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Use of organic acids in acne and skin discolorations therapy
Abstract
Acne is one of the most frequent skin disorders that occurs in puberty, but often adults also have acne. The most important factors responsible for acne are elevated production of sebum by hyperactive sebaceous glands and blockage of the follicle because of hyperkeratosis [14]. The third etiopathogenic factor of acne is excessive microflora reproduction [8]. The most significant bacterium that is responsible for formation of skin lesions is Propionibacterium acnes, a rod-shaped Gram-positive and aerotolerant anaerobic bacterium. It is estimated that P. acnes is responsible for acne in approximately 80% of people aged 11 to 30 [27,40]. Even healed skin lesions can often cause skin discolorations and scar formation [51]. Exfoliating chemical substances that are commonly used in dermatology and cosmetology are organic acids. Exfoliating treatment using organic acids is called "chemical peeling" and consists of controlled application of those substances on the skin [38]. The depth of exfoliation depends on organic acid concentration, type of substance and contact time with the skin [41]. Using exfoliating agents seems to be helpful in excessive keratinization - one of several factors responsible for acne. Moreover, epidermis exfoliation is a popular method of removing skin discoloration [22]. Considering chemical structure, exfoliating substances that are most often used in cosmetology contain alpha-hydroxyacids (glycolic acid, lactic acid, mandelic acid and citric acid), beta-hydroxyacids (salicylic acid) and other organic acids, such as trichloroacetic acid and pyruvic acid [47]. In this article, a literature review of use of organic acids in acne and skin discoloration therapy is presented.
... In-home care, products with Aesthetic Cosmetology and Medicine 3 / 2023 / vol. 12 salicylic acid in concentrations of 0.5-10% can be used on their own [3,10,[17][18][19][20]. ...
... • other recent treatments that interfere with a chemical peel; • a season of the year (spring, summer), due to the possi bility of sunburn or hyperpigmentation (applies to high concentrations of acid used) [3,17,20]. ...
... • the presence of conditions associated with an abnormal healing process, e.g. diabetes and autoimmune diseases [3,[17][18][19][20]. ...
Salicylic acid is an organic compound with multiple functions in cosmetics. The article aimed to discuss the wide range of applications of salicylic acid, with particular emphasis on its role in the cosmetic industry. Its effects in cosmetology were described in detail, including its use as a chemical peel in beauty salons as well as its role in the treatment of skin diseases and skin lesions. In addition, the potential side effects accompanying chemoexfoliation procedures were described. Salicylic acid is widely used in many kinds of cosmetics. It can be used alone or in combination with other ingredients in complex therapies. It is worth noting that it not only acts as an active ingredient, but also has preservative properties.
... It also has a brightening effect on the epidermis. 53 5.2.1.2.3 Salicylic acid. Salicylic acid, also known as 2hydroxybenzoic acid, is a BHA. ...
Acne is a long-standing skin condition characterized by plugged hair follicles due to the accumulation of dead skin cells, sebum, and Propionibacterium acnes (P. acnes) bacteria, causing inflammation, and the formation of pimples or lesions. Acne was recognized in the ancient times by the ancient Egyptians, Greeks, and Romans. Since ancient times, folk medicine from different cultures have comprised herbal and natural products for the treatment of acne. Current acne medications include antibiotics, keratolytics, corticosteroids, in addition to hormonal therapy for women. However, these conventional drugs can cause some serious side effects. And therefore, seeking new safe treatment options from natural sources is essential. Plants can be a potential source of medicinal phytochemicals which can be pharmacologically active as antibacterial, antioxidant, anti-inflammatory, keratolytic and sebum-reducing. Organic acids, obtained from natural sources, are commonly used as keratolytics in dermatology and cosmetology. Most of the promising phytochemicals in acne treatment belong to terpenes, terpenoids, flavonoids, alkaloids, phenolic compounds, saponins, tannins, and essential oils. These can be extracted from leaves, bark, roots, rhizomes, seeds, and fruits of plants and may be incorporated in different dosage forms to facilitate their penetration through the skin. Additionally, medicinal compounds from marine sources can also contribute to acne treatment. This review will discuss the pathogenesis, types and consequences of acne, side effects of conventional treatment, current possible treatment options from natural sources obtained from research and folk medicine and possible applied dosage forms.
... Los resultados exitosos se basan en una comprensión exhaustiva y la aplicación de los procedimientos correctos de exfoliación química, que incluyen la toma de historia, el pretratamiento, la preparación, la selección de exfoliación, la comunicación con el paciente y los regímenes de mantenimiento en el tratamiento a mano de dermatólogos y cirujanos plásticos (Kapuścińska & Nowak, 2015). ...
The objective of the article was to describe the applicability and effect of chemical peels as a correction of hyperpigmentation in the female genito-perineal area. A bibliographic review was carried out in: Pubmed and Google Scholar. Key terms such as: "Chemical peelings", "Female genital hyperpigmentation" "Treatment", "Hyperpigmentation" were used with the connectors "And" and "Or". With which no results were obtained, so a search was carried out by individual terms and the filters were applied: year of publications, type of articles and keywords, obtaining 8 articles, of which 3 were excluded according to criteria of inclusion and exclusion, leaving 5 articles for analysis and description according to the proposed objectives. The chemical peel represents an adequate treatment for dermal disorders, including hyperpigmentation in the genital region, easy to apply and has become very popular in recent times.
... Cząsteczka kwasu mlekowego jest większa niż kwasu glikolowego, przez co działa łagodniej oraz ma silniejsze właściwości nawilżające. Wyłącznie forma L kwasu mlekowego wykazuje aktywność biologiczną i jest głównym składnikiem naturalnego czynnika nawilżającego (NMF, natural moisturizing factor) [2,3]. Kwas mlekowy ma zdolność wiązania wody, zwiększając uwodnienie naskórka, dlatego znalazł szerokie zastosowanie w przemyśle kosmetycznym. ...
Up to now, research studies have compared various peeling substances affecting the skin, without taking into account the parameters responsible for the penetration and potency of the compounds. The aim of this study was to analyze the effects of lactic acid and mandelic acid on hydration, melanin, sebaceous gland activity and the stratum corneum barrier. Equal concentrations of chemical peels, similar pH of the solutions, and the base enabled comparison of results. A series of treatments with lactic acid resulted in a decrease in transepidermal water loss, an increase in hydration levels and a reduction in sebaceous gland activity, as well as a significant drop in melanin levels. Mandelic acid applied in a series of four treatments resulted in a noticeable improvement in the appearance of the epidermis. The activity of the sebaceous glands also decreased significantly. The use of both, a series and a single treatment with mandelic acid, strengthened the epidermal barrier. Comparing a series of treatments and a single procedure it was found that the value of transepidermal water loss increased. The study demonstrated that whereas many carboxylic acids exhibit similarities, they also possess notable distinctions in their topical effects and medicinal applications.
