Article

Pyruvic Acid Peels for the Treatment of Photoaging

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Abstract

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.

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... Local administration of pyruvate compounds and specifically sodium pyruvate (NaPy) appears to be very promising for preventing, arresting, ameliorating, or treating PUs at their earliest stage of cell-level damage. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Cells regularly produce NaPy, an organic salt of pyruvic acid, as an intermediate metabolite in the glycolysis pathway, and, hence, NaPy is a natural substance within the human body. It is also a standard practice to add NaPy to cell culture media as an energy supplement (ie, as an extra source of carbon in addition to glucose). ...
... Furthermore, for similar reasons, NaPy is often being used in facial and body skin care and in cosmetic products as well. 17 The use of NaPy is also common in nutritional products, for example, for fat and weight loss. 18 In the medical context of tissue protection, there is a plethora of published work regarding the effectiveness of NaPy in protecting brain, lung, kidney, vascular, and eye tissues exposed to traumatic, toxic, ischaemic, or a combination of these insults. ...
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The use of sacral dressings for pressure ulcer prevention is growing rapidly. In addition to their passive biomechanical role in pressure and shear reduction, in the near future, prophylactic dressings may also provide active tissue protection by releasing preventive agents or drugs into skin and deeper tissues. We investigated delivery of sodium pyruvate (NaPy) from an active dressing to potentially protect the sacral skin and underlying tissues in addition. We used four finite element model variants describing different skin roughness levels to determine time profiles of NaPy diffusion from the dressing into the skin layers. The NaPy concentrations for the different modelled cases stabilised after 1 to 6.5 hours from the time of application of the dressings, at 1% to 3% of the NaPy concentration in the dressing reservoir, which is considered potent. We conclude that prophylactic sacral dressings have the potential to deliver NaPy into skin and subdermally, to potentially increase soft tissue tolerance to sustained bodyweight‐caused cell and tissue deformations. The time durations to achieve the steady‐state potent NaPy dermal concentrations are clinically feasible, for example, for preparation of patients for surgery or for use in intensive care units.
... Pyruvate is widely used, e.g., for the synthesis of various chemicals and polymers or as ingredient or additive in food, cosmetics, and pharmaceuticals (Li et al. 2001; Zhu et al. 2008). Furthermore, it is used for other applications, e.g., weight loss diets (Stanko et al. 1992a; Stanko et al. 1992b; Roufs 1996), exercise endurance (Stanko et al. 1990), antiacne and anti-ageing skin treatment (Cotellessa et al. 2004; Ghersetich et al. 2004), and it serves as antioxidant (DeBoer et al. 1993) and acts positively on graft tolerance (Cicalese et al. 1997; Cicalese et al. 1999). Chemical production of pyruvate is realized by dehydration and decarboxylation of tartaric acid (Howard and Fraser 1932). ...
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A Corynebacterium glutamicum strain with inactivated pyruvate dehydrogenase complex and a deletion of the gene encoding the pyruvate:quinone oxidoreductase produces about 19 mM l-valine, 28 mM l-alanine and about 55 mM pyruvate from 150 mM glucose. Based on this double mutant C. glutamicum △aceE △pqo, we engineered C. glutamicum for efficient production of pyruvate from glucose by additional deletion of the ldhA gene encoding NAD+-dependent l-lactate dehydrogenase (LdhA) and introduction of a attenuated variant of the acetohydroxyacid synthase (△C–T IlvN). The latter modification abolished overflow metabolism towards l-valine and shifted the product spectrum to pyruvate production. In shake flasks, the resulting strain C. glutamicum △aceE △pqo △ldhA △C–T ilvN produced about 190 mM pyruvate with a Y P/S of 1.36 mol per mol of glucose; however, it still secreted significant amounts of l-alanine. Additional deletion of genes encoding the transaminases AlaT and AvtA reduced l-alanine formation by about 50%. In fed-batch fermentations at high cell densities with adjusted oxygen supply during growth and production (0–5% dissolved oxygen), the newly constructed strain C. glutamicum △aceE △pqo △ldhA △C–T ilvN △alaT △avtA produced more than 500 mM pyruvate with a maximum yield of 0.97 mol per mole of glucose and a productivity of 0.92 mmol g (CDW)−1 h−1 (i.e., 0.08 g g(CDW)−1 h−1) in the production phase.
... Związek ten wywołuje w skórze efekt metaboliczny, działając keratolitycznie oraz komedolitycznie. Ponadto, ze względu na działanie antybakteryjne oraz sebostatyczne, jest skutecz-nym środkiem w redukcji trzech najważniejszych czynników powodujących powstawanie trądziku [21]. Minimalny czas między kolejnymi zabiegami złuszczania za pomocą kwasu pirogronowego powinien wynosić 10-14 dni [29]. ...
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.
... VYC-12L has several features that differentiate it from other treatments intended to improve the appearance of the skin. For example, topical retinoids, 40,41 photodynamic therapy, 42 chemical peels, 8,43 laser skin resurfacing, 37 and nonablative skin rejuvenation devices 44 are applied to the surface of the skin, whereas VYC-12L is injected intradermally, with the objective being long-term improvements in skin appearance. 18 Treatment with injectable HA-based fillers has been shown to temporarily improve attributes of skin quality, by hydrating the dermis and stabilizing the structure of the extracellular matrix-supporting fibroblasts. ...
Article
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Background: VYC-12L is a hyaluronic acid (HA) injectable gel designed to treat fine cutaneous lines and improve skin quality attributes such as hydration and elasticity. Objective: Expert consensus was sought on VYC-12L injection technique and primary treatment target areas. Methods: A multinational group of aesthetic medicine clinicians (n = 128) attended product training and each identified ~10 patients for VYC-12L. After treating their first and last patients, the clinicians completed a survey on preferred injection methodology/technique, including injection angle, volume, and spacing. An expert panel (n = 12) discussed survey results and their clinical experiences to obtain consensus on VYC-12L technique and appropriate treatment areas. Results: Recommendations included micro-depot injections of VYC-12L into the deep dermis with a 32G ½ inch needle inserted at <45º to the skin, spaced 0.5‒1.0 cm apart, with 0.01‒0.05 mL volume per injection (full-face total volume: ~2 mL). Recommended primary treatment areas were the malar, perioral, neck, and décolletage regions. Injection techniques for different treatment areas/demographic characteristics were similar, with some variability in treatment approach. Patient selection criteria, pre- and post-treatment guidelines, and managing patient expectations are important components of treatment. Conclusion: These consensus recommendations may assist clinicians in optimizing the treatment of fine lines with VYC-12L.
