Complications of chemical peeling

Biodegradation and valorization of feather waste using the keratinase-producing bacteria and their application in environmentally hazardous industrial processes

Poultry feathers are widely discarded as waste worldwide and are considered an environmental pollutant and a reservoir of pathogenic bacteria. Therefore, developing sustainable and environmentally friendly methods for managing feather waste is one of the important environmental protection requirements. In this study, we investigated a rapid and eco-friendly method for the degradation and valorization of feather waste using keratinase-producing Pseudomonas geniculata H10, and evaluated the applicability of keratinase in environmentally hazardous chemical processes. Strain H10 completely degraded chicken feathers within 48 h by producing keratinase using them as sources of carbon, nitrogen, and sulfur. The culture contained a total of 402.8 μM amino acids, including 8 essential amino acids, which was higher than the chemical treatment. Keratinase was a serine-type metalloprotease with optimal temperature and pH of 30 °C and 9, respectively, and showed relatively high stability at 10-40 °C and pH 3-10. Keratinase was also able to degrade various insoluble keratins such as duck feathers, wool, human hair, and nails. Furthermore, keratinase exhibited more efficient depilation and wool modification than chemical treatment, as well as novel functionalities such as nematicidal and exfoliating activities. This suggests that strain H10 is a promising candidate for the efficient degradation and valorization of feather waste, as well as the improvement of current industrial processes that use hazardous chemicals.

Combining Laser Resurfacing and Facial Rejuvenation Surgery

Facial aging is a multifactorial process involving skin laxity, volume loss, facial rhytids and solar elastosis. Surgical interventions can address the laxity of the skin and restore volume loss but do not fully correct the texture of the skin. Historically, there were concerns over the safety of combining laser resurfacing with facelifting procedures, but now there is much evidence to support the safe use of this combination treatment. When done appropriately, the combination of laser resurfacing with facial rejuvenation surgery can provide a synergistic effect for optimal clinical results. Here, we review the many laser options available and how they may be combined safely with surgical facial rejuvenation. We also review clinical contexts and candidate selection to provide safe, reliable results and minimize complications.

Recognizing and Managing Complications in Laser Resurfacing, Chemical Peels, and Dermabrasion

Skin resurfacing techniques allow improvement of skin texture and color. This includes the effacement of wrinkles, signs of photoaging, and the softening of scars. Laser resurfacing, chemical peels, and dermabrasion are associated with overlapping risks of complications. The most common of these include infection, hypopigmentation, hyperpigmentation, and scarring. Patient evaluation helps provide treatment that gives the maximal benefit with a minimization of risks. This includes understanding the extent of each patient's issues (Glogau scale) and Fitzpatrick type. A thorough knowledge of potential risks will reduce their incidence and optimize early recognition and treatment of these complications when they do occur.

Pre- and Postoperative Care for Interventional Skin Rejuvenation

Facial aging is a combination of descent of facial tissues, atrophy of fat compartments, bony remodeling, and photoaging/chronologic changes of the skin. Photoaging of the skin is clinically and histologically distinct from the genetically programmed aging process. Photoaging is due to UV-A and UV-B-generated free radicals that cause DNA mutations, structural and enzymatic protein alterations, and lipid peroxidation.

Chemical Peel (Deep, Medium, Light)

With modern medicine increasing both the average life span and quality of life, there has been a greater demand for treatment of age-related skin changes. As many new options in skin resurfacing are developed annually, it is chemical peeling that has withstood the trials of time and scrutiny. The different variations of chemoexfoliation have been used for rhytids, actinic damage, lentigos, and dyschromias. This article describes the most recent knowledge about chemical peeling, and exposes previously accepted yet incorrect dogmas. Chemical peeling, when practiced with knowledge and good technique, can yield excellent results in skin rejuvenation.

Complications of medium depth and deep chemical peels

Superficial and medium depth peels are dynamic tools when used as part of office procedures for treatment of acne, pigmentation disorders, and photo-aging. Results and complications are generally related to the depth of wounding, with deeper peels providing more marked results and higher incidence of complications. Complications are also more likely with darker skin types, certain peeling agents, and sun exposure. They can range from minor irritations, uneven pigmentation to permanent scarring. In very rare cases, complications can be life-threatening.