... To optimize the exfoliation potential of soaps, a synergistic approach can be used by combining both mechanical (by abrasion) and enzymatic (involving small amounts of acids in the pomace) exfoliation methods. This dual strategy if applied could enhance the efficacy of the exfoliation process 8,9 . ...
The present study investigated several properties such as friction, hardness, penetration work, and cutting forces in soaps formulated with apple and carrot pomace at varying concentrations of 5%, 10%, and 15%. To gain insights into the molecular-level alterations within the formulated soap samples, they were spectroscopically analyzed using Fourier-transform infrared spectroscopy. The sliding friction analyses revealed that the investigated extrudate additives had no significant impact on the frictional forces of the soaps. However, notable differences were observed in the cutting force, hardness, and penetration work between the control and pomace-added samples. Excluding the control samples, no statistically significant distinctions were found between the cutting force, hardness, and work of penetration of soaps containing apple pomace and carrot pomace. Moreover, the quantity of pomace incorporated did not induce any significant variations in the results. The obtained samples were characterised at the molecular level using FTIR Fourier transform infrared spectroscopy. On the other hand, alterations in band intensities suggested improved molecular packing of the compounds within the samples due to the presence of the additives.
... Inflammation of the gum and after extraction Expectorant, diastolic, antiseptic [33] Fennel seed Gum inflammation Antiseptic [33] Chinese cinnamon bark Gum inflammation Diastolic, antiseptic, astringent [46] Lemon fruit Essential oils, vitamin C Cleansing, whitening [33] Yarrow herb Sunflower seed oil Linoleic acid Hydrating [35,85] Laurel oil Analgesic, bactericidal [35] Tea tree oil Antibacterial, antifungal [83] Savory herb extract Analgesic [35] Vitamin E Strengthens and regenerates epithelium [35] Vitamin A, palmitate [5,35] White willow bark Salicylic acid Acne Superficial epidermal peeling, cytotoxic, antibacterial [67,86] Deep-sea shark liver oil Complex fats, higher unsaturated fatty acids, alkylglycerols, squalene, vitamins A and D 3 ...
Citation: Pytko-Polończyk, J.; Stawarz-Janeczek, M.; Kryczyk-Poprawa, A.; Muszyńska, B. Abstract: Antioxidant-rich natural raw materials have been used for thousands of years in traditional medicine. In the past decade, there has been increasing interest in naturotherapy, which is a practice of using products with a natural origin. Natural products can be effective in the treatment and prevention of oral and dental diseases, among others. Such raw materials used in dentistry are characterized by antioxidant, anti-inflammatory, antibacterial, antiviral, antiedematous, astringent, anticoagulant, dehydrating, vitaminizing, and-above all-regenerative properties. Reports have shown that a relationship exists between oral diseases and the qualitative and quantitative composition of the microbiota colonizing the oral cavity. This review aimed to analyze the studies focusing on the microbiome colonizing the oral cavity in the context of using natural raw materials especially herbs, plant extracts, and isolated biologically active compounds as agents in the prevention and treatment of oral and periodontal diseases such as dental caries as well as mucosal changes associated with salivary secretion disorder. The present work discusses selected plant ingredients exhibiting an antioxidant activity with potential for the treatment of selected oral cavity and periodontal diseases.
... Several factors, such as hormones, diet, stress and environmental pollution, among others, may contribute to acne development. These factors trigger hyperactivity of sebaceous glands that produce elevated levels of sebum, hyperkeratosis by blockage of the hair follicle and, additionally, contribute to the excessive microbiota reproduction [1]. ...
Background
Acne is a common skin disorder that involves an infection inside the hair follicle, which is usually treated with antibiotics, resulting in unbalanced skin microbiota and microbial resistance. For this reason, we developed polymeric nanoparticles encapsulating thymol, a natural active compound with antimicrobial and antioxidant properties. In this work, optimization physicochemical characterization, biopharmaceutical behavior and therapeutic efficacy of this novel nanostructured system were assessed.
Results
Thymol NPs (TH-NP) resulted on suitable average particle size below 200 nm with a surface charge around − 28 mV and high encapsulation efficiency (80%). TH-NP released TH in a sustained manner and provide a slow-rate penetration into the hair follicle, being highly retained inside the skin. TH-NP possess a potent antimicrobial activity against Cutibacterium acnes and minor effect towards Staphylococcus epidermis, the major resident of the healthy skin microbiota. Additionally, the stability and sterility of developed NPs were maintained along storage.
Conclusion
TH-NP showed a promising and efficient alternative for the treatment of skin acne infection, avoiding antibiotic administration, reducing side effects, and preventing microbial drug resistance, without altering the healthy skin microbiota. Additionally, TH-NP enhanced TH antioxidant activity, constituting a natural, preservative-free, approach for acne treatment.
Graphical Abstract
... The formulation tested in this study contains 2% of Rhodomyrtus tomentosa extract and more particularly 0.1 mg·L −1 of rhodomyrtone, which may contribute to the efficacy against the pathogenic bacteria C. acnes. Our RT extract also contains acid compounds, such as malic acid, citric acid, shikimic acid and quinic acid, that are interesting for acne treatment, because of their chemical exfoliating properties, useful for fighting against excessive keratinization in acne pathology [50]. Moreover, Amrutha et al. [28] mentioned that organic acids such as citric acid have antibacterial properties and can inhibit biofilm formation. ...
