoma brucei sincronizadas con Estrumate®

The effects of experimental Trypanosoma brucei infection on receptivity to mating activity and pattern of vaginal exfoliates were monitored using twenty-one adult WAD goats which were synchronized with double injection, seven days apart of Estrumate®. The twenty-one goats consisted of 3 bucks and 18 does. The does were randomly divided into control group 'A' having 10 does and test group 'B' with 8 does. The goats were fed with Elephant grass in the morning and commercial feed containing 15.23 percent CP at the rate of 0.25kg/head in the afternoons. Freshwater was provided ad libitum. Results showed that while all the control does were observed to stand to be mounted and mated, none of the infected does did. Also, the pattern of the mean percentage vaginal exfoliated cell types encountered between the control and infected doe groups were converse. While parasabal cells changed from 2.90±0.03 percent during proestrus through 3.05 +/- 0.46 percent during estrus to 2.42 +/-0.08 percent at diestrus in the control does, it changed from 22.07 +/- 0.56 percent during expected proestrus through 8.48 +/- 0.05 percent during expected estrus to 28.05 +/-1.09 percent respectively in the infected does. In like manner, intermediate cell changed from 11.10 +/- 0.03 percent during proestrus through 11.10 +/- 0.31 percent during estrus to 1.21 +/- 1.00 percent during diestrus in control does while it changed from 27.27 +/- 0.08 percent during expected proestrus through 42.37 +/- 2.39 percent during expected estrus to 40.24 +/- 1.06 percent during expected diestrus in infected does. Similarly, superficial cells changed from 56.25 +/- 0.75 percent during proestrus through 63.70 +/- 1.05 percent during estrus to 7.37 +/- 0.01 percent during diestrus while it changed from 0.00 percent during expected proestrus through 3.39 +/- 0.02 percent during expected estrus to 63.70 +/- 1.05 percent during estrus to 6.10 +/- 0.01 percent during expected diestrus. In the control does, the ...

Los efectos de la infección experimental por Trypanosoma brucei sobre la receptividad a la actividad de apareamiento y el patrón de exfoliación vaginal fueron monitoreados utilizando 21 cabras WAD adultas sincronizadas con doble inyección, a los siete días de diferencia de Estrumate®. De las 21 cabras utilizadas eran 3 machos y 18 hembras. Las hembras se dividieron al azar en grupo control "A" con 10 sujetos y un grupo de prueba "B" con 8. Las cabras fueron alimentadas con pasto y alimento comercial que contenía 15,23 por ciento de CP en tasa de 0,25kg/por cabeza en las tardes. Agua fresca fue proporcionada ad libitum. Los resultados mostraron que mientras todos las cabras del grupo control pudieron ser montadas y acopladas, ninguna de las infectadas pudo. Además, fue contradictorio el patrón de la media porcentual de los tipos de células vaginales exfoliadas encontradas entre los grupo control e infectadas. Mientras que las células parabasales cambiaron desde un 2,90 +/- 0,03 por ciento durante el proestro, al 3,05 +/- 0,46 por ciento durante el estro y 2,42 +/- 0,08 por ciento al diestro en el grupo control, el grupo infectado cambió desde un 22,07 +/- 0,56 por ciento durante el proestro, al 8,48 +/- 0,05 por ciento durante el estro y 28,05 +/- 1,09 por ciento al diestro. De la misma forma, las célula intermedias cambiaron de un 11,10 +/- 0,03 por ciento durante el proestro, al 11,10 +/- 0,31 por ciento durante el estro y al 1,21 +/- 1,00 por ciento durante el diestro en el grupo control, mientras que en el grupo infectado pasó del 27,27 +/- 0,08 por ciento durante el proestro, al 42,37 +/- 2,39 por ciento durante el estro y al 40,24 +/- 1,06 por ciento durante el diestro. Las células superficiales pasaron desde un 56,25 +/- 0,75 por ciento durante el proestro, 63,70 +/- 1,05 por ciento durante el estro, hasta un 7,37 +/- 0,01 por ciento durante el diestro, mientras en el grupo infectado pasaron de un 0.00 por ciento durante el proestro, al 3,9 +/- 0,02 p...

Facial rejuvenation for middle-aged women: a combined approach with minimally invasive procedures.