... D iscontinuities in the facial skin surface, such as the development of superficial fine lines, are considered unattractive and are associated with aging. 1,2 Many treatments are available for reducing the appearance of fine lines, such as topical retinoids, 3,4 intradermal filler injections, 5,6 mesotherapy, 7,8 photodynamic therapy, 9 chemical peels, 10,11 and laser skin resurfacing. 12 Given the growing availability of such treatments, the number of rejuvenation procedures has substantially increased in the past decade 13 and is likely to continue to increase over the coming decades as the US population ages. ...
Article
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Background: A validated scale is needed for objective and reproducible comparisons of facial fine lines before and after treatment in practice and clinical studies. Objective: To describe the development and validation of the 5-point photonumeric Allergan Fine Lines Scale. Methods: The Allergan Fine Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live subject validation study (N = 289) completed during 2 sessions occurring 3 weeks apart. Results: A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% CI] absolute score difference, 1.06 [0.92-1.21] for clinically different image pairs and 0.50 [0.38-0.61] for not clinically different pairs). Intrarater agreement between the 2 live subject validation sessions was almost perfect (weighted kappa = 0.85). Interrater agreement was substantial during the second rating session (0.76, primary end point). Conclusion: The Allergan Fine Lines Scale is a validated and reliable scale for physician rating of severity of superficial fine lines.
... 24 The study using a colorimeter also showed lightening of discolorations after 4 sessions using 50% pyruvic acid. 25 After the third treatment with 50% pyruvic acid, statistically significant differences were observed in the amount of sebum secreted on the chin. A similar trend was observed on the left cheek. ...
Article
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.
... Following its keratolytic and desmoplastic properties, PA has been employed as a medium peeling agent in subjects with inflammatory acne, moderate acne scars, greasy skin, actinic keratosis, and warts. Apart from being useful for acne, photodamage, and superficial scarring, the agent has also shown benefit in several pigmentary disorders in light-skinned patients 11,12 . ...
Article
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Chemical peels are widely used as therapeutic agents in dermatology and cosmetology. This study aims to explore the differences in the effectiveness of azelaic and pyruvic acid peels in the treatment of acne vulgaris. Eligibility criteria for participants were: female gender, 18–25 years of age, no dermatological treatment within the last 12 months and mild to moderate papulopustular acne. We treated 120 young women (with a mean age of 22 years old) with six peeling sessions at 2-week intervals. In the parallel clinical study design, one randomized group (n = 60, 50%) was treated using azelaic acid (AA), whereas the second group participated in pyruvic acid (PA) sessions. We evaluated the patients clinically twice (before and after treatment), using the Scale of Hellegren–Vincent Severity Symptoms to assess the acne diagnosis, and the Nati Analyzer to estimate the skin properties (oily skin, desquamation, porosity, and moisture). The clinical evaluation of the patients demonstrated a significant reduction of acne severity symptoms in both the AA and PA groups, after the peeling sessions. An effect was also found in terms of decreasing desquamation and the oiliness of the skin. PA showed a more significant reduction of greasy skin than AA. In conclusion, after the six peeling sessions using AA and PA, all patients showed better skin parameters in term of reduced oiliness and desquamation. Both AA and PA peelings are a safe and efficient treatment for mild acne, however, during the selection of one of the two acids, side effects, skin properties, and patients’ preferences should be taken into account. This study was registered in the ISRCTN registry (registration number ISRCTN79716614, 17/01/2020).
... There are a number of chemical peels, which effectively used in acne, scars, photodamaged skin. Known chemical peels are ␣hydroxy acid, trichloro acetic acid, salicylic acid etc. [151,152]. ...
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Human beings are constantly exposed to UV radiations emitted by sun. Prolonged exposure to UV radiations initiates a series of pathophysiological events that account for photodamage in skin. Photoaging is the major contributor of skin melanoma and risk is particularly seen higher in fair skin population, with approximately 80 to 90% of European and North American population prevalent to skin photoaging. Importantly, skin cancer due to sun exposure is the most leading type of cancer prevalent in New Zealand; with approximately 67,000 new cases diagnosed every year with skin cancer. In fact, photoaging-associated skin cancer accounts for more than 65,000 deaths worldwide every year. This current and impending burden of the affected individuals provokes the need for further insight into the biochemical changes that contribute to the pathogenesis of skin cancer due to UV radiations and future therapeutic interventions to prevent and treat the associated skin disorders. On exposure to UV radiation, there is the generation of reactive oxygen species, reactive nitrogen species and inflammatory mediators. It also increases DNA damage in the body. All these factors together lead to degradation of collagen, and finally results in formation of wrinkles and angiogenesis which are the major clinical manifestations of photoaging. Further, UV radiations cause decrease in Langerhans cell, melanocyte, keratinocytes, fibroblast, collagen, tissue inhibitor of matrix metalloproteinase, various endogenous antioxidants and increase in level of various cytokines. Therefore, by understanding the molecular mechanisms underlying photoaging, new therapeutic managements can be identified and discovered.
... [8] Skin care procedures forming the daily routine described in Ayurvedic literature consist of numerous formulae involving herbs and other natural ingredients. They were used as external applications in the form of packs, oils, herbal waters, powders etc. Applications of these as pastes have been classifi ed into several kinds based on the temperature, duration and thickness of application, effect of the application for healing, beautifying, anti-aging etc. [9,10] Ayurvedic cosmeceuticals are very much prized for their safe, holistic action. Based on the vast and established knowledge of Ayurveda, herbal extracts, fruit extracts and essential oils are now being effectively used in medicines, food supplements and personal care. ...