Knowing that Rhodomyrtus tomentosa is known to have antibacterial effects, this study investigated the skin microbiota with a focus on Cutibacterium acnes (C. acnes) phylotypes in subjects with acne, and determined microbiota changes after 28 days of treatment with berries Rhodomyrtus tomentosa as an active ingredient (RT). Skin swabs from seventeen acne subjects were collected and the skin microbiome was analyzed using 16S rRNA gene sequencing. A culture-independent next-generation sequencing (NGS)-based SLST (single-locus sequence typing) approach was aimed at evaluating RT extract effects on C. acnes phylotype repartition. Clinical evaluations (lesion counts) were performed at baseline (D0) and after 28 days (D28) of twice-daily application of the RT active ingredient. We determined: (1) the skin microbiota at D0 was dominated by Actinobacteria followed by Firmicutes and Proteobacteria; (2) at the genus level, Cutibacterium was the most abundant genus followed by Staphylococcus and Corynebacterium; (3) C. acnes was the major species in terms of mean abundance, followed by Staphylococcus epidermidis (S. epidermidis) and Staphylococcus hominis (S. hominis); and (4) phylotype IA1 was most represented, with a predominance of SLST type A1, followed by phylotypes II, IB, IA2, IC, and III. After 28 days of RT extract treatment, phylotype repartition were modified with a decrease in abundance (approximately 4%) of phylotype IA1 and an increase in phylotype II and III. Cutibacterium granulosum (C. granulosum) abundance also decreased. Reduction of retentional and inflammatory lesions was also noted only after RT treatment; thus, RT extract acts as a microbiota-regulating agent.
... Acne is a common skin disorder of adolescence with a negative psychological impact. 1,2 The pathogenesis of acne is multifactorial. [3][4][5][6] Visfatin is a 52 kDa protein secreted mainly by visceral fat. ...
Background:
Acne is a chronic inflammatory disease of the pilosebaceous units, of multifactorial pathogenesis, one of which could be an adipokine such as visfatin.
Aim:
The aim of this study was to study visfatin expression both in lesional skin and serum, of acne patients versus healthy controls. The secondary aim was to study the relationship of visfatin levels with dyslipidemia/metabolic syndrome.
Methods:
This study included 30 patients with moderate and severe acne vulgaris and 30 age- and sex-matched healthy controls. Serum and tissue visfatin were estimated by enzyme-linked immune-sorbent assay. Clinical and laboratory examinations were done to assess the anthropometric data and various criteria of metabolic syndrome.
Results:
Tissue and serum visfatin levels were significantly higher in patients as compared to healthy controls. Tissue visfatin levels were significantly higher than its serum levels in both patients and controls. Serum visfatin was significantly higher in overweight individuals. No correlations were found between tissue and serum visfatin levels in both patients and controls. Moreover, serum and tissue visfatin levels did not correlate to any of the lipid profile parameters or criteria of metabolic syndrome in acne patients.
Limitations:
The study had a small sample size and did not localize the exact source of tissue visfatin. Polycystic ovary syndrome PCOS was not evaluated.
Conclusion:
Visfatin is an important proinflammatory adipokine, with significantly higher expression in acne patients. Tissue rather than serum visfatin might play a key role in acne.
... 20 It is one of the most effective natural humectants and is a component of NMF (Natural Moisturising Factor). 21 Pyruvic acid has the potential as a unique local exfoliating agent, combining the keratolytic effect of the alpha-keto acid and the water-retaining effect of the lactic acid. 22 A reduction in sebum and no significant differences in skin hydration were observed in subjects with high sebum production before treatment with 40%-50% pyruvic acid. ...
Background:
One of the ways to treat acne is by using chemical peels. Salicylic, glycolic and pyruvic acids due to their keratolytic and antibacterial properties are often recommended for acne patients.
Aims:
The aim of the study was to compare the effect of a preparation containing glycolic and salicylic acids with pyruvic acid.
Patients/methods:
14 women diagnosed with acne took part in the study. The facial treatment area was divided into two parts: right (a preparation containing 50% pyruvic acid) and left side ( a preparation containing glycolic and salicylic acids). A series of four treatments was performed at 2-week intervals. Skin parameters, namely hydration, sebum secretion and skin colour were measured.
Results:
As a result of using 50% pyruvic acid, the hydration of the right side of the face increased statistically and there was a decrease in the amount of melanin in the epidermis. On the left side of the face, there was an increase in skin hydration after using a mixture of glycolic and salicylic acids. The increase in skin hydration on the left side of the chin and nose was not statistically significant. The use of the mixture of glycolic and salicylic acids affected the skin colour on the left side of the face, on the forehead, cheek and nose.
Conclusion:
Chemical peels affect a wide range of pathological factors of acne. A mixture of acids yields fewer side effects than a single acid used in high concentration, but the therapeutic effects are comparable.
Zaburzenia barwnikowe skóry są spowodowane fizjologicznym nagromadzeniem się pigmentu w skórze i powstają na skutek nieprawidłowej syntezy naturalnego barwnika w organizmie człowieka tzw. melaniny. Celem pracy jest przedstawienie problemu jakim są przebarwienia skórne. Zaprezentowano wyniki badań, które miały wykazać jak bardzo rozpowszechniony jest wśród respondentek problem występowania przebarwień skórnych oraz czy ankietowane są świadome właściwej pielęgnacji skóry i postępowania kosmetologicznego w celu niwelowania zmian barwnikowych.
Introduction:
Acne vulgaris is a disease that has an enormous impact on appearance of the skin of the patients and also on their quality of life. Long-term dermatological treatment, which often lasts years, and disease relapses contribute to the occurrence of low self-esteem and depression. Acne is one of the 10 most common diseases in the world and the most common inflammatory skin disease. Many methods of dermatological treatment that bring very good results are available. However, educating people with acne on how to take care of their skin on a daily basis to minimize the bleak effects of the disease is an extremely important element. Contemporary cosmetology creates an environment for not only taking care of the skin at home, but also develops in-office treatments with exfoliation of the dead epidermis as an extremely important and priority part of treatment. The cosmetologist can propose both chemical and apparatus methods, which are selected individually for each client.
Objective:
The objective of this article is to provide information about cosmetological treatment used in acne vulgaris.
Methods:
In this article, we reviewed the published literature, article published in peer-reviewed journals.
Results:
There are many methods that work well in the case of acne skin care, more and more new treatments appear on the cosmetological market.
Conclusion:
Acne skin care in beauty parlor is very important element.
Orofacial clefts (OFC) present different phenotypes and severities with a postnatal challenge for oral microbiota development. In order to investigate the impact of OFC on oral microbiota, smear samples from 15 neonates with OFC and 17 neonates without OFC were collected from two oral niches (tongue, cheek) at two time points, i.e. at first consultation after birth (T0: Ø3d OFC group; Ø2d control group) and 4–5 weeks later (T1: Ø32d OFC group; Ø31d control group). Subsequently, the samples were processed and analyzed using next-generation sequencing. We detected a significant increase in alpha diversity and distinct phenotypes, e.g., anaerobic and gram-negative species from T0 to T1 in both groups. Further, we found that at T1 OFC neonates presented a significantly lower alpha diversity with lowest values for high cleft severity and significantly higher levels of Enterobacteriaceae (Citrobacter, Enterobacter, Escherichia-Shigella, Klebsiella), Enterococcus, Bifidobacterium, Corynebacterium, Lactocaseibacillus, Staphylococcus, Acinetobacter and Lawsonella compared to controls. Notably, neonates with unilateral and bilateral cleft lip (UCLP/BCLP) and palate presented similarities in beta diversity and a mixture with skin microbiota. However, significant differences were seen in neonates with cleft palate only compared to UCLP/BCLP with higher levels of anaerobic species . Our findings revealed an influence of OFC as well as cleft phenotype and severity on postnatal oral microbiota maturation.
