Content uploaded by Amira Ali
Author content
All content in this area was uploaded by Amira Ali on Aug 28, 2017
Content may be subject to copyright.
A preview of the PDF is not available
Dermal morphological changes following salicylic acid peeling and microdermabrasion
Abstract and Figures
Background:
Microdermabrasion and chemical peeling are popular, inexpensive, and safe methods for treatment of some skin disorders and to rejuvenate skin.
Objectives:
To study the alterations of the dermal connective tissue following salicylic acid peeling and microdermabrasion.
Methods:
Twenty patients were participated in our study. All participants underwent facial salicylic acid 30% peel or microdermabrasion (10 cases in each group) weekly for 6 weeks. Punch biopsies were obtained from the clinically normal skin of the right postauricular region 1 week before treatment (control group). Other punch skin biopsies were obtained 1 week after the end of the treatments from the left postauricular area. This region was treated in a similar way to the adjacent lesional skin (treated group). We used routine histological techniques (H&E stain), special stains (Masson trichrome and orcein stains), and image analyzer to study the alterations of the dermal connective tissues.
Results:
Our study demonstrates variations in the morphological changes between the control and the treated groups, and between chemical peels and microdermabrasion. Both salicylic acid 30% and microdermabrasion were associated with thickened epidermal layer, shallow dermal papillae, dense collagen, and elastic fibers. There was a significant increase among those treated sites vs control regarding epidermal thickness and collagen thickness. Also, there was a highly statistically significant increase among those treated with salicylic acid vs microdermabrasion regarding the epidermal, collagen, and elastin thickness.
Conclusions:
Both methods stimulate the repair process. The mechanisms underlying these variations are open for further investigations.
Figures - uploaded by Amira Ali
Author content
All figure content in this area was uploaded by Amira Ali
Content may be subject to copyright.
... Microdermabrasion affects the thickening of the epidermis and connective tissue of the skin. Abdel-Motaleb et al. [13] also indicated an increase in the amount of collagen in the reticulate and papillary layers, which might reduce fine wrinkles on the skin surface. After microdermabrasion treatments, a slight decrease in the amount of elastin fibers in the papillary and upper reticular layers was observed. ...
Diamond microdermabrasion is one of the most popular cosmetological treatments in the field of mechanical, controlled abrasion of the stratum corneum corneocytes. In this study, the influence of micropeeling on the optical properties of the skin features was investigated. The directional reflectance of the skin was measured before and after the procedure. The study involved 15 women aged 23–26. The tests were performed on the surface of the skin in 15 spots—on the forearms, arms and lower legs. Post-treatment reflectance increased significantly in the wavelength range of 700–2500 nm. In the remaining ranges it also increased, except for the range 480–600 nm, in which it decreased, but insignificantly. It was found that the optical properties of the skin after microdermabrasion changed, the directional reflectance of the skin increased, especially in the infrared range. The main conclusion from the conducted research is that the directional-hemispherical reflectance method can be used to identify female skin features in response of microdermabrasion treatment.
... Abdel-Motaleb et al. showed morphological changes between the control group and the group treated using chemical peels and microdermabrasion. Salicylic acids and microdermabrasion significantly increased epidermal thickness, collagen fibres, and elastin thickness [18]. A study by El-Domyati et al. was conducted on 38 patients (four groups: acne scars, melasma, photoageing, and striae distensae). ...
There are many cosmetic methods to reduce skin eruptions in people with acne vulgaris. As oxybrasion is a safe method of exfoliating dead epidermis, our objective was to investigate its effectiveness in young women with acne vulgaris. The Global Acne Grading System (GAGS) and Derma Unit SSC 3 device (Sebumeter SM 815, Corneometer CM 825) were used to assess acne vulgaris and skin properties. Twenty-four women aged 19–21 years (M = 19.50, SD = 0.66) with diagnosed mild acne vulgaris and a high level of sebum (more than 100 μg/cm2) participated in the study. Women on any dermatological treatment within the last 12 months and/or hormonal contraception were excluded. Probands were randomly assigned to two equal groups. Group A (experimental) was oxybrased with 0.9% sodium chloride solution simultaneously with compressed oxygen. Group B (placebo) was the group treated with non-carbonated mineral water and oxygen from the device (not pure). A series of five treatments was performed at 10-day intervals. Skin parameters were measured before and 30 days after the end of treatment. As a result, in group A (experimental), skin hydration and GAGS improved, while sebum on the epidermis was reduced. No side effects were noted. We concluded that oxybrasion is effective in women with acne and safe, as it improved skin parameters; however, further research is needed.