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The association between Ayurveda, anti-aging and cosmeceuticals is gaining importance in the beauty, health and wellness sector. Ayurvedic cosmeceuticals date back to the Indus Valley Civilization. Modern research trends mainly revolve around principles of anti-aging activity described in Ayurveda: Vayasthapana (age defying), Varnya (brighten skin-glow), Sandhaniya (cell regeneration), Vranaropana (healing), Tvachya (nurturing), Shothahara (anti-inflammatory), Tvachagnivardhani (strengthening skin metabolism) and Tvagrasayana (retarding aging). Many rasayana plants such as Emblica officinalis (Amla) and Centella asiatica (Gotukola) are extensively used.
... This awful side effect is associated with elevated acidity of AHA, as massive production of hydrogen ion during the dissociation process is harmful to the tissues. Nonetheless, high bioavailability of the active ingredients correlates with low pH, because only undissociated species effectively penetrate the skin and the exfoliation is most efficient with AHA used at pH lower than their pKa [14] [16]- [18]. ...
... Skin care procedures forming the daily routine described in Ayurvedic literature consist of numerous formulae involving herbs and other natural ingredients. They were used as external applications in the form of packs, oils, herbal waters, powders, etc. Applications of these as pastes have been classified into several kinds based on the temperature, duration and thickness of application, the effect of the application for healing, beautifying, anti-aging, etc. [34,35] Ayurvedic skin brightening agents are mostly compounds, which function by mechanism effecting melanin synthesis. Many Ayurvedic extracts from herbs, such as Nagakeshar (Ferula narthex), Yashtimadhu (Glycyrrhiza glabra), Amalaki (Embelica officinalis), Shalmali (Morus alba), have been demonstrated to be effective. ...
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Human physic receives the drug in two-ways. One through direct routs, i.e. through apertures of the body and another one are through the whole surface of the body. Absorption of drugs through body surface deserves special care for its optimum delivery. Ayurvedic Lepas do exit from the time immemorial from Vedas to Samhitas and in practice in a concurrent era too. This review article is the sincere attempt to summarize all the facts regarding Lepa Kalpana of Ayurveda. It includes its exploration in terms of therapeutics, cosmaceutics, and neutraceutics mentioned in various classical treatises specially mentioned in Schedule I of Drugs and Cosmetics Act, 1940. We tried to reveal adaptations of advanced technologies and its impact in the manufacturing of Ayurvedic Lepa licensed as classical and patent and proprietary medicines. In our critical analysis of facts, we had established that technology initiation in the preparation of Ayurvedic medicines, especially in Lepa Kalpana is like value addition in its pharmaceutics and therapeutic characteristics. The market of Ayurvedic cosmeceuticals is enhancing day-by-day. People believe in safety and efficacy of Ayurvedic topical applications. These are protective and promotive to skin as these are free from artificial chemicals. Still many formulations of Ayurveda are waiting for its reach to the common public that have been claimed for its clinical connotations for beauty and glowing skin; the first desire of women of any age. Tremendous business opportunity is hidden in the literature of Ayurveda for which we invite everyone interested to serve humanity through Ayurveda.
... Pyruvic acid is an α-keto-acid that converts to lactic acid. It can be used as a medium-depth peeling agent in the treatment of photoaged skin: 50% pyruvic acid peels performed on four occasions at 4-weekly intervals improved skin texture, fine wrinkles and hyperpigmentation in a group of 20 patients. [81] A further nonrandomized study of 20 patients with photodamage, superficial scarring or melasma treated with 50% pyruvic acid peels on four occasions at 2-weekly intervals demonstrated some improvement in wrinkles measured using an optical measuring device (Visioscan® VC; Courage + Khazaka, Cologne, Germany). The clinical improvement in ...
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In today's society the desire to maintain a youthful appearance has driven the development of minimally invasive dermatological procedures that are designed to rejuvenate the ageing face. The aim of this review is to present evidence for the use of techniques which can easily be incorporated into outpatient dermatology practice with low overhead expenditure. For this reason, laser and light-based treatments have been omitted. This review will instead focus on chemical peels, intradermal fillers and botulinum toxin. These techniques address the main aspects of facial ageing, namely photodamage, volume loss and dynamic lines, which correlate anatomically to skin, subcutaneous fat and muscle. A combination of such techniques will provide the practitioner with a reasonable portfolio of treatments for a balanced, holistic result.
... Chemical peeling is a safe and efficient treatment for moderate facial skin aging; in this treatment, chemicals remove layers of skin which results in smoother texture less evident fine wrinkles and evident lightening of hyperpigmentations . Commonly used peeling agent is glycolic acid and pyruvic acid [30]. ...
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Aging is a complex phenomenon, a sum total of changes that occur in a living organism with the passage of time and lead to decreasing ability to survive stress, increasing functional impairment and growing probability of death. There are many theories of aging and skin remains the largest organ of the study. Skin aging is described as a consequence of intrinsic and extrinsic factors. The most common amongst visible signs of skin aging are wrinkles and there are various therapies including antiaging cosmeceuticals, sunscreens, chemical peeling, injectable agents, such as botox, fibrel, autologous fat grafting as also few surgical procedures have been used. Ayurveda, the Indian traditional medicine, describes aging with great details. This review provides modern and Ayurvedic perspectives on theories and management of aging.
Chapter
Facial peeling with chemicals or chemical peeling is a procedure where a chemical agent or a combination of agents of defined strength is applied to the skin, causing a controlled destruction of the layers of the skin. This is followed by regeneration and remodeling leading to improvement of texture and surface abnormalities. The author discusses the basic principles and mechanism of action of peeling agents, histological classification of peels and peeling depths, peeling agents and selection of the peeling agent, technique, and possible complications.