Fungi is a notable asset for drug discovery and production of pharmaceuticals; however, slow growth and poor product yields have hindered industrial utilization. Here, the mycelial biomass of Xylaria sp. BCC 1067 was examined in parallel with the assessment of antimicrobial properties by using media-type selection. To enhance both mycelial content and antifungal activity, the media replacement approach was successfully applied to stimulate fungal growth and successively switched to poorer malt-peptone extract media for metabolite production. This simple optimization reduced fungal cultivation time by 7 days and yielded 4-fold increased mycelial mass (32.59 g/L), with approximately 3-fold increased antifungal activity against the model yeast Saccharomyces cerevisiae strain. A high level of β-glucan (115.84 mg/g of cell dry weight) and additive antibacterial effect against Propionibacterium acnes were also reported. This simple strategy of culture media optimization allows for investigation of novel and rich source of health-promoting substances for effective microbial utilization.
Skin is the organ in permanent contact with environmental factors which could accelerate the aging process. The changes occurring due to the aging process are particularly noticeable in the skin. Skin ageing is dependent on endogenous and exogenous factors determined by environmental factors, primarily the ultraviolet radiation (photoaging).The Authors reviewed the articles available at PubMed, ResearchGate and GoogleScholar on the composition and application of preparations containing snail mucus. The results of the literature analysis revealed that snail mucus contains substances such as allantoin, glycolic acid, lactic acid, collagen, elastin, extracellular matrix metalloproteinases as well as their inhibitors, and antioxidant enzymes. Also, it was demonstrated that the use of preparations containing snail mucus had beneficial effects on the condition of the skin, including improved skin hydration, normalisation of the thickness of the epidermis, improved skin structure, increased cell proliferation index, reduction of skin elastosis and decreased hyperpigmentation. Moreover, the regenerative mechanism of action of snail mucus resulted in a clinical alleviation of lesions in patients with dermatological problems of various aetiology. Therefore, it appears that snail mucus could be a good biostimulator and its use has many beneficial effects for the skin.
Mandelic acid belongs to α-Hydroxy Acids. Its natural sources are bitter almonds, cherry and apricot kernels. It has a wide spectrum of activities after topical application. Mandelic acid is very popular in cosmetology and dermatology. It is used as an active ingredient in many cosmetic preparations, both professional and generally available. It is one of the safest AHA used, but it can also cause some cutaneous complications.
The aim of this work was to analyze the composition of selected cosmetic preparations containing mandelic acid. The analysis was performed in terms of physicochemical forms, the applied concentration of mandelic acid and combinations with other active ingredients.
The analysis included 30 random products, both professional and generally available, using cosmetic databases and available literature.
Cosmetic forms included: cream, gel, tonic, peeling and serum. Concentrations used in the cosmetics were different, and information about this subject was usually given in professional preparations. Mostly, mandelic acid was combined with: hyaluronic acid, lactobionic acid, salicylic acid, azelaic acid and vitamin B5. The occurrence of plant raw materials in cosmetics with the addition of mandelic acid was varied.
Chemical peels have been time-tested and are here to stay. Alpha-hydroxy peels are highly popular in the dermatologist's arsenal of procedures. Glycolic acid peel is the most common alpha-hydroxy acid peel, also known as fruit peel. It is simple, inexpensive, and has no downtime. This review talks about various studies of glycolic acid peels for various indications, such as acne, acne scars, melasma, postinflammatory hyperpigmentation, photoaging, and seborrhea. Combination therapies and treatment procedure are also discussed. Careful review of medical history, examination of the skin, and pre-peel priming of skin are important before every peel. Proper patient selection, peel timing, and neutralization on-time will ensure good results, with no side effects. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the time for which it is applied. Hence, it can be used as a very superficial peel, or even a medium depth peel. It has been found to be very safe with Fitzpatrick skin types I-IV. All in all, it is a peel that is here to stay.
There is a great worldwide demand for citric acid consumption due to its low toxicity when compared with other acidulants used mainly in the pharmaceutical and food indus-tries. Other applications of citric acid can be found in detergents and cleaning products, cosmetics and toiletries, and other. Global production has now reached 1.4 million tonnes and there is annual growth of 3.5–4.0 % in demand/consumption of citric acid. As a result of the adverse market conditions, only big producers have survived. Any increase in citric acid productivity would be of potential interest and hence there is an obvious need to con-sider all possible ways in which this might be achieved. The production by submerged fermentation is still dominating. However, solid-state processes can create new possibili-ties for producers. Many by-products and residues of the agro-industry can be used in the production of citric acid. A cost reduction in citric acid production can be achieved by us-ing less expensive substrates. The use of agro-industrial residues as support in solid-state fermentation is economically important and minimizes environmental problems. Other per-spectives for citric acid production sector are the improvement of citric acid producing strains, which have been carried out by mutagenesis and selection.
Physiological acne is a milder form of clinical acne and is very frequent in adult women (18 years of age and older). Acne therapy is usually unnecessary in such cases, and so appropriate cosmetic treatments are sought.
To determine the effectiveness of a topical cosmetic hydrating skincare treatment for adult acne-prone skin (Normaderm, Vichy, France) against the clinical signs of physiological acne: few inflammatory and retentional lesions, uneven (grainy) skin relief, dilated pores, and occasional and/or local hyperseborrhea.
Within the study, the tested product's keratolytic, antimicrobial, and antiseborrheic properties, and its overall ability to improve the clinical signs of physiological acne present in adult subjects were evaluated through objective and clinical evaluation methods by the investigators and through self-evaluation questionnaires by the subjects themselves. The study group was composed of 50 adult women between 18 and 35 years of age with combination or oily acne-prone skin, who were chosen according to previously defined inclusion criteria. They applied the product tested twice daily on thoroughly cleansed skin for a period of 2 months. The results were evaluated after 30 (±2) and 60 (±2) days.