... Microdermabrasion, moderate to deep chemical peels, fractional radiofrequency microneedling, and fractional non-ablative and fractional ablative lasers, all demonstrate an induced wound repair response on histology [137][138][139] . Recent molecular analysis suggests that fractionated ablative CO 2 laser accomplishes this through alteration of inflammatory signal pathways, with damage-activating innate immune responses that in turn trigger the activation of retinoic acid-dependent pathways [140] . ...
Skin aging is a major cosmetic concern and associated with extensive changes in skin function and structure. The understanding of the basic science underlying skin aging is rapidly progressing, anchored around nine fundamental hallmarks of aging defined in 2013. Here we present the evidence for the relevance of each hallmark of aging to skin aging, emphasizing the uniquely prominent roles of oxidative damage and the extracellular matrix in photoaging. We review the existing evidence for how established treatments of skin aging target each fundamental hallmark and discuss targets for potential future treatments.
... 6 Microdermabrasion (MDA) is a common procedure of superficial resurfacing used to treat various skin problems including post acne scars, photodamaged skin, striae distensae and melisma. 7,8 Also, it could be beneficial in enhancing transdermal drug delivery through selectively removing the stratum corneum that is considered the main barrier for percutaneous delivery. 9,10 To date, limited studies addressed the enhanced skin permeability of microdermabrasion in different dermatologic conditions. ...
Background
Melasma is a disfiguring dermatologic condition and its treatment is still considered a challenge.
Objectives
To evaluate the efficacy and safety of microdermabrasion (MDA) combined with glycolic acid 70% (GA70%) peel versus GA70% alone in treating melasma in dark-skinned patients.
Patients and methods
This study included 30 female patients (skin type IV and V) with melasma. After cleansing the face, 3 passes of MDA were done on one side of the face. Then, GA70% was applied to the whole face in 1-2 uniform passes. Melasma area and severity index (MASI), modified MASI and hemi-MASI scores were used to assess the outcome.
Results
A significant decline of the mean MASI, mMASI and both hemi-MASI scores following treatment (p value= 0.000 for each). Furthermore, the hemi-MASI score on the MDA/GA70% treated side showed significantly greater decrease than the hemi-MASI score on GA70% treated side (p value=0.041).
Conclusion
MDA enhanced the improvement of GA70% peel effectively and safely.
This article is protected by copyright. All rights reserved.
... D'autres constituants majeurs de la matrice extracellulaire du derme, comme les protéoglycanes et les GAG, impactés par le vieillissement, peuvent être ciblés par des traitements anti-âge : c'est le cas, notamment, du C-xyloside qui stimule la production et le dépôt de ces composants, notamment de GAG [31], ainsi que des collagènes de la jonction dermo-épidermique [32]. Au niveau de l'épiderme, l'application d'exfoliants chimiques, comme l'acide trichloroacétique (TCA) ou des alpha/bêta-hydroxyacides (AHA ou BHA), permet de supprimer des couches cellulaires épidermiques, à des profondeurs variables selon les molécules utilisées, ce qui active la prolifération cellulaire et peut contribuer à restaurer l'architecture du tissu [33]. Les stratégies visant à améliorer la microcirculation cutanée chez les personnes âgées incluent l'activité physique régulière. ...
La peau est un organe sentinelle, soumis au vieillissement chronologique et environnemental qui fragilise sa structure et ses fonctions. La fonction barrière de la peau, ses propriétés élastiques et de résistance, ainsi que sa réactivité vasculaire sont atteintes par le vieillissement dans les compartiments épidermiques, dermiques et vasculaires. Les progrès de la recherche ont permis de révéler des processus biologiques sous-jacents, qui peuvent être ciblés par des approches médicamenteuses topiques ou globales à base notamment d’anti-oxydants ou de sénolytiques. Ces stratégies anti-âge pourront contribuer à restaurer, au moins en partie, l’intégrité fonctionnelle de la peau âgée.