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therefore, it is impor- tant to treat AKs to avoid the progression to invasive SCC. Studies have shown that more than 5 million Americans have at least one AK. 5 Risk factors include fair-skin phenotype, geo- graphic location (ie, closeness to equator), immunosuppression (eg, HIV-positive patients, those receiving organ transplants and patients with cancer) and supplementary sources of ultraviolet radiation (ie, artificial tanning and occupational exposure). The prevalence dramatically increases with age, which is indicative of the strong correlation between the amount of cumulative sun exposure and the occurrence of AK, as well as the fact that immune surveillance lessens with age. Occurrence of AK is high- er in men than in women. In a survey conducted in Tennessee, 26.5% of men and 10.2% of white women had one or more AKs. By age 75, 63.6% of the men had AKs. 6 Prevalence also increases with proximity to the equator. In Australia up to 60% of the population older than 40 years has AKs. 7,8
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Pyruvic (alfa-keto acid) and salicylic (beta-hydroxy acid) acids are superficial peels frequently used in patients with acne vulgaris.AimThe aim of the study was to compare the effect of 50% pyruvic and 30% salicylic peels on facial sebum secretion in patients with acne vulgaris, aged 13–30.Material and methodsThe level of secreted sebum was determined in 20 men and women. Ten patients were treated with 50% pyruvic acid and the remaining 10 with 30% salicylic acid. Each peel was applied five times at 2-week intervals. The sebum measurements were taken in the T- and U-zones using a Sebumeter SM 815 (Courage & Khazaka, Germany). The last, sixth measurement was taken 2 weeks after the treatment.ResultsA statistically significant decrease in the level of secreted sebum in both U- and T- zones was observed in the patients studied after the third application of 50% pyruvic peel and the second application of 30% salicylic peel. Two weeks following the completion of therapy, sebumetric measurements demonstrated a greater reduction in the facial skin lipid film among the patients treated with salicylic peel.Conclusions Peels with 50% pyruvic acid and 30% salicylic acid are the procedures that significantly contributed to a decrease in the level of secreted sebum on the facial skin surface in the group of patients studied. A greater therapeutic effect was observed following 30% salicylic peel, which might be associated with its high lipophilic properties and easier penetration through the lipid barriers of the epidermis.
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Ein Peeling erfolgt invasiv oder konservativ mit dem Ziel, die Hautstruktur nach vorausgehender Regeneration der Dermis und/oder Epidermis zu verbessern. Mittels verschiedener Verfahren kann das Abschälen (Syn.: Peeling) der Haut induziert werden (⊡ Tab. 5.1). Tab 5.1. Peelingverfahren
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Chemical peeling is becoming increasingly popular for the treatment of skin rejuvenation where it can improve damaged skin and fine wrinkles. The basic procedure aims at obtaining a controlled chemical burn of the epidermis and/or dermis. This results in epidermal regeneration and postinflammatory collagen neoformation with remodeling of collagen and elastic fibers and deposition of glycosaminoglycans in the dermis. Various chemicals have been used as peeling agents, of which the most used are the alpha-hydroxy acids, such as glycolic acid, or beta-hydroxy acids, such as salicylic acid. The choice of the compound is linked to the different indications and to the depth of the desired peeling. Phenol is still the best agent for deep peeling but requires specific indications, prescription, and post-peeling care. Combination of different compounds is one innovation in the field of chemical peelings. Further controlled studies are necessary to set up specific guidelines.
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The main processes involved in skin aging are intrinsic and extrinsic. Apart from them, so called stochastic aging connotes cell damage caused by metabolic processes, free radicals and cosmic irradiation. The clinical expression of intrinsic aging include smooth, dry, and thinned skin with accentuated expression lines. It is inevitable and time dependent. Extrinsically aged skin shows signs of photodamage which include appearance of wrinkles, pigmented lesions, actinic keratoses and patchy hypopigmentations. Therapeutic modalities imply photoprotection with sunscreens that prevent sunburns and block ultraviolet irradiation. Other modalities include use of retinoids which regulate gene transcription with subsequent cellular differentiation and proliferation. The topical and peroral administration of network antioxidants, such as vitamin E and C, coenzyme Q10, alpha-lipoic acid and glutathione, enhance antiaging effect. The other antioxidants such as green tea, dehydroepiandrosterone, melatonin, selenium and resveratrol, have also antiaging and anti-inflammatory effects. Topical bleaching agents such as hydroquinone, kojic acid and azelaic acid can reduce signs of aging. Studies confirm the efficacy of these topical agents in combination with superficial and/or medium depth or deep peeling agents for photodamaged skin treatment. Indications for type of chemical peels according to various clinical diagnosis are done, as well as advantages and disadvantages of different types of chemical peels.
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Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. PHYSICIANS' QUALIFICATIONS: The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. FACILITY: Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient's skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. ENDPOINTS IN PEELS: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner's solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.
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Successful treatment of actinic keratosis (AK) requires an understanding of available treatments and matching those treatments with each patient's disease severity, lifestyle, insurance coverage, and primary reason for the physician visit. Cryotherapy and other destructive strategies are optimal for hypertrophic and clearly delineated lesions, but they may not address subclinical lesions and are associated with risk of scarring, infection, and pigmentary changes. Topical therapies such as the fluorouracil creams are appropriate for treating large regions of affected skin but are associated with application-site irritation. A combination of destructive and topical approaches may benefit patients with multiple lesion pathologies.
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Chemical peels have become established over the past 40 years as an effective outpatient method for skin rejuvenation as well as the treatment of a variety of skin conditions. Although laser skin rejuvenation has claimed much attention in recent years, phenol peels, despite problems with scarring and hypopigmentation, remains the gold standard for skin resurfacing [11], against which other methods should be evaluated [21]. We present both a theoretical overview of chemical peels and practical step-for-step instructions.