The number of inflammatory and retentional lesions on the forehead, cheeks, and chin decreased after 60 days of use (an average of 30.7% and 70.7%, respectively). The level of sebum secretion on the forehead decreased by 33.4% and the level of skin scaling decreased by 38.5% after 60 days of use. The moisture content in the horny layer on the forehead, cheeks, and chin increased by an average 39.7%. The decrease in pore size and content after 60 days of use was very noticeable. The subjects evaluated all the studied characteristics of the product tested very positively, with results already showing after 30 days of use.
The results of the study confirm that the product tested is suitable for the cosmetic care of adult acne-prone skin, either as an independent cosmetic hydrating skincare treatment, as a complementary cosmetic part of acne therapy, or as a subsequent cosmetic regimen to sustain the results of the acne therapy for a longer period of time.
Alpha-hydroxy acids (AHAs), primarily glycolic and lactic acids, are widely used in cosmetics to alleviate dyspigmentation, photodamage, and other aging skin conditions and as pH adjusters. Glycolic acid reportedly enhances skin damage after repeated ultraviolet light exposure, e.g., increased sunburn cell formation. This study assessed potential in vitro skin penetration of lactic acid and malic acid incorporated into rinse-off personal care products, compared with rinse-off and leave-on exposures to glycolic acid (10%, pH 3.5) in a reference lotion. Radiolabeled AHA-fortified shampoo, conditioner, and lotion were evenly applied as single doses to human epidermal membranes mounted in static diffusion cells (not occluded). Exposures were 1-3 min (rinse-off) or 24 h (leave-on). Epidermal penetration of malic acid and lactic acid from the rinse-off shampoo and conditioner, respectively, was negligible, with >99% removed by rinsing, a negligible portion remaining in the stratum corneum (≤0.15%), and even less penetrating into the viable epidermis (≤0.04%). Glycolic acid penetration from the leave-on reference lotion was 1.42 μg equiv./cm2/h, with total absorbable dose recovery (receptor fluid plus epidermis) of 2.51%, compared to 0.009%, 0.003%, and 0.04% for the rinse-off reference lotion, shampoo (malic acid), and conditioner (lactic acid) exposures, respectively. Dermal penetration of AHAs into human skin is pH-, concentration-, and time-dependent. Alpha-hydroxy acids in rinse-off shampoos and conditioners are almost entirely removed from the skin within minutes by rinsing (resulting in negligible epidermal penetration). This suggests that ultraviolet radiation-induced skin effects of AHA-containing rinse-off products are negligible.
Glycolic acid is a member of the AHA family, which occurs naturally in foods and has been used for centuries as a cutaneous rejuvenation treatment. It is used in many cosmetic products as an exfoliant and moisturizer. When glycolic acid is used in greater amounts, however, there are greater cosmetic benefits but also potential for skin irritation as far as burning increases. The aim of this work was to investigate the feasibility of a topical delivery system as a multiple emulsion combining glycolic acid, strontium nitrate, and dexpanthenol in order to optimize the acid's cosmetic properties and lowering its side effects.
The effect of medicines and cosmetics on people showing acne has been studied by many researchers. The application of AHA either as such or in the form of inclusion complexes, which ensures controlled release of glycolic acid, constitutes certainly a novelty. Sebum secretion in people with comedonal acne and cosmetic acne - two kinds of acne vulgaris - considerably decreased following application of cosmetics containing β-cyclodextrins. This paper examines in vivo changes in sebum secretion on the skin of volunteers after application of cosmetic products containing β-cyclodextrin, records the results and proceeds to their statistical analysis. Sebum plays a role in the overall pathogenesis of the disease because sebum is comedogenic, causes inflammation when injected into skin, and acne can be controlled by factors which inhibit sebaceous glands.
In the last few years AHA, and particularly glycolic acid, are in increasingly successful use in cosmetology, dermatology and esthetics. Their application is not a novelty, as they are simple well-known biochemical substances largely used in many fields and for various purposes. However, the ability of glycolic acid to form inclusion complexes (cyclosystem complex glycolic acid 50%) with cyclodextrins (CDs), particularly β-cyclodextrin, which ensures controlled release of glycolic acid, constitutes certainly a novelty and sparks off further research. This paper examines in vivo elasticity and humidity changes on the skin of volunteers following the application of cosmetic products containing cyclosystem complex glycolic acid and records the results.
Alpha-hydroxy acids (AHAs) are carboxylic acids characterized by a hydroxy group on the α carbon atom of the molecules. The constituents of AHAs include glycolic acid, lactic acid, malic acid and tartaric acid. The profound effect of AHAs on disorders of keratinization was first to report by Van Scott and Yu in 1974. Recently, medium concentrations of AHAs have been used in the chemical peeling of photo-aged skin, acne and some skin disorders in Japan. However, the overall knowledge of the pharmacological actions of AHAs on the human skin remains insufficient. I herein briefly reviewed our data and the most recently reported information. The principal action of lower concentrations (5-12%) of AHAs, when applied topically to human skin, is based on an accelerated detachment of corneocytes. The pharmacological effects of a medium concentration (15-30%) of AHAs are a thickening of epidermis, a decreased number of atypia in basal cells, an increase in the amount of acid mucopolysaccharides in the papillary dermis, and an increased expression of factor XIII a transglutaminase in the dermal dendrocytes associated with an increased level of mast cell degranulation. Ultrastructurally, AHAs-treated photo-aged skin samples show a decreased number of desmosomes and thus results in an accumulation of tonofilaments and opening of intercellular spaces of kerationocytes, while no appreciable changes are observed in the melanocytes. In vitro studies revealed that AHAs could induce an increased degree of fibroblast proliferation and collagen production, while they may also suppress tyrosinase activity in human melanoma cell line. Recently, AHAs are becoming one of the unique rejuvenating agents in Japan. Dermatologists have to establish more effective and safer protocols in order to widely use AHAs and also further verify the action mechanisms of AHAs, utilizing image, biochemical and molecular biological analyses.
Background:
Salicylic acid was recently formulated in a hydroethanolic vehicle at a concentration of 20% to 30%. Salicylic acid has strong comedolytic effects because of its lipophilic nature.
Objective:
To compare the therapeutic efficacy and tolerability of salicylic acid peels with those of Jessner's solution peels in patients with acne vulgaris.
Methods:
Thirteen patients (13 men; mean age 22.6, range 20-28) with facial acne were enrolled. Jessner's solution was applied to one side of each patient's face and 30% salicylic acid to the other in three sessions at 2-week intervals. A blinded investigator counted noninflammatory and inflammatory lesions before treatment and 2 weeks after each treatment.