Facial rejuvenation is a significant process involved in restoring youthfulness. The introduction of less invasive procedures has increased acceptance of such procedures. Often a combination of different techniques allows individualized treatment with optimal outcomes. Furthermore, this leads to a natural look without a significant downtime. We report herein the use of such a combined approach in middle-aged women with particular emphasis on botulinum toxin type A, dermal fillers, and chemical peels.

5-Fluorouracil superficial peel for multiple actinic keratoses.

BACKGROUND: Chronically photodamaged skin usually presents with multiple, widespread, actinic keratoses (AKs), and treatment of the entire affected area is recommended. METHODS: We report our experience with a combination of Jessner's solution or 70% glycolic acid (GA) with 5% 5-fluorouracil (5-FU) solution for superficial pulse peeling used in the treatment of widespread AKs in 31 patients. Pulse peelings were performed at biweekly intervals. The endpoint for treatment was complete or maximum clearance of the lesions at clinical evaluation. Pre- and post-skin biopsy and histopathologic examination were performed in three patients for the purpose of demonstrating the pulse peel effects. RESULTS: All patients achieved a satisfactory result, including the complete regression, or at least 80% clearing, of AK lesions and an overall improvement of photodamaged skin. CONCLUSION: We consider this superficial 5-FU pulse peel to be a safe, well-tolerated, very effective, and highly inexpensive therapeutic option for the treatment of multiple, diffuse AKs. Its benefit/cost ratio will be of interest to public health services, mainly in developing countries.

Tratamiento combinado de cicatrices de larga evolución: Resultado estético y reparador en una adolescente / Combined treatment of old scars: Aesthetic and reparative results in an adolescent

Las cicatrices extensas son lesiones que condicionan la vida de los pacientes que las padecen, produciendo retracción social o como en este caso condicionando la vestimenta de una joven adolescente de 15 años. Se realiza el tratamiento de cicatrices postquemadura que padece desde los 2 meses de edad, combinando diversos métodos como peeling, mesoterapia, dermoabrasión y ultrasonido, obteniendo como resultado la mejoría clínica, estética y psicológica, brindándole una calidad de vida superior.

Extensive scars modify the patient's life. Significant scarring causes functional and cosmetic deformities, discomfort and psychological stress. We report a teenager, who suffered from burning when she was two months old. She has been under scar treatment combining several methods such as peeling, mesotherapy, manual dermoabrasion and ultrasound. Up to now, we improved the patient's life quality, obtaining a clinical improvement, such as aesthetic and psychological one.

Elderly skin and its rejuvenation: products and procedures for the aging skin.

In the last few decades, there has been a substantial increase in the population of people over 60 years of age. Most of them maintain a good general health and physical activity and fitness. For these individuals there is a good number of dermatologic procedures, medications, and cosmetics that can be prescribed to improve the aspect of skin aging, providing an improvement in their self-esteem and quality of life as a result of their better look. We will discuss the mechanisms of skin aging, and the procedures and substances used to minimize its deleterious effects, such as sunscreens, estrogens, chemical peels, toxin botulinum, fillers and surgical procedures, among others. The use of makeup and the adverse reactions to cosmetics will also be mentioned.

The use of fluor-hydroxy pulse peel in actinic porokeratosis.

BACKGROUND: The use of Fluor-Hydroxy pulse peel (Drogaderma, Sao Paulo, Brazil) was reported by Katz to treat solar damage and actinic keratosis-associated lesions. OBJECTIVE: The objective was to use this combined treatment to produce therapeutic and cosmetic benefits in a patient with actinic porokeratosis. METHODS: A case of actinic disseminated porokeratosis was treated with a combination of a 70% glycolic peel and a 5% 5-fluorouracil solution (Drogaderma) every 2 weeks for 4 months. A biopsy was done before and after eight treatment pulses. RESULTS: Improvement in the appearance and texture of the treated areas and decreased dyskeratosis and epidermal atypia. CONCLUSION: The Fluor-Hydroxy pulse peel can be an effective alternative for the treatment of actinic porokeratosis.

An ophthalmologist's guide to chemical peels.

This article discusses the use of different chemical peels-very superficial, superficial, and medium depth. Once ophthalmologists understand the value and indications of this therapy, learn the techniques of application, and feel comfortable and confident with these methods, they should be able to treat the entire face.