Glycolic peels

Why glycolic peels?

• Alpha hydroxy acids/ fruit acids

• Commonly used, popular

• Superficial peels with a quick recovery time- “lunchtime peels”

• Used in all skin types

• Gold standard of peeling agents

How do they act?

• Dual mode of action

• At acidic ph, keratolytic action

• With a higher ph, moisturizer

• They act on kinases,sulfotransferases,

phosphotransferases( responsible for

corneocyte adhesion )

exfoliation

• Not a self-neutralizer

Choosing a glycolic peel

• Choose a glycolic peel based on the vehicle they are dissolved.

• Water/alcohol/propylene glycol

• Concentation-35 to 70%

i. Free acid- non-neutralized, greater bioavailability, increased reactivity. But has greater burning and stinging

ii. Buffered- partially neutralized, less irritant

iii. Esterified- glycol-citrate,less irritant

iv. Gel based- less free acid, less efficacious, suitable for sensitive skins

What do we need?

1. Correctly labelled glycolic acid solutions, 35%, 50%, 70%

2. Alcohol – to clean

3. Acetone - to degrease

4. Cold water

5. Syringe with saline- accidental spillage in eyes

6. Neutralising agent

7. Glass cups

8. Head band

9. Gloves

10. 2”x2” cotton gauze

11. Timer

Indication

• Acne scarring

• Facial rejuvenation

• Wrinkles

• Hyperpigmentation

• Melasma

• Lentigines

• Keratosis

• Actinic keratosis – combination with 5-FU

• Sebarrhoeic keratosis ( cryo )

• Keratosis pilaris

contraindication

• Active viral/bacterial infections

• Inflammatory dermatoses

• Unrealistic expectations

• Photosensitising drugs

• Patients undergone resurfacing procedures in the last 6 months

Photosensitizing drugs

I. Antibiotics- tetracycline, sulfonamides, ciprofloxacine

II. NSAIDs- ibuprofen, naproxen…

III. Diuretics- frusemide, hydrochlorothiazide

IV. Reinoids

V. Hypoglycemics- sulfonylureases

VI. Neuroleptics

VII. Other drugs- dapsone, enalapril, quinidine

VIII.PABAs, salicylates, 5FU,coal tar

Prepeel assessment

Detailed history

Keloidal tendency, PIH

Occupation- to check level of sun exposure

General medical history

Priming

• Sunscreen & hypopigmenting agents- 2 weeks prior

• Stop all resurfacing procedures & retinoids

• Informed consent & photographic documentation

• Contact lenses removed before peel

Procedure

wash the face

pull back the hair

cleanse & degrease

peeling agnt in a beaker( 35%- thin, dry, sensitive skin 50%- normal skin )

Sensitive areas covered with Vaseline

peel neutralized after 3-5 mins

Peel endpoint

Level 1 – mild erythema – very superficial

• Level 2 – superficial epidermal pigmentation

• Level 3 – deeper peel – superficial scar

• Level 4 – blistering – textural changes, scars, pigmentary changes

Postpeel care- DON’T MAKE THINGS WORSE !

• Expect edema, erythema and desquamation for 1-3 days ( superficial peel ), 5-10 days ( deeper peel ) DONOT PANIC !!!

• Non-soap cleanser, broad spectrum sunscreen, moisturizers and hypopigmenting agents are a must!!!!!!!!!!!

How frequent can I peel ?

• Every 2 weeks for 12-16 weeks, till response

• Maintenance peel- every 6 months

complications

1. Epidermolysis- topical moisturizer and 1% hydrocortisone.. Severe edema, corticosteroids prednisolone 30-40mg, single dose, morning, 3-5 days

2. Pigmentary changes

3. Persistent erythema

4. Infections

5. Scarring

6. Urticaria

7. Lines of demarcation

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SERVICE WITH A SMILE

HAVE A WONDERFUL DAY AHEAD