Keratoacanthoma (KA) is a benign, cutaneous tumor that presents as a dome shaped nodule and is characterized by rapid growth. We present a case of rapid evolvement of keratoacanthoma apparently provoked by a facial chemical peel. With this case we wish to highlight keratoacanthoma as a possible complication to this category of skin rejuvenation treatments.
There is extensive literature on the repair process, morphogenesis, and neocollagenesis, which follow different chemical peelings, dermabrasion, and lasers, both ablative and non-ablative (fractionated or not), in addition to microneedling. Interestingly, all these interventions present particularly different responses due to the pattern of damage they promote. A thorough knowledge of these patterns and the repair cascades they induce not only tends to maximize results based on the best indications but also can lead to idealize new treatments or a combination of procedures. In the case of percutaneous collagen induction (PCI), the tissue response is extremely dependent on the density of the perforations and the depth they reach. In the conditions that will be described later, the different types of aggression induced by microneedling also lead to their own effects on skin physiology, which should be clarified in further research. Microneedling promotes consistent thickening of the epithelium, with regularization of the nuclear polarity of the basal layer, reduction of solar elastosis, and increase of types I and III collagen and of type VII collagen (component of the basal membrane zone). A 5% reduction in melanin density and granulation of melanosomes, structural increase of the basal membrane zone, and 32% increase in keratinocyte proliferation rate (Ki67) can also be observed. These changes in the epidermis may justify the appearance of improvement in skin texture.
Background
Oxybrasion is one of the types of microdermabrasion. This method removes a superficial epidermal layer with the use of a stream of 0,9% saline solution and compressed air.
Aims
The assessment of skin hydration, sebum, pH, TEWL and pigmentation using oxybrasion.
Material and methods
The study involved 27 female subjects. Five treatments were performed every two weeks using the oxygen microdermabrasion. Measurements of the skin parameters were taken before each treatment and two weeks after the last procedure. The measurement points were on the forehead, the cheek and on the petal of the nose.
Results
Sebum measurement showed some statistically significant differences between the sebum level on the cheek and the nose after a series of treatments. A higher hydration level was found at all measurement points. There were no statistically significant differences in TEWL parameter. pH measurement showed that the pH value decreased after each of the procedures. Most of the pigmentation measurements differed in a statistically significant way.
Conclusion
Results of the study indicate that the oxybrasion treatments increase the skin hydration and they have a significant influence on the decrease of the skin hydrolipid coat and pH.
Background: Striae distensae (SD) are common skin conditions.
Objectives: This study was done to test the hypothesis that ‘the use of microneedling (MN) before platelet-rich plasma (PRP) application will allow for deeper penetration and therefore, augment its efficacy in the treatment of SD.’
Patients and methods: Forty patients with SD were divided into (i) Group I, the patients were treated with MN only, and (ii) Group II, the patients were treated with combined MN-PRP. The clinical improvement was evaluated by two dermatologists. Skin biopsies were obtained before and after therapy to examine immunohistological changes.
Results: As compared to the use of MN alone, therapy with combined MN-PRP was associated with: (i) a marked to the excellent improvement of the skin lesions of SD, (ii) a more significant deposition of collagen and elastic fibers, (iii) increased proliferative activity in the epidermis, and (iv) a decreased caspase-3 protein expression values in the epidermis.
Conclusions: This study proved that the combined MN-PRP is more effective than MN alone for the treatment of the lesions of SD. The underlying molecular mechanisms are open for future studies.
Chemical peeling is a widely used procedure in the management of acne and acne scars, but there are very few studies on Asian populations who are more prone to develop hyper pigmentation. This article aims to summarize and evaluate the existing studies on the role of chemical peels in the treatment of acne and acne scars among Asians. An online search was conducted to identify prospective studies published in English that evaluated the use of chemical peels in active acne and acne scars in Asian populations. There were six studies for acne and eight studies for acne scars that were identified using our search parameters. Most were single-centre, open label and with small sample sizes. Acne severity was not uniformly reported and the objective outcome measures of some studies were not explicitly reported as well. The general trend of the results of the studies support the safety and efficacy of chemical peels for acne and acne scars including those of darker skin types. The existing studies support the use of chemical peels in the treatment of acne and acne scars in Asians. Further clinical trials with better study design and more subjects are needed to further establish the role of chemical peels in Asian acne patients.
