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Chemical Peel For Acne Scars

Chemical Peel For Acne Scars
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  •    March 28, 2017
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Chemical Peel For Acne Scars

CHEMICAL PEELS FOR ACNE SCARS IN ASIANSTrichloroacetic acidThere were two open label studies and one pilot study that evaluated high concentrations of TCA using a technique called “chemical reconstruction of skin scars” (CROSS) to focally treat atrophic acne scars. This involves the application of the solution using a sharp tipped wooden applicator into the base of the scar, sparing the normal surrounding skin. This technique takes advantage of the dermal thickening and increased collagen production that normally results from repeated application of high concentrations of TCA (60-100%).An open label, comparative study first evaluated the safety and efficacy the CROSS technique for acne scars in Asians and using two concentrations of TCA, 65% and 100%. While both groups showed improvement, the number of treatments received was proportional to the degree of improvement and that 100% TCA was more effective than 65% TCA.A pilot study was done to evaluate the safety of the CROSS technique using 100% TCA among Asians with darker skin types. All patients had good to excellent results however, there was one patient who noticed a reduced effect at three months without further improvement until the end of the sixth month follow up period. All the patients were able to tolerate the procedure well. There was one case each of transient hypo-pigmentation and hyper pigmentation.Following the aforementioned pilot study, the authors conducted a larger study using the same method described. Excellent results were achieved in more than 70% of patients; while 20% of patients showed good improvement and 6.7% of patients had fair results after receiving four peels. There were no cases of neither scarring nor prolonged pigmentary alteration. The authors of both studies concluded that 100% TCA was safe and effective in treating ice pick acne scars in patients with Fitzpatrick skin types IV-V.TCA combined with Jessner’s solutionAn open label study evaluated the combination of two peeling agents to achieve a medium depth peel for treatment of acne scars. Improvement occurred in all except one patient who had mainly pitted scars and deep atrophic scars. They also noted that those who did not develop hyper pigmentation had lighter skin complexion than those who did.Lactic acidA pilot study evaluated the effects of pure full strength lactic acid peel for superficial acne scarring. Patients were assessed to have good to significant improvement (>50% clearance) in four patients, while the three patients had mild to moderate (<50% clearance) improvement. There was also improvement in the texture and pigmentation as well as the appearance of pores.Glycolic acidA study by Sharad evaluated the use of glycolic peel as an adjuvant to micro needling in Indian patients. Three months after the last treatments were performed, while both groups showed improvement of the acne scars, the group that had received GA was significantly superior. This indicated that glycolic acid peeling had an additive effect to the micro needling in improving the acne scars by promoting neocollagenesis. In addition to this, GA improved pigmentation from acne and the procedure.In an open label, non-randomized comparative study that evaluated GA against SM, both peels produced equally significant improvement in the number of boxcar scars but had no significant effect on rolling scars and minimal effect on ice pick scars.Phenol peelA study done in Korea previously evaluated the use of phenol peel, not for acne scars but for small pox scars. However, it was during this study that many side effects were seen such as cardiac arrhythmia. In view of this safety issue, Park and colleagues evaluated the effectiveness of a modified phenol peel also for Korean patients. Seven out of the 11 acne patients had good to excellent results and no cases of systemic toxicity were reported. However, 74% of patients experienced hyper pigmentation. One case had persistent hypo-pigmentation. Though the modified phenol peel was found to be safe and effective in treating acne scars in Asians, it was less effective when compared to laser resurfacing.
chemical peel for acne scars 1

Chemical Peel For Acne Scars

CONCLUSIONSChemical peels are considered as adjuvant therapy in treating all forms of acne. The addition of chemical peels leads to a faster clinical response and patient satisfaction.Salicylic acid at 30% concentration and 35-70% glycolic acid has been shown to be effective in reducing both inflammatory and non-inflammatory lesions of acne in Asian skin. Glycolic acid was shown to be safe in the treatment of acne even in darker skin types as well as adjunctive therapy for the treatment of acne scars. Salicylic acid also has the added advantage of having a whitening effect, which is favourable for Asians with darker skin types, as well as those with co-existing hyper pigmentation. Jessner’s solution was found to be as effective as 70% GA but the exfoliation it produced was bothersome for some patients. The combination peel of salicylic acid and mandelic acid had superior results compared to 35% GA, which calls for further studies to cement its role as a standard peel for acne.In the treatment of acne scars, the most commonly used peel is TCA at concentrations of 35 to 100% either alone or in combination with another peeling agent, such as Jessner’s solution. Lower concentrations are useful for atrophic boxcar scars or rolling scars while the CROSS method using 100% TCA is useful for ice pick scars that are difficult to treat. Another peel useful for more superficial scars is the full strength lactic acid peel. Since it is non-aggressive it is not recommended for those with ice pick scars or deep rolling and boxcar scars. Glycolic acid was also shown to have an additive effect to a resurfacing procedure, and further study may be done to evaluate its utility and efficacy. Phenol however, was associated with a lot of side effects, and was less effective when compared to laser skin resurfacing, considering how tedious the procedure was.However, notwithstanding the level of evidence of the studies that were cited, chemical peeling stands a useful adjuvant in the management of acne and as a first line therapy for acne scars. Most of the peeling agents were evaluated to be safe, efficacious, and easy to administer. Compared to newer machine-based technologies for acne and acne scars, chemical peeling is affordable and with minimal downtime, and can be performed in any dermatologist’s office. It is hoped that more randomized clinical trials with larger sample sizes be undertaken in order to strengthen the current body of knowledge on the safety and utility of chemical peeling for Asian patients. This review on chemical peels for acne and acne scars will hopefully aid the physician in designing an optimum treatment plan in Asian patients.
chemical peel for acne scars 2

