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There are several different peels targeting the superficial tissues to mid-dermis available to the aesthetic dermatologist today, implemented for various cosmetic ends. Not every peel though has the same cosmetic efficiency in patients. Pivotal points include the nature of the peel, its strength and length of application, as well as the patientÂ´s skin type, specifically in patients with racially or ethnically mixed skin. Here, a review from one expert, on which peels are effective and how to achieve optimal cosmetic results in patients with darker skin types.
Alexandria, Egypt - There are several different indications for chemical peels, but the common treatment goal is to effect a clear, bright and youthful complexion.
However, the benefits vary in different ethnic and racial groups, and executing an optimal cosmetic peel in darker skin can be a lot more challenging than one may suppose.
Sahar F. Ghannam, M.D., assistant professor, department of dermatology and venereology, Alexandria University, and an aesthetic dermatology consultant in Kuwait, discusses the art of chemical peeling of darker skin and offers insights on achieving the best aesthetic outcome.
Controlling peel variables
Dr. Ghannam says controlling the peel variables is paramount in attaining a successful cosmetic result.
"The practitioner must keep in mind that a 100 percent safe chemical peel or procedure does not exist; however, the risk can be significantly lowered with the procedures that give the physician more control of the variables associated with the peel. Control of the variables can lead to more predictable acid penetration depth, thus increasing the likelihood of good results and avoidance of complications," she explains.
According to Dr. Ghannam, Fitzpatrick skin types I through III have been considered the ideal skin types for these procedures, while types IV through VI have been considered the more difficult types because of the high incidence of post-inflammatory hyperpigmentation and the possibility that the procedure will permanently change the skin color.
One peel that has offered pleasing results is the Amelan peel (a combination of azelaic acid, kojic acid, phytic acid, vitamin C and retinoic acid), applied in two stages - Amelan R (retinoic) and then Amelan M (maintenance).
Amelan R can either be applied on the first day for six to eight hours or on the first day for four to five hours, followed by a two-hour to three-hour application weekly. Then Amelan M is applied twice a day for two weeks (at least three hours/application), then once a day for a year.
Dr. Ghannam says the most important variable in the quality of outcome and safety of a TCA peel procedure is the depth of acid penetration.
Accurate assessment of the skin type as well as pre- and post-op skin condition also play a vital role in outcomes. TCA peels in concentrations of 10 percent, 35 percent and 50 percent have been classified as superficial, medium and deep, respectively, with the erroneous assumption that a certain concentration penetrates to a certain depth.
"TCA concentration determines only the speed at which the acid penetrates the skin, with higher concentrations penetrating faster. Any concentration can be made to penetrate at any depth. The therapeutic and caustic effects of TCA are directly related to their concentration," Dr. Ghannam says.
According to Dr. Ghannam, the easy peel consists of a weak concentration of TCA (15 percent to 20 percent m/m), a base solution and a post-peel mask. She explains that the addition of the right amount of 50 percent TCA in the base solution can transform it into a 15 percent to 20 percent m/m adjuvated and stabilized TCA. TCA self-neutralizes by combination and denaturizes skin proteins, producing a peeling effect, improving penetration of the post-peel mask and creating dermal stimulation.
TCA can be combined with ascorbic acid/citric acid (which enhance and impart uniformity to the penetration of the TCA), cocamides (which protects the skin and improves the efficacy of saponines) or sodium laureth sulphate (surface active emulsifying and wetting agents).