By the grace of peeling: the brace function of the stratum corneum in the protection from photo-induced keratinocyte carcinogenesis

Update Dermatologische Lasertherapie II – Weiterentwicklung der photodynamischen Therapie durch Laser‐assistierte transkutane Applikation von Topika

Die technische Fortentwicklung der jüngeren Vergangenheit bietet dem Dermatologen Zugriff auf neue Laser, Strahlquellen und Behandlungskonzepte. Seit langem eingeführte Wellenlängen zur Ablation sind nunmehr fraktioniert applizierend verfügbar und stehen nunmehr für eine wirksamere und effizientere Behandlung von zahlreichen Hautveränderungen zur Verfügung. Das gezielte Einbringung von Topika (laser assisted drug delivery; LADD) ist das wichtigste Beispiel. Die LADD erfordert eine spezifische Weiterbildung, um sicher und wirksam zur Therapie (prä-)maligner nichtmelanozytärer Neoplasien der Haut wie der Feldkanzerisierung in Form der Laser-assistierten photodynamischen Therapie angewandt werden zu können. Bisher verfügbare Daten weisen auf eine höhere Effektivität im Vergleich zu konventionell verwendeten Topika hin, wobei anhaltend über Weiterentwicklungen berichtet wird. Unter anderem wurde die Kombination mit Tageslicht oder alternativen tageslichtähnlichen Strahlquellen bekannt. Dieses Update basiert wie zitiert gekürzt und aktualisiert auf "Paasch, U. 2019. Laser-assistierte photodynamische Therapie. p. 226-239. In G. Kautz (ed.) Energie für die Haut. Springer Nature, Springer Nature.".

Update on dermatologic laser therapy II - advances in photodynamic therapy using laser-assisted drug delivery

Technical advances in recent years have led to the development of new dermatologic laser systems, light sources, and treatment concepts. With the introduction of ablative fractional lasers (using common wavelengths) in the field of dermatology, it is now possible to more effectively and efficiently treat a variety of skin disorders. One important example of these advances is laser-assisted drug delivery (LADD). A type of LADD, laser-assisted photodynamic therapy has been successfully employed in the treatment of non-melanoma skin cancer including field cancerization. This treatment concept has been continually modified and today includes the use of daylight as well as artificial daylight systems. This update is based as cited, shortened and updated according to "Paasch,U. 2019. Laser-assistierte photodynamische Therapie. p. 226-239. In G.Kautz (ed.) Energie für die Haut. Springer Nature, Springer Nature".

The rise of Chemical Peeling in 19th-century European Dermatology: emergence of agents, formulations and treatments

BACKGROUND

Considering the increasing number of chemical peeling applications, also the interest in the history of chemical peelings and agents, has grown in dermatology. Research ascribes the first use of phenol as a chemical peeling agent to William Tilbury Fox (1836-1879) in 1871. Furthermore, Ferdinand von Hebra (1847-1902) is said to describe the properties of various peeling agents in 1874, and Paul Gerson Unna (1850-1929) adds resorcinol and trichloroacetic acid in 1882.

OBJECTIVE

To identify the first mentions of chemical peeling applications and agents in 19th-century dermatology.

METHODS

Nineteenth-century dermatologists were identified by an examination of literature of the last 30 years on the history of chemical peeling. Systematic examination of the medical textbooks of Hebra, Fox and Unna was conducted. It was proved whether the mentioned agents were used for chemical peeling applications.

RESULTS

The skin peeling property of phenol was already discovered by its first describer, the chemist Friedlieb Ferdinand Runge (1795-1867) in 1834. The Viennese dermatologist Hebra described phenol as a chemical peeling agent in 1860. Hebra and his associate Moriz Kaposi (1837-1902) stated that 'Lotio carbolica' was already used in London. Fox used phenol mostly as a disinfectant and not for chemical peelings since 1869. Unna described the chemical peeling property of salicylic acid in 1882 and gave the most comprehensive account of chemical peels of the 19th century in 1899. Unna also introduced the Gutta-percha plaster with salicylic acid and phenol. Around 1900, Unna was famous for his peeling paste with resorcinol in Germany.

CONCLUSIONS

A new chronology of the introduction of chemical peeling in dermatology can be drawn from the results. The German-speaking dermatology pioneered the treatment of skin diseases with chemical peelings as well as for aesthetical purposes 21 years earlier than hitherto known.

[Chemical peeling in dermatology]

In this article, a comprehensive, yet introductory overview on chemexfoliation is given. The molecular mechanisms for selected indications are exemplified and the prerequisites, necessary precautions as well as potential complications are addressed. Finally, selected available superficial peeling substances are presented and the principal peeling procedure is outlined briefly.

Effect of chemical peeling on the skin in relation to UV irradiation

Chemical peeling is one of the dermatological treatments available for certain cutaneous diseases and conditions or improvement of cosmetic appearance of photoaged skin. However, it needs to be clarified whether the repetitive procedure of chemical peeling on photodamaged skin is safe and whether the different chemicals used for peeling results in similar outcomes or not. In this article, we reviewed the effect of peeling or peeling agents on the skin in relation to ultraviolet (UV) radiation. The pretreatment of peeling agents usually enhance UV sensitivity by inducing increased sunburn cell formation, lowering minimum erythematous dose and increasing cyclobutane pyrimidine dimers. However, this sensitivity is reversible and recovers to normal after 1-week discontinuation. Using animals, the chronic effect of peeling and peeling agents was shown to prevent photocarcinogenesis. There is also an in vitro study using culture cells to know the detailed mechanisms of peeling agents, especially on cell proliferation and apoptotic changes via activating signalling cascades and oxidative stress. It is important to understand the effect of peeling agents on photoaged skin and to know how to deal with UV irradiation during the application of peeling agents and treatment of chemical peeling in daily life.

Facial rejuvenation for middle-aged women: a combined approach with minimally invasive procedures

Facial rejuvenation is a significant process involved in restoring youthfulness. The introduction of less invasive procedures has increased acceptance of such procedures. Often a combination of different techniques allows individualized treatment with optimal outcomes. Furthermore, this leads to a natural look without a significant downtime. We report herein the use of such a combined approach in middle-aged women with particular emphasis on botulinum toxin type A, dermal fillers, and chemical peels.