Article
Background: Pyruvic acid is an alpha-keto acid that presents keratolytic, antimicrobial, and sebostatic properties as well as the ability to stimulate new collagen production and elastic fibers formation. Because of its low pKa and its small dimension, it penetrates rapidly and deeply through the skin, so far as to be considered a potent chemical peel agent. It has proven its efficacy for the treatment of many dermatological conditions such as acne, superficial scarring, photodamage, and pigmentary disorders. Pyruvic acid application usually induces intense burning, and the postpeeling period is characterized by erythema, desquamation, and, sometimes, crusting. Objective: The aim of the study is to assess the efficacy and tolerability of 50% pyruvic acid in a new non-erythematogenic formulation (pyruvic acid 50%, dimethyl isosorbide, propylene glycol, ethyl alcohol, dimethyl sulfone, ethyl lactate, water) for the treatment of photodamage, superficial scarring, and melasma. Materials and methods: Twenty subjects affected by photodamage, superficial scarring, and melasma, but otherwise healthy, entered the study. Four peeling sessions were performed once every 2 weeks. The patients were evaluated clinically and by means of several noninvasive methods in order to monitor the following parameters: hydration, color (erythema and pigmentation), elasticity, skin smoothness, skin roughness, scaliness, and wrinkles. Results: The patients did not report any discomfort either during the peeling session or during the postpeeling period, without any impact on their social life. We did not observe any case of persistent erythema as well as any case of postinflammatory hyperpigmentation. Instrumental evaluations showed a significant reduction in the degree of pigmentation in patients with melasma, a significant increase in skin elasticity, and an improvement of the degree of wrinkling in all the patients. Conclusion: This innovative formulation of 50% pyruvic acid peel has been shown to be safe and effective to treat photodamage, melasma, and superficial scarring, allowing the patients to carry out regularly their working life as well as their social life. Furthermore, the results have been evaluated by means of noninvasive devices, which have permitted one to quantify the improvements.
Article
Unlabelled: Aging is a complex, multifactorial process resulting in several functional and esthetic changes in the skin. These changes result from intrinsic as well as extrinsic processes, such as ultraviolet radiation. Recent advances in skin biology have increased our understanding of skin homeostasis and the aging process, as well as the mechanisms by which ultraviolet radiation contributes to photoaging and cutaneous disease. These advances in skin biology have led to the development of a diversity of treatments aimed at preventing aging and rejuvenating the skin. The focus of this review is the mechanism of photoaging and the pathophysiology underlying the treatments specifically designed for its prevention and treatment. Learning objectives: At the conclusion of this learning activity, participants should be familiar with the mechanism of photoaging, the treatments for photoaging, and the data that supports the use of these treatments.
Article
Superficial chemical peeling (SCP) involves the application of a peeling agent to the skin, resulting in destruction of part or all of the epidermis. SCP is mainly recommended for facial rejuvenation, photoaging and superficial rhytides, pigmentary dyschromias and acne. It can be used on all Fitzpatrick skin types, no sedation is needed, and the desquamation is usually well accepted. Overpeel and complications are very rare. The most commonly used SCP agents are glycolic acid 20-70%, trichloroacetic acid 10-35%, Jessner's solution, salicylic acid, pyruvic acid, resorcinol 30-50% preparations, and solid carbon dioxide. The careful selection of patients is critical for the outcome of a SCP and contraindications must be seriously considered. The peel procedure is generally common for all SCP agents but a good knowledge of the specific characters of each agent is of great importance in order to decide which to use for each individual patient.
Article
Background: Chronic solar irradiation results in both morphological and functional changes in affected skin. Superficial peels have been shown to improve all symptoms of photodamaged skin. Objective: This study was designed to compare the efficacy and tolerability of glycolic acid (GA, 70%) with trichloroacetic acid (TCA, 15%) for the treatment of photoaging. Materials and methods: Twenty female patients affected by photodamage were treated with graded concentrations of 70% GA and 15% TCA peel. Each patient was submitted to 5 sessions of these peels, with an interval of 14 days between each session. Four clinical parameters of surface evaluation of the living skin (hydration, elasticity, melanin, and erythema) were measured. The records were made before each treatment and 3 months after the last application. Results: The statistical significance in each group of patients was observed with elasticity and hydration. Decrease in melanin content in the skin occurred significantly after the application of a series of treatments with GA. Increase in severity of erythema showed statistical significance after the treatment with TCA. Conclusion: Superficial peels, such as 70% GA and 15% TCA, proved to be an effective treatment modality for photodamaged facial skin. Both acids contribute to improvement of the photodamaged skin's parameters. Glycolic acid increases skin's hydration faster.
Article
In summary, multiple studies have documented the efficacy of topical agents (retinoids, antioxidants, and topical bleaching agents) used in combination with superficial and/or mediumdepth or deep peeling agents for photodamage. The treatment of photodamage requires a multifaceted approach incorporating sun protection, antioxidants, exfoliating agents, retinoids, and resurfacing procedures. Despite the evolution of new and advanced laser technologies, chemical peeling remains a viable, efficacious, and cost-effective treatment for photodamage.
Article
Full-text available
В статье представлены данные о влиянии применения жидкостей с различным окислительно-восстановительным потенциалом в период реабилитации после косметологических процедур на качество жизни пациентов. Цель исследования: установить влияние жидкостей с различным окислительно-восстановительным потенциалом качество жизни пациентов в постпилинговом периоде. Пациентам была проведена процедура ретиноевого химического пилинга. При применении жидкостей с различным окислительно-восстановительным потенциалом осложнения в реабилитационном периоде после этой процедуры были значительно менее выраженными. Полученные данные характеризуют течение реабилитационного периода после химического пилинга при применении жидкостей с различным окислительно-восстановительным потенциалом как более благоприятное, с более высоким качеством жизни.
Chapter
Pyruvic acid has been considered as an important agent for peel because of its important ability to weaken keratinocytes cohesion and generates epidermolysis with no systemic toxicity. Given that, it can be used as a superficial to medium-depth peeling to approach inflammatory acne, moderate acne scars, oily skin, folliculitis, photoaging, and actinically damage skin.
Article
Hygiene of the bee products, especially for the use of people, is very important. Although many studies have been done to prevent bacterial contamination of honey and pollen, there is a lack of research on the hygiene of propolis. Although the risk of contamination by spore-forming bacteria is high, bees use propolis to clean hives. In order to determine the standard propolis quality, the sterilization process will be a matter of scientific interest in near future. Thus, this study examines the impact of sterilization process on chemical composition and antimicrobial activity of propolis. In this study, 250 grams of propolis was collected, and the sample was divided into three parts. Raw propolis (RP) was sterilized without any pretreatment, but sterilization made it sticky and hard, and it burned during the process. Both sterilized (SEEP) and non-sterilized (NSEEP) ethanol extracts of propolis samples were analyzed by GC-MS for their chemical contents. Susceptibility patterns of three bacteria (Escherichia coli, Staphyllococcus aureus, Pseudomonas aeruginosa) and one yeast (Candida albicans) strains to NSEEP and SEEP were assessed by the disc diffusion method. The MIC values were determined for both NSEEP and SEEP. The results show that NSSEP contains far more chemical components than SEEP, and its antimicrobial activity is much higher. It is easy to say that the sterilization process changes the chemical composition of propolis and leads to the loss of some substances and its antimicrobial activity. Therefore, it is not considered necessary. Instead of microbial contamination, chemical contamination constitutes a greater risk for human consumption.