To investigate dermal remodeling effects of crystal-free microdermabrasion on photodamaged skin.
Biochemical analyses of human skin biopsy specimens following microdermabrasion treatment in vivo.
Academic referral center.
Volunteer sample of 40 adults, aged 50 to 83 years, with clinically photodamaged forearms. Intervention Focal microdermabrasion treatment with diamond-studded handpieces of varying abrasiveness on photodamaged forearms and serial biopsies at baseline and various times after treatment.
Quantitative polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay were used to quantify changes in inflammatory, proliferative, and remodeling effectors of normal wound healing. Type I and type III procollagen served as the main outcome marker of dermal remodeling.
Coarse-grit microdermabrasion induces a wound healing response characterized by rapid increase in induction of cytokeratin 16 and activation of the AP-1 transcription factor in the epidermis. Early inflammation was demonstrated by induction of inflammatory cytokines, antimicrobial peptides, and neutrophil infiltration in the dermis. AP-1 activation was followed by matrix metalloproteinase-mediated degradation of extracellular matrix. Consistent with this wound-healing response, we observed significant remodeling of the dermal component of the skin, highlighted by induction of type I and type III procollagen and by induction of collagen production enhancers heat shock protein 47 and prolyl 4-hydroxylase. Dermal remodeling was not achieved when microdermabrasion was performed using a medium-grit handpiece.
Microdermabrasion using a coarse diamond-studded handpiece induces a dermal remodeling cascade similar to that seen in incisional wound healing. Optimization of these molecular effects is likely the result of more aggressive treatment with a more abrasive handpiece.
A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin and rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but patients are in control with this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the last in a three-part series describing noninvasive facial rejuvenation. Here the authors review the mechanism, indications, and possible complications of lasers, chemical peels, and other commonly used noninvasive modalities.
Background. Microdermabrasion is a non chemical superficial resurfacing procedure that removes the stratum corneum. Because it is a somewhat subtle procedure, it may be difficult to demonstrate its cosmetic benefit.
Objectives. To assess the efficacy of microdermabrasion in treatment of melasma, postacne scarring, striae distensae and photoaging by a series of microdermabrasion sittings through clinical, histometric and histopathologic analysis .
Patients and Methods. The study was conducted on 38 patients constituting 4 groups (melasma, acne scars, striae destinsae and photoaging), each patient was subjected to a series of 8 microdermabrasion treatments performed at one week interval. Punch biopsies; at base line, one week after the 4th and the 8th session were obtained from each subject for histometric and histopathologic analysis.
Results. Clinically, the improvement in melasma, acne scars and striae distensae groups was mainly mild to moderate, while in photoaging group was mainly mild. Histometric analysis of epidermal thickness showed insignificant changes in all groups. Histopathologically, decreased melanization and regular distribution of melanosomes in the epidermis was noted in melasma group while increased density of collagen fibers with more regular arrangement in collagen bundles was detected in all candidates of acne scars, striae distensae and photoaging groups. Meanwhile, Orcein stain did not show any significant changes in elastic fibers.
Conclusions. Microdermabrasion is an easy and safe technique. In the present study, most cases showed mild to moderate improvement. Decreased melanization with regular distribution of melanosomes and increased collagen density with regular arrangement of collagen bundles were the most common observed histologic changes.
Background. Microdermabrasion (MDA) is a new procedure used for the treatment of cosmetic problems, particularly to combat photoaging and intrinsic aging. Though excellent clinical improvement has been well documented, histologic support is limited.Objective. To determine if microscopic changes correlate with clinical improvement and to examine the depth of penetration compared to chemical peels.Methods. Seven women were submitted to five MDA sessions at weekly intervals. Skin biopsies were performed in all of them, before and after the treatment. Clinical and photographic assessments were recorded weekly. Data concerning skin features, including oiliness, thickness, dilated pores, and general appearance, were all assessed. Microscopic improvement of changes associated with cutaneous aging in the epidermis and dermis where all assessed. For statistical analysis, a t-test for small samples was utilized.Results. All the patients showed clinical and microscopic improvement in all of the parameters assessed. The t-test for small samples showed a P < .05.Conclusion. MDA is a good alternative for facial rejuvenation. Improvements in both clinical and microscopic parameters are readily demonstrable.
