Harold J. Brody

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

BACKGROUND Melasma can be resistant to topical therapy. OBJECTIVE Our purpose was to evaluate the efficacy of superficial peels in conjunction with topical tretinoin and hydroquinone in patients with melasma and to evaluate the ability of Woods light examination to predict response to treatment. METHODS We measured increased light reflectance in melasma areas with a colorimeter. Clinical observations were scored through an index designed to weigh numerically homogeneity, intensity of color, and area of melasma. RESULTS Colorimetric analysis showed an average lightening of 3.14 +/- 3.1 on the glycolic acid-treated side and 2.96 +/- 4.84 on the Jessners solution-treated side. There was no statistically significant difference between the right and left. There was an overall decrease in melasma area and severity of 63%. CONCLUSION Superficial peels hasten the effects of topical therapy in melasma. Woods light examination did not help predict response to treatment.

Hyaluronidase in the office: A necessity for every dermasurgeon that injects hyaluronic acid

Soft tissue augmentation plays an increasingly important role in the management of the aging face. The recent explosion of dermal filler use in aesthetic dermatology has brought with it the expected reporting of rare but significant side effects. These include the too‐superficial placement of product which can yield an undesirable bluish discoloration due to the Tyndall effect, the use of excessive product, persistent granulomatous foreign‐body reactions and, most significantly, the risk of injection necrosis.

ADVANCES IN CHEMICAL PEELING

Chemical peeling is traditionally discussed in terms of the depth of injury: superficial, medium, or deep. There have been a number of important advances in both superficial and medium-depth chemical peeling over the last several years. This article reviews the state of the art of these techniques and the increasing understanding of their effects on skin.

COMPLICATIONS OF CHEMICAL RESURFACING

Complications of chemical resurfacing may occur even though a controlled chemical wound has been induced. The surgeon must be totally familiar with the types of peels and the management of postoperative wound care based on the skin type of the patient. A thorough understanding of the concepts involved will enable early treatment and avoidance of permanent sequelae, such as pigmentary dyschromias, infection, or scarring.

Trichloroacetic acid application in chemical peeling

In chemical peeling of the skin for photoaging, the absorption of trichloroactic acid (TCA) after contact with the epidermis depends on the photoaged status of the skin in concert with the actual method of application. Protein coagulation and increasing penetration are reflected in the frost, but only an approximate inexact definition of depth estimation can be ascertained from the color. Although 35% TCA has an excellent record of safety and clinical results, 50% TCA is frought with more complications owing to the inherent unpredictability of the agent, and the addition of additives to slow penetration does not alter its increased capability for scarring. Either 35% TCA as a single agent or techniques to admit 35% TCA to deeper depths in the dermis by altering the epidermis immediately preceeding application have enabled excellent clinical results to be obtained with a minimum of complications.

Do chemical peels tighten the skin

Chemical peeling has been performed for over a century in dermatology and dermatologic surgery asaresurfacingmethodfor the softeningoreliminationof wrinkles, improving skin texture, eliminating precancers, lightening hyperpigmention, and improving depressed acne scarring. In the early 1980s, deep peeling was the first procedure to be marketed as a nonsurgical face-lift. Dermal peeling cannot be used on nonfacial areas in the same way as radio-frequency (RF) or microfocused ultrasound because of the risk of scarring in the areas lackingadnexa for skin reepithelialization.On facial skin, however, there is excellent evidence that blepharopeeling for the upper eyelids produces skin tightening.

Solid Carbon Dioxide: Usage in Slush or Block Form as Therapeutic Agent in Dermatology

The use of solid carbon dioxide (CO2) in dermatology is valuable to treat acne vulgaris, acne excoriee and as an adjunct in chemical peeling for the treatment of photo-aging and depressed scarring. This cryosurgical option is a cost-effective, viable treatment in the twenty-first century in the face of a flood of expensive devices for contemporary consideration. At −78 °C, a block of solid dry ice can be slushed in acetone and alcohol to efface comedones and promote more even healing of excoriated lesions. In addition, the combination of solid carbon dioxide followed immediately by trichloroacetic acid as a medium depth chemical peel has a place in the armamentarium of treatment in a series of over 4000 cases with a wide margin of safety in lighter skin types.

The Phenol–Croton Oil Peel Was Originally Investigated in the 1980s

TO THE EDITOR I read with interest the excellent article by Drs. Larson, Karmo, and Hetter regarding the animal model for the phenol–croton oil peel ( Aesthet Surg J 2009;29:47–53). The article, however, …