Article
We demonstrate sodium pyruvate (NaPy) pre‐treatment as a successful approach for pressure ulcer (PU) prevention by averting their aetiological origin—cell‐level damage and death by large, sustained mechanical loads. We evaluated the NaPy pre‐treatment effect on permeability changes in the cell's plasma membrane (PM) following application of in vitro damaging‐level strains. Fibroblasts or myoblasts, respectively, models for superficial or deep‐tissue damage were grown in 0 or 1 mM NaPy, emulating typical physiological or cell culture conditions. Cells were pre‐treated for 4 hours with 0 to 5 mM NaPy prior to 3‐hour sustained, damaging‐level loads (12% strain). PM permeability was quantified by the cell uptake of small (4 kDa), fluorescent dextran compared with unstrained control using fluorescence‐activated cell sorting (FACS). Pre‐treatment with 1 mM, and especially 5 mM, NaPy significantly reduces damage to PM integrity. Long‐term NaPy pre‐exposure can improve protective treatment, affecting fibroblasts and myoblasts differently. Pre‐treating with NaPy, a natural cell metabolite, allows cells under damaging‐level mechanical loads to maintain their PM integrity, that is, to avoid loss of homeostasis and inevitable, eventual cell death, by preventing initial, microscale stages of PU formation. This pre‐treatment may be applied prior to planned periods of immobility, for example, planned surgery or transport, to prolong safe time in a position by preventing initial cell damage that can cascade and lead to PU formation.
Chapter
Chemical peels have always been the most economical therapeutic modality for skin rejuvenation and classified as superficial, medium, or deep based on their depth of penetration into the epidermis and dermis. Non-facial chemical peelings are best confined to light to medium peels because of the paucity of adnexal structures. These regimens of light to medium peels may yield significant improvement but must be performed conservatively and serially over time until results are satisfactory. The results are heavily dependent on concentration, contact time with the skin, and the manner of prepeel preparation. Deeper peels confer the risk of scarring, dyschromia, creation of a demarcation line between the treated and untreated area, and prolonged erythema.
Chapter
Chemical peels are an increasingly popular method for skin rejuvenation and removal of hyperpigmentation. In skin of color, superficial to medium-depth peels are most typically used to reduce the risk of scarring and dyspigmentation. Common peeling agents include alpha-hydroxy acids, beta-hydroxy acids, trichloroacetic acid, Jessner’s solution, and retinoids. Taking into account the patient’s phototype, race, ethnicity, treatment indication, and response to prior procedures, clinicians can carefully choose a peeling agent with appropriate titration concentrations to maximize clinical benefit while minimizing the risk of complications.
Chapter
Chemical peels have always been the most economical therapeutic modality for skin rejuvenation and classified as superficial, medium, or deep based on their depth of penetration into the epidermis and dermis. Non-facial chemical peelings are best confined to light to medium peels because of the paucity of adnexal structures. These regimens of light to medium peels may yield significant improvement but must be performed conservatively and serially over time until results are satisfactory. The results are heavily dependent on concentration, contact time with the skin, and the manner of prepeel preparation. Deeper peels confer the risk of scarring, dyschromia, creation of a demarcation line between the treated and untreated area, and prolonged erythema.
Article
The antioxidant properties of three alpha-keto acids, pyruvate, oxaloacetate and alpha-ketoglutarate were tested in vitro and in vivo. In vitro, the keto acids demonstrated a good H2O2-scavenging activity, but were less effective as scavengers of free radicals or reductants of oxidized compounds. Alpha-ketoglutarate was a more effective H2O2 scavenger as well as HO· in Fe3+–ascorbate–EDTA–H2O2 system than other keto acids. All keto acids did not demonstrate iron-chelating activity. It was supposed that ability of keto acids to inhibit HO· production in the Fenton reaction could be mainly conditioned by their H2O2-scavenging activity. In vivo experiments, the addition of alpha-keto acids to the incubation medium significantly increased the resistance of exponentially growing yeast Saccharomyces cerevisiae cells to H2O2, transition metal ions (Fe2+), but not to menadione, a superoxide anion-generating compound. Similar results were obtained on fruit fly Drosophila melanogaster. In particular, co-treatment with alpha-ketoglutarate enhanced resistance of adult flies to H2O2 and did not prevent menadione-induced death of flies. Collectively, the results obtained indicate that exogenous alpha-keto acids as antioxidants are able efficiently to protect living organisms against stressors in which effects are mediated by H2O2. Therefore, they can be considered as available natural supplements to alleviate the harmful effects of reactive oxygen species.
Chapter
Pyruvic acid is a carboxylic acid having a keto group at the α position of the aliphatic carbon atom (α-keto acid). Because of its low pKa and its small dimension, it penetrates rapidly and deeply through the skin and is considered a potent chemical peel agent.
Chapter
Pyruvic acid peels can be classified as an intermediate peel, for possessing qualities of both superficial and medium-strength peelings. The depth of penetration depends on the pyruvic acid concentration, friction, vehicle, passes, and exposure time. Pyruvic acid may be added to croton oil for achieving deep peels; however, this modality remains to be further investigated to reach full clinical application. This chapter describes how to better indicate different modalities of pyruvic acid peels. Specific limitations, contra-indications, preparation and postpeeling regimens are described.