Ultrastructural changes occurring in the skin at early times after chemical peels as well as effects on the wound healing with moisturization after these peels have been examined. This study evaluated the changes seen in the skin 3 days and 5 days after 35% trichloroacetic acid peels, and the effect of moisturization on this healing was evaluated. Biopsies at 3 days showed an outermost layer of necrotic stratum corneum and stratum granulosum and an underlying layer of new stratum corneum. There were increased cytoplasmic vacuoles in the keratinocytes of the stratum spinosum, stratum granulosum, and stratum basale layers. There was extensive intercellular spacing between the basal keratinocytes. At 5 days the necrotic layer of stratum corneum and stratum granulosum was gone. The lower epidermis at 5 days showed less intercellular spacing, and there was less vacuolization within keratinocytes. In seven of eight patients treated with moisturization after the peel (p = 0.0325), the ultrastructural changes at 5 days were consistent with a more advanced state of healing compared with those that were treated dry. Ultrastructural morphology at this time showed less intercellular spacing and fewer cytoplasmic vacuoles, indicative of an advanced state of wound repair. These moisturized skin specimens had returned to an almost normal state of structure compared with the skin that had been treated dry.
Chemical peeling is a popular, relatively inexpensive, and generally safe method for treatment of some skin disorders and to refresh and rejuvenate skin. This article focuses on chemical peels and their use in routine clinical practice. Chemical peels are classified by the depth of action into superficial, medium, and deep peels. The depth of the peel is correlated with clinical changes, with the greatest change achieved by deep peels. However, the depth is also associated with longer healing times and the potential for complications. A wide variety of peels are available, utilizing various topical agents and concentrations, including a recent salicylic acid derivative, beta-lipohydroxy acid, which has properties that may expand the clinical use of peels. Superficial peels, penetrating only the epidermis, can be used to enhance treatment for a variety of conditions, including acne, melasma, dyschromias, photodamage, and actinic keratoses. Medium-depth peels, penetrating to the papillary dermis, may be used for dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders. Deep peels, affecting reticular dermis, may be used for severe photoaging, deep wrinkles, or scars. Peels can be combined with other in-office facial resurfacing techniques to optimize outcomes and enhance patient satisfaction and allow clinicians to tailor the treatment to individual patient needs. Successful outcomes are based on a careful patient selection as well as appropriate use of specific peeling agents. Used properly, the chemical peel has the potential to fill an important therapeutic need in the dermatologist's and plastic surgeon's armamentarium.
To analyze the onset and extent of the dermatological changes associated with microdermabrasion.
Eleven volunteers, aged 31-62 years old, underwent a series of six aluminum oxide microdermabrasion facial treatments spaced over 7 to 10-day intervals. White light photography and digital ultraviolet fluorescent photography and skin biopsies were obtained prior to the study, after three treatments, and after six treatments. A 90-day no-treatment period ensured, after which biopsies and photographs were taken.
Clinical improvements in dyschromia, actinic changes and fine rhytides were observed after six treatments. Compared with the controls, the treated areas demonstrated the following histological changes: epidermal thickening with basal cell hyperplasia and mitotic activity; flattening and widening of the rete pegs; papillary dermal thickening with deposition of collagen and elastic fibers; and perivascular inflammation in the dermis. After the no-treatment period some of the clinical and histologic changes persisted although they were less than those present immediately after the last treatment. Serial ultraviolet photography following microdermabrasion treatments revealed changes in the skin's pigmentation pattern that correlated clinically with improvements in dyschromia.
Clinical and histological changes are most likely secondary to a mechanism resembling a reparative process. The persistent changes after a period of no-treatment suggests that some of the changes could be permanent. Clinicians can use this data to better determine the optimal interval frequency and treatment intervals with microdermabrasion.