Standard guidelines of care for chemical peels
Niti Khunger
【 文献重点摘要 】
Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations.
Physicians’ qualifications
The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility: Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility.
Preoperative counseling and Informed consent
A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient’s skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks.
Endpoints in peels
For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner’s solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.
Keywords
Glycolic acid, Trichloroacetic acid, Salicylic acid
化学脱皮是将化学制剂应用于皮肤,可控制地破坏部分或整个表皮,包括真皮或不带真皮,导致表皮剥落和表层病变的移除,然后再生新的表皮和真皮组织。“化学脱皮”是指将化学物质应用于皮肤,可控制部分或整个表皮或整个表皮的破坏,包括真皮或非真皮,从而导致表皮和真皮新组织的脱落和去除。化学性脱皮的适应症包括色素紊乱、浅表痤疮疤痕、老化皮肤变化和良性表皮生长。禁忌症包括活动性细菌、病毒或真菌感染、瘢痕疙瘩形成倾向、面部皮炎、服用光敏药物和不切实际的期望。
医生的资格
进行化学剥离的医生应该已经完成了皮肤科的研究生培训。化学剥离的培训可以在毕业后获得,或稍后在提供皮肤外科教育和培训的中心或在提供此类培训的重点车间获得。医生应该对使用的不同脱皮剂、伤口愈合过程、技术以及并发症的识别和处理有足够的了解。设施:在任何诊所/门诊日间皮肤科设施都可以安全地进行化学去皮。
术前咨询与知情同意
患者应签署一份详细的同意书,列出手术细节和可能的并发症。同意书应明确说明该程序的局限性,并应清楚说明是否需要更多的程序才能获得适当的结果。患者应该有足够的机会通过小册子、陈述和个人讨论来寻求信息。应强调术后药物治疗的必要性。在印度患者中,浅皮被认为是安全的。中等深度的皮肤剥离应该非常小心,特别是在皮肤黝黑的患者。对于印度人的皮肤,深皮是不推荐的。用防晒霜、对苯二酚和维甲酸对患者的皮肤进行2-4周的剥离前涂抹是必要的。
以皮为单位的端点
对于羟基乙酸果皮:在预定的时间(通常是3分钟)之后,果皮被中和。然而,如果出现红斑或表皮松解,出现表皮灰白色外观或小水泡,必须立即用10-15%的碳酸氢钠溶液中和,无论使用时间长短。终点是三氯乙酸去皮的糖霜,用中和剂或冷水中和,从眼皮开始,然后是整个脸。对于水杨酸果皮,终点是水杨酸结晶时形成的假霜。一般情况下,要涂上1-3层大衣,以获得均匀的霜;3-5分钟后,待灼热消退后,用水洗净。将Jessner的溶液涂抹在1-3层大衣上,直到出现均匀的糖霜或红斑。术后护理包括防晒霜和润肤霜,根据皮肤的类型和深度,可以每周、每两周或每月重复一次。
关键词
乙醇酸、三氯乙酸、水杨酸