Results:
Inflammatory and noninflammatory acne lesion counts decreased in proportion to the duration of treatment. Inflammatory acne lesion counts did not differ significantly between salicylic acid and Jessner's solution peels, although in terms of noninflammatory acne lesion counts, sites treated with salicylic acid showed significant improvement (p = .04), whereas those treated with Jessner's solution did not.
Conclusion:
We found that 30% salicylic acid peels were effective for inflammatory acne and more effective than Jessner's solution peels for treating noninflammatory acne.
General description Chemical peeling is a procedure frequently used lo treat unaesthetic cutaneous alterations such as photoageing, actinic keratosis, chloasma, senile lentigo, and post-acneic scars as well those of a non-strictly aesthetic nature such as seborrhoeic keratosis and flat warts. Several chemical agents are used depending on the depth of peeling to be obtained. The most commonly used agents are: alpha-hydroxy-acids, resorcinol, Jessner's solution, and trichloroacetic acid. In the present study the characteristics of the individual substances, technical procedure, and applications are taken into consideration. Finally, the main risks and side-effects, depending on the depth of peeling, are considered.
Learning objective The reader will have learned what a chemical peeling is, what chemical agents are available, and how to perform chemical peeling in the office. The mechanism of action of different chemical agents, expectations from this procedure, potential risks and complications are also reviewed with insight into criteria for selecting patients.
For decades, chemical peels have remained a trusted option for treatment of aging facial skin. However, emerging technologies are being adopted by many practitioners who may not have had sufficient opportunity to learn the art of chemical peeling. Properly performed peels can improve the condition of the skin, are less expensive than light-based machines, and exfoliate the skin without the thermal damage associated with light-based machines. This article presents a new variation of a trusted method, using a series of low-strength trichloroacetic acid peels and proper skin preparation that is cost-effective and produces excellent results in selected patients.
Abstract Background: Deep peeling using phenol and percutaneous collagen induction (PCI) are used in treating acne scars. Aim: To compare deep peeling using phenol and PCI combined with trichloroacetic acid (TCA) 20% in treating atrophic acne scars. Methods: 24 patients with post-acne atrophic scars were randomly divided into two groups; group 1 was subjected to one session of deep peeling using phenol, and group 2 was subjected to four sessions of PCI combined with TCA 20%. As a secondary outcome measure, side effects were recorded and patients were asked to assess their % of improvement by a questionnaire completed 8 months after the procedure. Results: Scar severity scores improved by a mean of 75.12% (p < 0.001) in group 1 and a mean of 69.43% (p < 0.001) in group 2. Comparing the degree of improvement in different types of scars, within the same group after treatment, revealed a significant highest degree of improvement in the rolling type (p = 0.005) in group 2. Conclusion: Deep peeling using phenol and PCI with TCA 20% were effective in treating post-acne atrophic scars.
The hydroxyacids are represented by the alpha-hydroxyacids, beta-hydroxyacids, polyhydroxy acids, and bionic acids. Together, these ingredients form a class of compounds with unparalleled benefits to the skin and unprecedented usage in the cosmeceutical market in cosmetic and therapeutic formulations alike. The most commonly used hydroxyacid is glycolic acid, an alpha-hydroxyacid that has been used extensively in cosmetic antiaging formulations, moisturizers, and peels, and in treatment products to improve hyperpigmentation and acne. The newer polyhydroxy and bionic acids offer the benefits of alpha-hydroxyacids without irritation, making them suitable for use on sensitive skin, rosacea, and after cosmetic procedures. They also provide additional antioxidant/chelation, barrier strengthening, and moisturizing effects. Bionic acids inhibit matrix metalloproteinase enzymes in skin, providing a preventative antiaging benefit. The hydroxyacids as a class can be combined with therapeutically active materials and cosmetic procedures to increase therapeutic effects and improve tolerability and outcomes of medicinal agents and procedures.
Medium peels are an excellent modality for treating actinically damaged skin. Because they create wounds that extend only down into the upper dermis, they have less risk of complications than deeper phenol peels. Conversely, because of their more superficial nature, they also are not as effective as phenol peels in improving deep scars and wrinkles. Cosmetic surgeons should consider medium-depth peels a useful addition to their current armamentarium against aging skin, rather than a replacement for phenol peels.
We conducted a double-blind, placebo-controlled, prospective, randomized study to assess the effects of tretinoin pretreatment on healing after trichloroacetic acid (TCA) chemical peel. Sixteen male patients (mean age, 67 years) with actinically damaged skin were treated daily with 0.1% tretinoin and placebo creams to the left and right halves of the face and the left and right forearms and hands, respectively, for 14 days prior to the 35% TCA peel. We subjectively noted that during the peel, "frosting" was more pronounced and uniform and occurred earlier in tretinoin-pretreated skin in 94% of the patients. Healed skin was measured planimetrically, and the healed area was determined with point stereology. Regardless of pretreatment, the face healed twice as fast as the forearm or hand. In all regions, the mean area healed was significantly greater in skin that had been pretreated with tretinoin. The differences between tretinoin and placebo, respectively, in healed skin were maximal after 5 days for the face (68% vs 52%), after 11 days for the forearms (72% vs 24%), and after 9 days for the hands (61% vs 29%). After 7 days, 75% of the tretinoin-pretreated hemifaces were completely healed, as opposed to 31% of the placebo-pretreated hemifaces. By visual inspection, we could not appreciate a cosmetic difference between tretinoin- and placebo-pretreated skin 2 weeks and 3 months after the TCA peel. We conclude that 0.1% tretinoin pretreatment for 2 weeks prior to the TCA peel will significantly speed healing, which may result in greater patient satisfaction. Patients presently being treated with tretinoin who later undergo a TCA peel might be expected to have similar results.
In spite of controlled wounding with chemical peeling agents, complications may occur, resulting in patient and physician dissatisfaction. Precautions and factors causing these complications are examined, and relative contraindications to chemical peeling are discussed.
Trichloroacetic acid chemexfoliation is an effective, versatile, and safe therapeutic option for patients with extensive actinic keratoses of the face and scalp. With an experienced and skilled operator, the associated complications are rare and tend to be mild. Cosmetically, the patient not only benefits from removal of the erythematous, scaly actinic keratoses but also obtains cosmetically pleasing rejuvenation of facial skin and diminution of fine facial wrinkles. Two representative cases are presented. In comparison with other available treatment modalities, trichloroacetic acid chemexfoliation involves a shorter treatment period and wound healing time and is not dependent on patient compliance.
