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Transcript of acne
peeling with longer follow up and more number of patients
Light chemical peeling is not effective for deep scars or ice-pick
acne scars because these lesions extend into the deeper layers
of the dermis. so, high TCA concentrationis recommended with
pre peel preparation with jessners” solution e.g. TCA Cross technique.
It is not advisable to evaluate the final plastic result until 9-12
months after peeling because maturation of the wound takes
twelve months to occur. Aluminum Oxide Crystals.
Sodium Bicarbonate & Sodium
Organic Grains (crystals).
Diamond Tips. A COMPARATIVE STUDY between MICRODERMABRASION and LIGHT CHEMICAL PEELING for different types of skin
Professor Dr.Ahmed Gamil El-sharqawi
Dr.Hatem Helmy Zaky
Dr.Fady Magdy Yacoub By:
Raed Ahmed Farhat SKIN SKIN TYPES Fitzpatrick WOUND HEALING The Inflammatory phase,
which takes about
1 to 3 days. The Proliferative phase,
which takes about
2 to 3 weeks, associated
with increase fibroplasias. The Maturation phase,
which persists for
12 to 18 months,
associated with collagen
and remodeling. ACNE CAUSES PROBIONIBACTERIUM HORMONES Poor hygiene,
are also common
acne. ACNE SCAR Scar is defined as “ the fibrous tissue that
replaces normal tissue destroyed by injury or
disease”. Acne scar formation can be broadly
categorized as either the result of increased
tissue formation or,more commonly,
loss or damage of local tissue. Scarring can lead to emotional debilitation,
social isolation, depression The aim of the treatment is to
remove the outermost layer of the skin
which includes the whole or part of the
epidermis. CAUSES Another cause of acne scarring,is the
pinching or popping of the actual blemishes themselves that spread the infection around to other areas .This can damage the tissues found there, and a scar will appear. Acne scars are caused by untreated acne.
Sometimes acne can be mild and
sometimes severe, but even the slightest
cases of acne can leave scars behind. TYPES ATROPHIC ACNESCAR HYPERTROPHIC ACNESCAR
KELOID ROLLING SCAR Bands of tissue develop
between the skin's surface
and deeper structures beneath.
These bands pull at the skin,
giving the skin's surface a rolling,
"wave-like" appearance. TREATMENT
Punch techniques with local anaesthesia.
Subcision:this method uses a needle to break up the fibrous bands that cause rolling acne scars. ALSO In an attept to induce light exfoliation Indian women mixed urine with pumice for skin application.
In 1882, P.G.Unna, a German dermatologist, described the properities of salicyclic acid, resorcinol, phenol and trichloracetic acid.
In the early 1960s,Dr.Thomas Baker,a plastic surgeon in Miami, used peeling for treatment of wrinkles and scars.
Monheit in 1989 used resorcinol,salicylic acid and lactic acid (jessners’ solution) followed by TCA for skin resurfacing. CLASSIFICATION OF
AGENTS Superficial peeling: Medium peeling:
Jessners’ solution +35%TCA.
Superficial peelings are utilized to induce
a damage limited to the epidermis and
papillary dermis.This results in epidermal
regeneration and post inflammatory
collagen new formation.Because their
potency is mild,repeated treatment are
required to obtain the desired effects.
Their efficacy is limited to mild atrophic
scars. TCA is a man made chemical based on acetic acid .Three chlorine atoms substitute for 3 hydrogen atoms Making up the TCA solution: To make a15% preparation ,we use 15g of TCA crystals
USP(united state pharmacopia),dissolve in a small amount
of water and add water to make a total volume of 100 ml. ADVANTAGES OF TCA Stable at room temperature or refrigerated.
Not light sensitive.
TCA solution has a shelf life of 6 months.
TCA peels do not need or require neutralization. MEDIUMS Pre-peel skin
The skin is scrubbed with acetone for
10 minutes until the sebaceous oils have been
thoroughly removed. When this step is completed,
the smallest scales on the skin turn white because
all of the oils are removed. The skin is washed
with saline to correct the pH of the skin. After the patient has been prepared,TCA 15% is applied with gauze.Cotton tip applicators are usefull to quantitate the amount of peel solution to be applied.
The cotton tipped applicator is
moistened with TCA 15% and rolled
against the wall of the glass cup to
remove excess fluid.TCA 15%is applied
to an area of skin by firmly rubbing
the moistened applicator in longitudinal fashion. Post- peel care: Frosting is completed. Cool saline compresses offer symptomatic relief for a peeled area. The compresses are applied 5 to 10 minutes after the peel until the patient is comfortable.
Avoid all sun exposure including beds since skin is vulnerable to sun damage.
Do not rub or pick the skin.
Avoid alpha hydroxy acids, it will cause stinging.
