CHEMICAL PEELS

Carlos Wambier, MD, PhDAdjunct Professor State University of Ponta Grossa (UEPG)

Researcher Ribeirao Preto School of Medicine - University of Sao Paulo (USP)

Active Member — International Peeling Society (IPS)

Where Do We Stand? The Pathogenesis and treatment of Melasma

Adjascent Skin Melasma

Fontana-Masson

From Prof. Helio Miot, MD, PhD, Sao Paulo State University - UNESP (Botucatu, Brazil)

Verhöff: Elastosis

Melasma

Adjascent

Skin

Retroauricular

skin

From Prof. Helio Miot, MD, PhD, Sao Paulo State University - UNESP (Botucatu, Brazil)

F.M.: MelanossomesPicrosirus red: Collagen

Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination. J Am Acad Dermatol 1997;36:589.

Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner's solution chemical peels. Dermatol Surg 2006;32:1429–36.

Ejaz A, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner's solution for superficial chemical peeling in epidermal melasma. J Coll Phys Surg Pak 2008;18:205.

CLASSICS:JS30% Salicylic Acid70% Glycolic Acid10-20% Trichloroacetic Ac

ANY SUPERFICIAL CHEMICAL PEEL

NEO-CLASSICS:MJS92% Lactic Acid40% Pyruvic Acid10-40% Mandelic Acid5% Retinoic Acid

Wambier CG, MD, PhD

Wambier CG, MD, PhD

EVOLUTION OF JESSNER’s SOLUTION (JS)

Jessner’s SolutionpH 1.6

Salicilic Acid 14%Lactic Acid, Racemic 14%

Resorcinol 15%Ethanol q.s.p

Modified Jessner’s SolutionpH 1.7

Salicilic Acid 17%Lactic Acid, Racemic 17%

Citric Acid 8%Ethanol q.s.p

MODIFIED JESSNER’s SOLUTION (MJS)

AVOID RESORCINOL :

-Persistent erythema;-Allergic contact dermatitis;

-Toxicity to thyroid (cumulative).

ADD CITRIC ACID:-More stable formula.

-LESS PIH.Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A STUDY COMPARING CHEMICAL PEELING USING MODIFIED JESSNER’S SOLUTION AND 15% TRICHLOROACETIC ACID VERSUS 15%

TRICHLOROACETIC ACID IN THE TREATMENT OF MELASMA. Indian J. Dermatol. 2009;54(1):41–5.

Abdel-Meguid AM, Taha EA, Ismail SA. Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned

Patients.Dermatol Surg. 2017 May;43(5):651-656.

Wambier CG, MD, PhD

Wambier CG, MD, PhD

MAIN MECHANISM OF ACTION IN MELASMA

Fontana-Masson (Detail)

14-20% SA, 10% TCA

30% SAAHA (70% GA, 14-92% LA)

AKA (40% PA)

5% RA

MJS/JS+20-30%TCA

Wambier CG, MD, PhD

SUPERFICIAL PEELS UPPER EPIDERMIS

MJS

JSLA 40-88%SA 30%RA 5%**TCA 10-15%

OTHERS:MA 30%PA 40%GA 50-70%

MJS+TCA 35%

MEDIUM DEPTH PEEL:FULL PAPILARY DERMIS

MJS + 35% TCA

Wambier CG, MD, PhD

Daily Practice 90% of my casesLow fluency Q-Switched 1064nm

Wambier CG, MD, PhD

Daily Practice:

Q-Switched 1064nm + MJS – 1 session

Wambier CG, MD, PhD

With acne and PIH

Q-Switched 1064nm + MJS – 2 sessions

Wambier CG, MD, PhD

With acne and PIH

Q-Switched 1064nm + MJS – 8 sessions

Wambier CG, MD, PhD

With acne and PIH

Q-Switched 1064nm + 5% Retinoic acid

Wambier CG, MD, PhD

WHAT’s NEW?>> Fashionable Retinoic Acid 5% peels <<

THE ”GOLD” PEEL (WITH MICA, MELATONIN, CURCUMA)

5% Retinoic Acid,1% Melatonin: Anti-inflammatory0.1% Curcuma longa (curcumin):

antibiotic, anti-inflammatoryIn GOLD CREAM (Mica)

Wambier CG, MD, PhD

WHAT’s NEW?>> Fashionable Retinoic Acid 5% peels <<

PINK OCTOBER (BREAST CANCER AWARENESS MONTH)

Wambier CG, MD, PhD

In the near futurePHENOL-Euphorbiaceae oil peels?

• INCREASED INFLAMATION BY PHORBOLs

Ricinus communisCASTOR oil

Croton tigliumCROTON oil

TAKE HOME MESSAGE:

- IF MELASMA RESISTANT TO BASICS:

- ADD Q-Switched NdYAG and/or Superficial Chemical peels- (Biweekly)

- REALISTIC EXPECTIATIONS

Wambier CG, MD, PhD

Wambier CG, MD, PhD

Hands-on Training:

peelingsociety.com

Wambier CG, MD, PhD

Simão J.C.L., Wambier C.G. (2018) Combining Superficial Chemical Peels. In: Issa M., Tamura B. (eds) Chemical and Physical Procedures. Clinical Approaches and Procedures in CosmeticDermatology, vol 2. Springer, Cham

Wambier C.G. (2017) My Personal Experience with Peelings. In: Issa M., Tamura B. (eds) Chemical and Physical Procedures. Clinical Approaches and Procedures in Cosmetic Dermatology.Springer, Cham

Wambier C.G. (2018) Pyruvic Acid Peel. In: Issa M., Tamura B. (eds) Chemical and Physical Procedures. Clinical Approaches and Procedures in Cosmetic Dermatology, vol 2. Springer, Cham

Brody HJ. (2009) Chemical Peeling and Resurfacing. 3rd ed. Atlanta, USA: Emory University Digital Library Publications. Available from: https://pid.emory.edu/ark:/25593/s2xpg

Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A STUDY COMPARING CHEMICAL PEELING USING MODIFIED JESSNER’S SOLUTION AND 15% TRICHLOROACETIC ACID VERSUS 15% TRICHLOROACETICACID IN THE TREATMENT OF MELASMA. Indian J. Dermatol. 2009;54(1):41–5.

Abdel-Meguid AM, Taha EA, Ismail SA. Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned Patients.Dermatol Surg.2017 May;43(5):651-656.

Piamphongsant T. Phenol-castor oil: modified peel for dermal melasma. Dermatol Surg. 2006; 32(5):611-7.

Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: a comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination.J Am Acad Dermatol 1997;36:589.

Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner's solution chemical peels. Dermatol Surg2006;32:1429–36.

Ejaz A, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner's solution for superficial chemical peeling in epidermal melasma. J Coll Phys Surg Pak 2008;18:205.

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