Chemical Peel For Acne Scars

AbstractChemical peeling is a widely used procedure in the management of acne and acne scars, but there are very few studies on Asian populations who are more prone to develop hyper pigmentation. This article aims to summarize and evaluate the existing studies on the role of chemical peels in the treatment of acne and acne scars among Asians. An online search was conducted to identify prospective studies published in English that evaluated the use of chemical peels in active acne and acne scars in Asian populations. There were six studies for acne and eight studies for acne scars that were identified using our search parameters. Most were single-centre, open label and with small sample sizes. Acne severity was not uniformly reported and the objective outcome measures of some studies were not explicitly reported as well. The general trend of the results of the studies support the safety and efficacy of chemical peels for acne and acne scars including those of darker skin types. The existing studies support the use of chemical peels in the treatment of acne and acne scars in Asians. Further clinical trials with better study design and more subjects are needed to further establish the role of chemical peels in Asian acne patients.KEYWORDS: Acne, acne scars, asians, chemical peel, glycolic acid, salicylic acid, trichloroacetic acid
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Chemical Peel For Acne Scars

EPIDEMIOLOGY OF ACNE AND ACNE SCARS IN ASIANSAcne is one of the most prevalent skin conditions affecting humans globally and the single most common reason for dermatologic consult.Goh et al. surveyed visits by 74,589 Asians (e.g., Chinese, Malaysians, and Indians) in a Singapore clinic and determined that acne vulgaris was the second most common diagnosis, occurring in 10.9% of the adult patient population and was the eighth most common diagnosis in a paediatric population, occurring in 3.1%.In 2002, the first Asian community based study was conducted to measure both the prevalence and complications of acne among adolescents and young adults ranging from 15 to 25 years old. The study was conducted in Hong Kong to determine the prevalence and severity of acne in a randomized sample of 522 from a total of 5,522 persons interviewed. The prevalence of self-reported acne was 91.3% while there were 52.2% of respondents who had active acne during the time of the interview were reported. There was a higher prevalence among the 15-20 year age group as compared to the 21-25 year age group, the latter being 43.5% as compared to 55.8%. It showed that acne scarring and hyper pigmentation occurred in 52.6% of all respondents interviewed, with females accounting for 57% as compared to males at 48%.Several studies have been done regarding the epidemiology of acne in the Philippines, where the majority of citizens have Fitzpatrick skin types III-V. A survey done in 2002 by Roa et al. showed that out of the 114 Filipino dermatologists surveyed, 44% were treating more than 50% of acne cases in their daily practice. At the Research Institute for Tropical Medicine, acne vulgaris was the number one dermatologic diagnosis among 32,313 new consults between 2004 and 2007.A preliminary study investigating the epidemiology of skin concerns and diseases in a population of South Asian descent in the United States, showed that 49% of those surveyed responded to having visited a dermatologist with acne being at the top of the list accounting for 37% of all dermatologic diagnoses.Asian acne patients have clinical features distinct from that of Caucasians. One is the lesser incidence of nodulocystic acne. However, Asians represent a rather challenging group of patients because of the greater tendency to develop post-inflammatory hyper pigmentation as sequelae of acne or any inflammation of the skin.Acne scars, on the other hand, correlate with the duration of acne, the severity of the lesions and the delay in treatment. It is more common in those with persistent acne belonging to the 25 to 44 years old age group. Minor scarring may occur in up to 95% of patients while more severe acne scarring may occur in only up to 22%. Acne scars are generally classified based on their morphology and are of three main types, namely rolling scars, boxcar or punched out scars and ice pick scars, the latter being the most difficult to treat.

Chemical Peel For Acne Scars

Chemical Peel For Acne Scars
Chemical Peel For Acne Scars
Chemical Peel For Acne Scars

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