Quantitative study of the microflora of 5 open and 5 closed comedones in each of 15 acne patients yielded anaerobic diphtheroids in 92 percent of lesions at a geometric mean density of 8.2 × 104 organisms per lesion. Open comedones (blackheads) contained higher numbers of yeasts and aerobic bacteria than closed ones (whiteheads). Study of individual comedones yields no more information than pooled samples. An association was found between severe acne and the incidence and density of Coryrnebacterium acnes group II.
With the advent of newer chemical peels, there is now a wide range of peeling agents that can be applied on specific patients.
The purpose of this study was to closely examine the more common chemical peeling agents at different concentrations.
The study methods were carried out by thoroughly cleansing the skin surface with acetone. Different concentrations of the chemical peels were applied on different skin areas (2 x 2 cm each) and left on the skin for 15 minutes: phenol-Bakers, 25%, 50%, 75%, 88%; trichloroacetic acid, 25%, 50%, 75%; glycolic acid, 50%, 70%; and pyruvic acid, 50%, 100%. Serial biopsies were taken from each peeling site at 1, 7, and 21 days post-peel. Biopsies were then evaluated for epidermal changes, inflammation, and collagen deposition.
The results show that Bakers phenol peel caused the most inflammation and nonspecific reaction, and in addition, a proportionate amount of new collagen deposition. Plus, increasing concentrations of phenol and TCA caused increasing amount of epidermal sloughing and inflammation after 1 day post-peel. The extent of reaction from the phenol and TCA was directly proportional to the collagen deposition at 21 days.
The glycolic acid and pyruvic acid caused minimal nonspecific reaction. However, the collagen deposition caused by the glycolic acid and pyruvic acid was disproportionately increased suggesting a direct stimulatory effect by the two agents.
Many alpha-hydroxy acid products, containing low- or high-acid concentrations, are being used. It is not known whether different products perform differently or whether they modulate changes in both the epidermis and dermis.
The purpose was to examine whether treatment with 5% and 12% lactic acid produces different cosmetic results and produces changes in the epidermis and dermis.
Test participants applied either 5% or 12% lactic acid twice a day for 3 months. Changes in skin smoothness and texture, the depth and number of lines and wrinkles, and epidermal and dermal firmness and thickness were determined.
Treatment with 12% lactic acid resulted in increased epidermal and dermal firmness and thickness and clinical improvement in skin smoothness and in the appearance of lines and wrinkles. No dermal changes were observed after treatment with 5% lactic acid; however, similar clinical and epidermal changes were noted.
The results demonstrate that cosmetic benefits from the use of alpha-hydroxy acids are caused by modification of the skin surface, the epidermis and the dermis. Although 5% lactic acid modulates surface and epidermal changes, 12% lactic acid influences both the epidermis and the dermis.
Postinflammatory hypopigmentation and hyperpigmentation are frequently encountered problems and represent the sequelae of various cutaneous disorders as well as therapeutic interventions. However, the underlying mechanisms and the variability individuals show for developing hypopigmentation or hyperpigmentation are not well understood. The authors propose an inherited individual chromatic tendency that is based on "weak" or "strong" melanocytes and their tendency to respond to trauma or inflammation with either hypopigmentation or hyperpigmentation. Clinical examples and management of both hypopigmentation and hyperpigmentation are discussed.
Recently, there has been an exponential increase in the use of alpha-hydroxy acids in dermatologic practice. Their inclusion in a myriad of cosmetic preparations underscores their popularity. Among the clinical effects of alpha-hydroxy acids are their ability to prevent the atropy resulting from potent topical corticosteroids, improve the appearance of photoaged skin, and correct disorders of keratinization. Despite this range of desirable effects, very little is known about the specific changes produced by various alpha-hydroxy acid preparations in the epidermis and dermal extracellular matrix. Previous work by others has demonstrated the ability of another alpha-hydroxy acid to increase viable epidermal thickness, and dermal glycosaminoglycans.
In this study, we examined the effect of 20% citric acid lotion, as compared with vehicle alone, on skin thickness, viable epidermal thickness, and dermal glycosaminoglycan content. Biopsy samples were harvested after 3 months of treatment.
Image analysis of biopsy sections revealed increases in viable epidermal thickness and dermal glycosaminoglycans in treated skin.
Topical citric acid produces changes similar to those observed in response to glycolic acid, ammonium lactate, and retinoic acid including increases in epidermal and dermal glycosaminoglycans and viable epidermal thickness. Further studies of citric acid and other alpha-hydroxy acids are warranted to clarify their clinical effects and mechanisms of action.
Noninvasive techniques that provide detailed information about molecular composition, structure, and interactions are crucial to further our understanding of the relation between skin disease and biochemical changes in the skin, as well as for the development of penetration enhancers for transdermal drug administration. In this study we present in vitro and in vivo Raman spectra of human skin. Using a Raman microspectrometer, in vitro spectra were obtained of thin cross sections of human skin. They provided insight into the molecular composition of different skin layers. Evidence was found for the existence of a large variation in lipid content of the stratum corneum. A simple experimental setup for in vivo confocal Raman microspectroscopy of the skin was developed. In vivo Raman spectra of the stratum corneum were obtained at different positions of the arm and hand of three volunteers. They provided evidence for differences in the concentration of natural moisturizing factor at these positions.
Hyperpigmentation is a common disorder of the skin, particularly in brown-skinned patients. Melasma is a common cause of facial hyperpigmentation and can be resistant to treatment. A combination of topical creams and gels, chemical peels, and sunscreens may be necessary for significant improvement. Erythema dyschromicum perstans is a dermal pigmentation seen on the trunk and proximal extremities, most commonly presenting in dark-skinned Hispanics. Drug-induced and postinflammatory hyperpigmentation may last for many months after the offending drug or dermatitis has been eliminated. These disorders, including their management, is reviewed in this article.
Multiple modalities are available for treating acne scars, one of which is chemical peeling.
To evaluate the efficacy of medium-depth peels in the treatment of acne scars.
A total of 15 patients (14 women and 1 man) were seen between November 1998 and March 2000. A medium-depth chemical peel was performed. The peel was performed using a combination of Jessner's solution followed by the application of 35% trichloroacetic acid (TCA). The mean age of patients who entered the study was 28 years. A total of 42 peeling sessions were performed: 13 patients had the full three-session regiment, 1 patient had two sessions, and 1 had only one session.
