Anti-acne peel: Innovative topical therapy effective in patients with mild-to-moderate lesions

February 1, 2009
Ilya Petrou, M.D.

A novel peel is proving to be very effective in the treatment of comedonic as well as mild-to-moderate acne lesions. This approach could spare acne patients from repeated antibiotic therapies for considerably benign cosmetic lesions.

Key Points

According to one expert, this novel peeling formulation has the potential to become a gold standard treatment for the treatment of acne.

The salicylic acid component is a keratolytic agent, but also has some anti-inflammatory properties that positively impact the arachidonic acid cascade.

The ethyl linoleate component of the peel acts through the PPAR (peroxisome proliferator-activated receptor) receptors to initiate anti-inflammatory processes. Ethyl linoleate also inhibits keratinocyte proliferation and differentiation, sebum and squamous production, and modulates the activity of 5-alpha reductase, which is also important in decreasing acne lesions.

"Previously, peels served just to help remove some cosmetic lesions such as scars, fine lines or dark melasma lesions. This peel, however, has shown to be very effective in clearing mild-to-moderate acne, as well as comedonic acne lesions," says Malgorzata Sokolowska-Wojdylo, M.D., department of dermatology, venereology and allergology, Medical University, Gdansk, Poland.

Choosing the 'right' patient

According to Dr. Sokolowska-Wojdylo, the peel is extremely easy to perform, but it is important to choose the right patient - meaning patients presenting with comedonic or mild or moderate inflammatory acne lesions.

The peel can also be useful in treating superficial acne scars, but Dr. Sokolowska-Wojdylo says the optimal treatment for such patients would be to combine this peel with a TCA peel treatment.

Technique

Patients are told to pre-treat their skin two weeks prior to the actual peel treatment with a daily application of 15 percent glycolic acid or topical retinoids.

These pre-treatments can also be combined before the peel.

After the sebum is removed with a preparatory solution, one or more layers of the novel peel solution are applied to the skin, and after a few seconds, the targeted skin will begin to create a frost-like surface.

This white precipitate has represented the salicylic acids' crystallization and should not be confused with protein agglutination appearing as real frost during other peelings (e.g., TCA).

The white precipitate can be rinsed with water. However, Dr. Sokolowska-Wojdylo says that this "frosting" does not always need to be removed, because it will neutralize itself.

The patient should then apply cream (indicated for acneic skin) containing a sunscreen to the treated area. The peel is repeated every one or two weeks, depending on the level of inflammation of the acne lesions, for a total of five to six treatments.

After care

"Between peels, and especially after the completion of the therapy, it is very important for patients to use the cream or lotion containing both triethyl citrate and ethyl linoleate at home. The product can be used for a very long time and can help smoothen the skin and help avoid lesion recurrences," Dr. Sokolowska-Wojdylo tells Dermatology Times.

Safety

Dr. Sokolowska-Wojdylo says the peel is safe for Fitzpatrick skin types I to VI. It is not indicated in patients with sensitive skin, hypersensitivity to any ingredient (very rare), or pregnancy, or who have been treated with oral isotretinoin to six months before, or have active viral disorders such as herpes virus infection.

Burning sensation, redness and irritation are transient - lasting, in most of cases, just from 30 minutes to a few hours following the treatment. According to Dr. Sokolowska-Wojdylo, most patients are satisfied with the treatment approach and its cosmetic results.

Combining treatments

According to Dr. Sokolowska-Wojdylo, this peel treatment could replace antibiotic therapies. However, a combined treatment could be used to achieve even better results in select cases.

Previous studies comparing the medical device containing salicylic acid, triethyl citrate and ethyl linoleate with clindamycin with concomitant benzoyl peroxide treatment have shown comparative therapeutic results in patients with mild to moderate acne lesions.

Dr. Sokolowska-Wojdylo says this peel therapy could be a future gold standard for the treatment of mild-to-moderate acne, as it is safe and effective and spares the patient from continuous or repeated regimens of antibiotic therapy.

Disclosures: Dr. Sokolowska-Wojdylo has been a consultant and independent adviser to General Topics.

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