Article
Background: A validated scale is needed for objective and reproducible comparisons of facial skin roughness before and after aesthetic treatment in practice and in clinical studies. Objective: To describe the development and validation of the 5-point photonumeric Allergan Skin Roughness Scale. Methods: The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 290) completed during 2 sessions occurring 3 weeks apart. Results: A score difference of ≥1 point was shown to reflect a clinically meaningful difference (mean [95% confidence interval] absolute score difference 1.09 [0.96-1.23] for clinically different image pairs and 0.53 [0.38-0.67] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (weighted kappa = 0.83). Interrater agreement was almost perfect during the second rating session (0.81, primary end point). Conclusion: The Allergan Skin Roughness Scale is a validated and reliable scale for physician rating of midface skin roughness.
Chapter
Chemical peeling is a dermatological procedure indicated both for unaesthetic cutaneous conditions and for skin rejuvenation. It consists of the application of one or more chemical exfoliating compounds to the skin in order to destruct first and then regenerate part of epidermis and dermis to improve physical appearance [1, 2].
Article
Pyruvic acid (CH3-CO-COOH) is an alpha-keto-acid characterized by the presence of three carbon atoms. Several properties make it particularly effective as a topical peeling agent. The small dimension of the molecule allows a deep penetration in skin layers. Pyruvic acid is characterized by a pKa of 2.39, so it is stronger than glycolic and salicylic acid, but less aggressive than trichloroacetic acid. Under physiological conditions, pyruvic acid converted to lactic acid, the corresponding alpha hydroxy acid. A well-equilibrated proportion of water and ethanol in the vehicle is able to balance the strength of the acid, inducing the transformation of a part of pyruvic acid into lactic acid. Furthermore, for the presence of a ketonic group, pyruvic acid is less hydrophilic as compared to alpha hydroxy acid, but it presents a more evident lipophily: This characteristic consents a good penetration into sebaceous glands, where pyruvic acid has showed a sebostatic and anti-microbial activity. At epidermal level, pyruvic acid induces keratinocyte detachment with thinning of the upper layers of the epidermis. It also penetrates down to the upper papillary dermis and stimulates an increased production of collagen, elastic fibres and glycoproteins. This action is more evident using high concentrations. Based on its peculiarities, pyruvic acid has been successfully employed in the treatment of several dermatological diseases. The Authors describe their experience with pyruvic acid at different concentration in the treatment of inflammatory acne, moderate acne scars, seborrhoeic dermatitis, aging and photoaging, superficial hyperpigmentations and striae cutis distensae.
Article
Background: Chemical peelings are procedures that employ various agents to produce skin injury and accelerated exfoliation; they are indicated for many conditions and classifi ed as superfi cial, medium-depth, and deep. There are a great number of articles on this matter, but critical analysis is necessary to assure the real benefi ts. Objectives: To evaluate the effi cacy and safety of chemical peelings through a systematic review of the literature. Method: The MEDLINE (1966-2009), LILACS and Cochrane Library databases were searched from January 5 to February 15, 2009. For study selection and assessment of methodological quality, some criteria were established. The best controlled or comparative studies were described. The remaining review, descriptive, and experimental articles were analyzed together. Results: We found 414 articles and 165 were selected for revision; 129 or 78% were descriptive (82), review (37), and experimental (10) articles; 36 or 22% were controlled or comparative, 19 or 53% randomized, but only 4 had the ideal design (placebo-controlled, randomized and blind). The agents more frequently reported were: glycolic acid, salicylic acid, trichloroacetic acid (TCA), and phenol. Few studies evaluated histological aspects or quantitative parameters to assess effi cacy and/or safety. Limitations: Heterogeneity of the studies; few with good methodological quality. Conclusions: There is no doubt about the benefi ts of chemical peelings; nevertheless, these benefi ts have been demonstrated much more by practice than existence of well conducted studies. Therefore, further reproducible studies of high quality are necessary to elaborate new guidelines.
Article
Chemical and mechanical skin resurfacing has been utilized by humans to improve the overall appearance and well-being of skin. The first chemical peels date back to the Egyptians who used sour milk baths (lactic acid), various chemicals (e.g., alabaster and salt), and sandpaper in order to attain a smoother skin surface [1]. In 1882, P.G.Unna, a German dermatologist, described the properties of salicylic acid, resorcinol, phenol, and trichloroacetic acid (TCA) and used these chemicals as peeling agents [2]. In 1976, Resnik et al. described the utility of TCA peels in various skin conditions [3]. In the late 1980s and the 1990s, a-hydroxy acids (AHAs) became available for superficial peeling agents. For nearly 20 years, a newer technique for superficial skin resurfacing, microdermabrasion, has become a key player in the arena of noninvasive anti-aging medicine.Over the last several decades, the science behind resurfacing procedures has expanded, as has the public's increasing demand for cosmetic surgery and skin rejuvenation. To date, chemical peeling and microdermabrasion are among the most common procedures performed in dermatologic offices and are an important component of our armamentarium in the management of both cosmetic and noncosmetic skin conditions.
Article
A chemical peeling involves the application of an exfoliating chemical agent on the skin to produce a controlled, partial-thickness injury with subsequent removal of superficial lesions within the skin layers, regeneration of new tissue with improvement of skin texture, and long-lasting therapeutic and cosmetic benefits.
Article
Steroid-induced rosacea is a relatively common dermatosis that is caused by the prolonged application of topical steroid to the face. The purpose of this investigator-blind, split-face study was to evaluate the efficacy and safety of pimecrolimus 1% cream for the treatment of steroid-induced rosacea. Patients were instructed to apply pimecrolimus 1% cream twice daily to the involved areas of a randomly allocated half side for the first 2 weeks, and to follow this by applying pimecrolimus 1% cream to both sides for a further 6 weeks. Fifteen of the 18 patients completed the 8-week study. After 1 week of application, a statistically significant improvement was observed for investigator's global assessments of erythema and papules on prior-treated sides (P-side). Later-treated sides (L-side) showed subsequent improvement after use of pimecrolimus on the L-side. Likewise, a statistically significant improvement was also observed for numbers of papules/pustules on P-sides after 1 week, and L-sides showed a significant improvement after application of pimecrolimus on the L-side. Comparative reflectance colorimetric assessments revealed that DeltaL*, Deltaa* and Deltab* tended to converge to zero during the first 4 weeks. A statistically significant improvement was observed for percentage area affected on P-sides after 1 week of application. The L-side showed a significant improvement after use of pimecrolimus cream on that side. The visual analogue scale of P-sides decreased more rapidly than those of L-sides. Cutaneous side-effects were mild and transient. This study suggests that pimecrolimus 1% cream is an effective and well-tolerated treatment for steroid-induced rosacea.
