Where Do We Stand? The Pathogenesis and treatment of ... F039... · Carlos Wambier, MD, PhD Adjunct...
Transcript of Where Do We Stand? The Pathogenesis and treatment of ... F039... · Carlos Wambier, MD, PhD Adjunct...
CHEMICAL PEELS
Carlos Wambier, MD, PhDAdjunct Professor State University of Ponta Grossa (UEPG)
Researcher Ribeirao Preto School of Medicine - University of Sao Paulo (USP)
Active Member — International Peeling Society (IPS)
Where Do We Stand? The Pathogenesis and treatment of Melasma
Adjascent Skin Melasma
Fontana-Masson
From Prof. Helio Miot, MD, PhD, Sao Paulo State University - UNESP (Botucatu, Brazil)
Verhöff: Elastosis
Melasma
Adjascent
Skin
Retroauricular
skin
From Prof. Helio Miot, MD, PhD, Sao Paulo State University - UNESP (Botucatu, Brazil)
F.M.: MelanossomesPicrosirus red: Collagen
Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination. J Am Acad Dermatol 1997;36:589.
Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner's solution chemical peels. Dermatol Surg 2006;32:1429–36.
Ejaz A, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner's solution for superficial chemical peeling in epidermal melasma. J Coll Phys Surg Pak 2008;18:205.
CLASSICS:JS30% Salicylic Acid70% Glycolic Acid10-20% Trichloroacetic Ac
ANY SUPERFICIAL CHEMICAL PEEL
NEO-CLASSICS:MJS92% Lactic Acid40% Pyruvic Acid10-40% Mandelic Acid5% Retinoic Acid
Wambier CG, MD, PhD
EVOLUTION OF JESSNER’s SOLUTION (JS)
Jessner’s SolutionpH 1.6
Salicilic Acid 14%Lactic Acid, Racemic 14%
Resorcinol 15%Ethanol q.s.p
Modified Jessner’s SolutionpH 1.7
Salicilic Acid 17%Lactic Acid, Racemic 17%
Citric Acid 8%Ethanol q.s.p
MODIFIED JESSNER’s SOLUTION (MJS)
AVOID RESORCINOL :
-Persistent erythema;-Allergic contact dermatitis;
-Toxicity to thyroid (cumulative).
ADD CITRIC ACID:-More stable formula.
-LESS PIH.Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A STUDY COMPARING CHEMICAL PEELING USING MODIFIED JESSNER’S SOLUTION AND 15% TRICHLOROACETIC ACID VERSUS 15%
TRICHLOROACETIC ACID IN THE TREATMENT OF MELASMA. Indian J. Dermatol. 2009;54(1):41–5.
Abdel-Meguid AM, Taha EA, Ismail SA. Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned
Patients.Dermatol Surg. 2017 May;43(5):651-656.
Wambier CG, MD, PhD
Wambier CG, MD, PhD
MAIN MECHANISM OF ACTION IN MELASMA
Fontana-Masson (Detail)
14-20% SA, 10% TCA
30% SAAHA (70% GA, 14-92% LA)
AKA (40% PA)
5% RA
MJS/JS+20-30%TCA
Wambier CG, MD, PhD
SUPERFICIAL PEELS UPPER EPIDERMIS
MJS
JSLA 40-88%SA 30%RA 5%**TCA 10-15%
OTHERS:MA 30%PA 40%GA 50-70%
MJS+TCA 35%
Wambier CG, MD, PhD
WHAT’s NEW?>> Fashionable Retinoic Acid 5% peels <<
THE ”GOLD” PEEL (WITH MICA, MELATONIN, CURCUMA)
5% Retinoic Acid,1% Melatonin: Anti-inflammatory0.1% Curcuma longa (curcumin):
antibiotic, anti-inflammatoryIn GOLD CREAM (Mica)
Wambier CG, MD, PhD
WHAT’s NEW?>> Fashionable Retinoic Acid 5% peels <<
PINK OCTOBER (BREAST CANCER AWARENESS MONTH)
Wambier CG, MD, PhD
In the near futurePHENOL-Euphorbiaceae oil peels?
• INCREASED INFLAMATION BY PHORBOLs
Ricinus communisCASTOR oil
Croton tigliumCROTON oil
TAKE HOME MESSAGE:
- IF MELASMA RESISTANT TO BASICS:
- ADD Q-Switched NdYAG and/or Superficial Chemical peels- (Biweekly)
- REALISTIC EXPECTIATIONS
Wambier CG, MD, PhD
Simão J.C.L., Wambier C.G. (2018) Combining Superficial Chemical Peels. In: Issa M., Tamura B. (eds) Chemical and Physical Procedures. Clinical Approaches and Procedures in CosmeticDermatology, vol 2. Springer, Cham
Wambier C.G. (2017) My Personal Experience with Peelings. In: Issa M., Tamura B. (eds) Chemical and Physical Procedures. Clinical Approaches and Procedures in Cosmetic Dermatology.Springer, Cham
Wambier C.G. (2018) Pyruvic Acid Peel. In: Issa M., Tamura B. (eds) Chemical and Physical Procedures. Clinical Approaches and Procedures in Cosmetic Dermatology, vol 2. Springer, Cham
Brody HJ. (2009) Chemical Peeling and Resurfacing. 3rd ed. Atlanta, USA: Emory University Digital Library Publications. Available from: https://pid.emory.edu/ark:/25593/s2xpg
Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A STUDY COMPARING CHEMICAL PEELING USING MODIFIED JESSNER’S SOLUTION AND 15% TRICHLOROACETIC ACID VERSUS 15% TRICHLOROACETICACID IN THE TREATMENT OF MELASMA. Indian J. Dermatol. 2009;54(1):41–5.
Abdel-Meguid AM, Taha EA, Ismail SA. Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned Patients.Dermatol Surg.2017 May;43(5):651-656.
Piamphongsant T. Phenol-castor oil: modified peel for dermal melasma. Dermatol Surg. 2006; 32(5):611-7.
Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination.J Am Acad Dermatol 1997;36:589.
Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner's solution chemical peels. Dermatol Surg2006;32:1429–36.
Ejaz A, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner's solution for superficial chemical peeling in epidermal melasma. J Coll Phys Surg Pak 2008;18:205.
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