Avoid hot water when bathing it will cause irritation. Prepeel care: Do not use Accutane or any exfoliating treatment,laser, waxing or hair removal creams; two weeks before treatment.
Keep the new skin clean and moisturized by zinc,vitamine E.
Use a gentle cleanser Procedure The microdermabrasion procedure generally takes about 30-60 minutes per session.
Apply stripping solution to normal to oily skin types to eliminate all excess oil from surface for better peel.
Detect the acne scar area and stretch it between 2 fingers.
Check the parameters in the machine.
Making full contact of skin to aperture (typically at a 45 degree angle).
Move the Diamond head over the treated area 3 times in different directions to avoid scratch marks.
Clean the treated area with water and compress by cold fomentation for 5 minutes. Post-peel care Do not rub or pick the skin.
Avoid alpha hydroxy acids, it will cause stinging.
Avoid hot water when bathing it will cause irritation.
Avoid sun exposure.
Apply antibiotic cream (polysporin) to avoid any infection.
Apply vitamin C serum as antioxidant and promote healing. Gender distribution of all studies patients Distribution of Recruited Patients according to skin type Comparison between the improvement
after microdermabrasion and TCA
among patients with acne scars Conclusion
TCA THE STUDY CHEMICAL PEELING (TCA) DEFINITION Synonyms of chemical peeling include
chemical resurfacing ,chemoexfoliation
and chemosurgery. Chemical peeling
involves the application of a chemical
agent that result in exfoliation of skin
followed regrowth of new skin leading
to skin rejuvenation. The skin which undergoes
peeling shows a new collagen
formation which enhances the
contour of the skin after peeling. HISTORY Peeling was found in ancient Egyptian papyrus for the purpose of rejuvenation of the skin .During this time peels consisted of fruit acids combined with skin irritants. Such acids include ewes milk (lactic acid), wine or vinegar (acetic acid or an ester of acetic acid) and many other fruits such as cucumber and others. These aggressive peels have resulted in people having to hide from society for about 2-3 weeks. LATER Chemical Peeling : Performing
a TCA Peel
Stripping solution (acetone).
Gauze pad for applying TCA.
Signed informed consent form Patch test (spot test)
before treatment especially
for women with hormonal
treatment ocp, minocycline.
This test before 24 h from
the procedure. DEFINITION Microdermabrasion (MDA) is a minimally invasive mechanical exfoliation procedure for superficial skin resurfacing.
MDA is one of the most commonly performed cosmetic procedures in the United States, with more than a half million treatments performed annually.
Microdermabrasion gently removes damaged skin by “sand blasting” the top layers of the skin with tiny crystals or diamond. This removes the outermost layer of skin (“exfoliation”) and exposes the newer skin cell below. This also stimulates the growth of new skin cells below, leading to more youthful-appearing skin. HISTORY MICRODERMABRASION In a response to the risks of dermabrasion, the first microdermabrasion machine was developed in 1985 in Italy by Drs Mattioli and Brutto. The device projects very fine diamond particles onto the skin to clean the pores, loosening dead skin cells before suctioning them off, while massaging and stimulating the tissue beneath the skin to promote oxygenation and blood circulation. The process of diamond microdermabrasion is quick and generally painless,with low risks and associated side effects.
How Diamond MDA works: Patient Selection Our study included the different skin types of 20 patients, according to FITZPATRICK CLASSIFICATION (I, II, III, IV, V &VI), of age between 20-45 years old who suffer from post-acne scar. Materials & Method The 20 patients consisted of:
_10 Patients managed by diamond microdermabrasion.
_10 Patients managed by chemical peeling agent, Trichloracetic acid (TCA), 15%.
Session: 6-12 Sessions in 14-21 days interval.
Clinical evaluation for the treated area will be by serial photographs and notes; to evaluate any gross changes, improvement, complication and patient’s satisfaction. WHAT IS ACNE? The Result Comparing the effect of microdermabrasion and chemical
peeling as modalities in treatment of acne atrophic scar,
the present study showed statistically significant difference
between two modalities .microdermabrasion treatment
was better than TCA15% peeling , more safe, less
complication, little risk and no downtime. Recomendations Acne is the term for plugged pores (blackheads and whiteheads, pimples. And even deeper lumps (cysts, or nodules).
In 1994, the Food and Drug
Administration gave approval
to be marketed in the
Stripping solution Gauze 4x4
Signed informed consent form. DEFFINITION ICE-PICK SCAR Narrow,sharp and depressed
tracks that extend vertically to
the deep dermis or
subcutaneous tissue. BOXCAR SCAR Round to oval with sharply
demarcated vertical edges. Application of the
peeling agent: Performing a Microdermabrasion In 1994 the
Food and Drug
brassion to be
market in the
Trichlora etic cid ,15%to25%
Combination of salicylic acid or Jessners’ peel with trichloracetic acid. T C A