Article
Full-text available
Pyruvic acid (PA) is an alpha-hydroxy acid with potent keratolytic properties. Fifty-six patients with common warts treated with two PA formulations were surveyed 2 to 29 months after beginning treatment (mean, 18 months). Thirty-eight patients used a 70 percent PA formulation with added 0.5 percent 5-fluorouracil (PA-5FU). Eighteen patients used a plain 70 percent PA formulation without added 5FU. Three-quarters of the patients reported using the formulation for 4 weeks or less. Overall, 64 percent of the patients treated with either of the two formulations experienced complete clearing of their lesions. There was no increased efficacy noted with the PA-5FU formulation. Eighty-two percent of eighteen children, aged 16 years or younger, experienced clearing of lesions.
Article
Backgroound: alpha-Hydroxy acids (AHAs) have been reported to improve aging skin. The mechanisms of action of AHAs on epidermal and dermal compartments need clarification. Objective: Our purpose was to determine the effects of AHAs on photoaged human skin by clinical and microanalytic means. Methods: Patients applied a lotion containing 25% glycolic, lactic, or citric acid to one forearm and a placebo lotion to the opposite forearm for an average of 6 months. Thickness of forearm skin was measured throughout the study. Biopsy specimens from both forearms were processed for analysis at the end of the study. Results: Treatment with AHAs caused an approximate 25% increase in skin thickness. The epidermis was thicker and papillary dermal changes included increased thickness, increased acid mucopolysaccharides, improved quality of elastic fibers, and increased density of collagen. No inflammation was evident. Conclusion: Treatment with AHAs produced significant reversal of epidermal and dermal markers of photoaging.
Article
Several chemical agents are currently used to perform superficial chemical peels of the face. These include trichloracetic acid (15-30%), alpha-hydroxy acids (e.g., glycolic acid, 40-70%), and Jessner's solution (14% lactic acid, 14% resorcinol, and 14% salicylic acid). We have developed salicylic acid, a beta-hydroxy acid, at a higher strength (30% in a hydro-ethanolic vehicle) as an alternative peel. This peel has distinct advantages for resurfacing moderately photodamaged facial skin. We have peeled patients singly and multiply at 4-week intervals. The benefits are fading of pigment spots, decreased surface roughness, and reduction of fine lines.
Article
Twelve patients with multiple actinic keratoses were treated with either 5-fluorouracil and pyruvic acid or pyruvic acid alone. Three patients were treated with 5 percent 5-fluorouracil cream for one to three weeks for comparison. Exposure time to alpha-hydroxy acids varied between one and ten minutes. Biopsy specimens were taken at times varying from immediately after treatment to eight weeks after treatment. The results show that the combination of 5-fluorouracil and pyruvic acid is an effective treatment for actinic keratoses. In addition, the exposure time to 5-fluorouracil is decreased and therefore this treatment is better tolerated than prolonged treatment with 5-fluorouracil alone.
Article
A 'Minolta Tri-Stimulus Colorimeter II' was evaluated for obtaining objective measurements of early changes in erythema and tanning. The meter showed a subtle, continuous transition between the primary erythematous response and the delayed tanning of skin which was below the visual threshold for detection. Thereafter, the a* (redness) value of the meter showed a significant linear correlation with the dermatologist's perception of erythema while the b* (yellow) value showed a significant correlation with the perception of tanning. This capability of the tri-stimulus colorimeter to simultaneously evaluate the hue and saturation of skin color affords an improved opportunity to quantitate the transition from erythema to tanning without subjective bias.
Article
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.
Article
alpha-Hydroxy acids (AHAs) have been reported to improve aging skin. The mechanisms of action of AHAs on epidermal and dermal compartments need clarification. Our purpose was to determine the effects of AHAs on photoaged human skin by clinical and microanalytic means. Patients applied a lotion containing 25% glycolic, lactic, or citric acid to one forearm and a placebo lotion to the opposite forearm for an average of 6 months. Thickness of forearm skin was measured throughout the study. Biopsy specimens from both forearms were processed for analysis at the end of the study. Treatment with AHAs caused an approximate 25% increase in skin thickness. The epidermis was thicker and papillary dermal changes included increased thickness, increased acid mucopolysaccharides, improved quality of elastic fibers, and increased density of collagen. No inflammation was evident. Treatment with AHAs produced significant reversal of epidermal and dermal markers of photoaging.
Article
Acne is one of the most common dermatological diseases, affecting about 50% of adolescents. Different chemical peelings are used in local treatment, either alone or in association with other therapies. To evaluate the efficacy and tolerability of chemical peeling with pyruvic acid for treatment of mild to moderate papulo-pustular acne. We conducted an open-label study in which patients affected by mild to moderate papulo-pustular acne were treated with 40-50% pyruvic acid every 2 weeks for a total of 3-4 months. Forty patients (26 women and 14 men), ranging in age from 18 to 30 years, were enrolled in the study. Evaluations of sebum production and skin hydration were performed before and after treatment in 24 patients. Complete remission was observed in 16 patients (40%), partial remission was detected in 20 patients (50%), and no improvement was seen in four patients (10%). No side-effects were observed during or after treatment. Post-treatment evaluation of sebum production in 24 patients revealed a reduction in sebum levels in all patients. Post-treatment values of cutaneous hydration did not vary significantly from pretreatment values in the 24 patients evaluated. The results of our study indicate that peeling with pyruvic acid can be considered an effective, safe and well-tolerated procedure in the treatment of patients affected by mild to moderate papulo-pustular acne.
The use of pyruvic acid as a chemical peeling agent
  • Griffin Td
  • Van Scott Ej
  • Maddin
Griffin TD, Van Scott EJ, Maddin S. The use of pyruvic acid as a chemical peeling agent. J Dermatol Surg Oncol 1989;15: 1316.
St Louis: Mosby-Year Book
  • H Brody