Patients in our study had two forms of acne scars, the atrophic saucer or crater-like form and the pitted (ice-pick) form. Improvement occurred in all except one of our patients. Significant improvement (greater than 75% clearance of lesions) occurred in 1 patient (6.6%), moderate improvement (51-75% clearance) in 8 patients (53.3%), mild improvement (26-50% clearance) in 4 patients (26.6%), minimal improvement (1-25% clearance) in 1 patient (6.6%), and no response in 1 patient (6.6%). All patients had different combinations of the above two forms. Four patients (26.6%) had mainly pitted scars and deep atrophic scars. The clinical response in those patients was moderate, mild, minimal, and no response, respectively. The remainder of our patients had mainly atrophic scars of moderate depth. Nine patients (73.4%) suffered from transient postinflammatory hyperpigmentation. In two of them it was preceded by erythema that lasted for more than 1 month. All patients were free of noticeable pigmentation 3 months after the final peel. Patients in whom hyperpigmentation did not develop were of light brown complexion.
We conclude that medium-depth chemical peel is a safe and effective method of treating acne scars even in patients with dark complexion.
Pyruvic acid (CH3-CO-COOH), an alpha-keto-acid, has been recently used as a medium chemical peeling agent in subjects with inflammatory acne, moderate acne scars, greasy skin, actinic keratosis, and warts.
The aim of our study was to evaluate the efficacy and tolerability of 50% pyruvic acid on moderately photodamaged facial skin.
We treated 20 patients with four peeling sessions at 4-week intervals. We evaluated the patients clinically, and in order to obtain an objective assessment of the effect of pyruvic acid on pigmentary components of the skin, erythema and hyperpigmentation response were measured in all the patients before and after treatment using a Minolta Tri-Stimulus Colorimeter II.
The clinical evaluation of the patients after the peeling sessions demonstrated a smoother texture, less evident fine wrinkles, and evident lightening of hyperpigmentations (freckles and lentigines). In fact, chemical peels cause a thinning of the epidermis and a thickening of the dermis. The patients treated reported very limited or no discomfort in the postpeel period.
Thus, 50% pyruvic acid peeling can be proposed as a safe and efficient treatment for moderate facial skin aging.
Melasma is a common disfiguring skin problem. Multiple modalities have been used in the treatment of melasma, such as bleaching agents and chemical peels. Many chemicals have been used in the skin peeling for melasma, such as Jessner's solution and glycolic acid. Lactic acid is an alpha-hydroxy acid that has not been used before in chemical peeling of melasma.
The purpose of the present work is to evaluate the efficacy and safety of lactic acid in chemical peeling of melasma.
This study was conducted at the outpatient Department of Dermatology and Venereology, Baghdad Teaching Hospital, in the period between April 2001 and August 2002. Twenty patients with melasma were included in this study; 18 (90%) were female and 2 (10%) were male, with an age range from 24 to 38 years and a mean of 29 +/- 4.264 SD. Full clinical examination was done of all patients, including Wood's light. The severity of melasma was assessed by the Melasma Area Severity Index (MASI). Pure lactic acid, full strength (92%; pH 3.5), was used as a new peeling agent. The chemical peeling sessions were done every 3 weeks until the desired response was achieved, but not more than six sessions. Follow-up was carried out for 6 months after the last session. All patients had skin type IV; morphologic forms of melasma were a mask-like shape in seven patients (35%), a butterfly shape in nine patients (45%), and a horseshoe shape in 4 patients (20%).
Eight patients defaulted from the study after the first session for unknown reasons. Twelve patients completed the study. Eleven patients were female (91.7%), and one patient was male (8.3%). Their ages ranged from 24 to 38 years, with a mean of 29.25 +/- 4.9 SD. Wood's light examination showed increased contrast in all patients (epidermal melasma). The number of sessions ranged from two to six. All 12 patients showed marked improvement, as calculated by the MASI score before and after treatment, and the response was highly statistically significant. No side effect was recorded in all treated patients.
Lactic acid was found to be a new effective and safe peeling agent in the treatment of melasma.
Several pathogenic factors contribute to the development of acne, among them, seborrhea, follicular hyperkeratosis, propionibacteria, and inflammatory events. This article reviews current knowledge of these pathogenic factors.
Common skin conditions during pregnancy generally can be separated into three categories: hormone-related, preexisting, and pregnancy-specific. Normal hormone changes during pregnancy may cause benign skin conditions including striae gravidarum (stretch marks); hyperpigmentation (e.g., melasma); and hair, nail, and vascular changes. Preexisting skin conditions (e.g., atopic dermatitis, psoriasis, fungal infections, cutaneous tumors) may change during pregnancy. Pregnancy-specific skin conditions include pruritic urticarial papules and plaques of pregnancy, prurigo of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid gestationis, impetigo herpetiformis, and pruritic folliculitis of pregnancy. Pruritic urticarial papules and plaques of pregnancy are the most common of these disorders. Most skin conditions resolve postpartum and only require symptomatic treatment. However, there are specific treatments for some conditions (e.g., melasma, intrahepatic cholestasis of pregnancy, impetigo herpetiformis, pruritic folliculitis of pregnancy). Antepartum surveillance is recommended for patients with intrahepatic cholestasis of pregnancy, impetigo herpetiformis, and pemphigoid gestationis.
Chemical peeling is an in-office procedure that involves the application of a chemical agent to the skin to induce controlled destruction or exfoliation of old skin and stimulation of new epidermal growth with more evenly distributed melanin. When peel agents reach the dermal layer, important wound-healing activities occur that cause skin remodeling and skin smoothing, both antiaging benefits. There are a number of key factors in selecting a peeling agent and procedure, and each is discussed. Variables to consider are the peeling agent and its formulation, the concentration of the agent, the patient's skin type, the site to be peeled, the skin preparation procedure prior to and immediately preceding the application of the agent, the application method, the duration of contact, and the patient's medical history and lifestyle. Various types of peels are discussed. Of particular interest are superficial chemical peels, which offer great flexibility over a range of skin types and conditions with minimal to no "downtime." Alpha-hydroxyacid (AHA) peels are superficial and can be combined with other cosmetic procedures in the office to maximize benefits. In addition, AHA peels work well when combined with supportive homecare products including AHAs or polyhydroxy acids (PHAs), topical retinoids, and antiacne/antirosacea treatments. Case studies are presented of patients using AHA peels for the treatment of acne and hyperpigmentation in a variety of skin types, including Asian skin.
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