Profilaxis antiherpética en intervenciones de dermoexfoliación facial

In recent years, a spectacular increase has taken place in the demand for techniques to improve the appearance of the skin, both for cosmetic and reparative purposes. The techniques used may have complications that interfere with the healing process, and therefore may affect the results from an aesthetic standpoint. The most significant complication is herpes simplex infection. Furthermore, accurate, early diagnosis of herpes infection makes greater individual and community control possible, thanks to the current availability of effective antiviral agents. The scientific literature relating to herpes simplex prophylaxis was reviewed, and this information was pooled with the knowledge and experience of a multidisciplinary group of experts. After all of this data was analyzed, the consensus was reached that all patients should be treated with specific oral medications for herpes simplex as a preventive measure.

Medium depth peels

Medium depth chemical peels offer an excellent tool for skin rejuvenation. The improvement in rhytids, dyschromias, and photodamage with relatively little downtime confirms its importance in the facial plastic armamentarium.

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.

Dermal peels

Dermal chemical peeling is a very satisfying procedure for patients and physicians alike. Although not providing the ablation of deep wrinkles and scars that dermabrasion and laser procedures may accomplish, trichloroacetic acid peels usually result in few complications and rapid recovery. Patients can usually expect photographic improvement in their skin. The results are usually long lasting, and most patients do not need to repeat dermal peels for at least 2 years. Of all resurfacing procedures, dermal peeling provides the best benefit-to-risk ratio.

Formulation of trichloroacetic acid peeling solution: a bibliometric analysis

Since the beginning of this century, trichloroacetic acid solutions of various concentrations have been used for chemical exfoliation. These solutions have been prepared by using four different formulas. To prepare a 50% solution, for instance, water may be added to 50 g of trichloroacetic acid crystals until 100 ml of solution is obtained (weight-to-volume solution). Alternatively, 50 g of water may be added to 50 g of trichloroacetic acid crystals (weight-to-weight solution), or 50 g of trichloroacetic acid crystals may be solved in 100 ml of water (weight-plus-volume solution). Finally, a saturated trichloroacetic acid solution (or "100% solution") may be diluted by an equal volume of water (dilution). Depending on the method used, these so-called 50% solutions contain 40 to 71 weight-to-volume percentages of trichloroacetic acid. From a review of 120 publications on trichloroacetic acid peeling that have appeared since 1926, it was concluded that the authors of 87 of these publications (73 percent) did not report their formula for the trichloroacetic acid solution. Any one of the four methods was reported to have been used by the 33 authors who did report their formula. Eight of 10 internationally reputed pharmacopeias were found not to include the formula of a trichloroacetic acid solution. Proper evaluation of results and prevention of complications of trichloroacetic acid chemexfoliation is only feasible if both the concentration and the formula of trichloroacetic acid solution are reported by the author. Practitioners who use a trichloroacetic acid solution need to establish that the concentration of the solution they apply corresponds with that of the solution reported in the literature.

Use of valacyclovir for herpes simplex virus-1 (HSV-1) prophylaxis after facial resurfacing: A randomized clinical trial of dosing regimens

BACKGROUND

Reactivation of herpes simplex virus-1 (HSV-1) after facial resurfacing has led to severe outbreaks, delayed reepitheliazation, and scarring. Current recommendations regarding the dosing of antivirals used prophylactically are based mostly on anecdotal experience. No studies have addressed the question of when such antiviral prophylaxis should begin.

OBJECTIVE

The purpose of this study was to compare the efficacy of valacyclovir used as an antiviral prophylaxis when started the morning before versus the morning of facial resurfacing procedures.

METHODS

Eighty-four patients who presented for facial resurfacing were enrolled. Resurfacing was performed using laser (CO2, Er:YAG), chemical peeling, dermabrasion/dermasanding, or some combination of these techniques. Patients were randomly assigned to start valacyclovir 500 mg twice daily either the morning before or the morning of the procedure. Viral cultures were performed at baseline on all patients, at any sign of infection, and at the end of the 14-day treatment period. All patients were followed for 21 days postoperatively.

RESULTS

Valacyclovir was 100% effective in the prevention of HSV reactivation in both regimens with no adverse effects reported.

CONCLUSION

This study demonstrates the efficacy of valacyclovir as a preventive agent against HSV outbreaks following facial resurfacing whether started the day before or the day of surgery.

Management of infraorbital dark circles. A significant cosmetic concern

Despite the frequency with which it occurs, little has been written in the scientific literature on the treatment of infraorbital dark circles. I have developed a technique that simultaneously treats the 2 contributing causes of these circles: hyperpigmentation of skin and pseudoherniation of orbital fat. The technique involves simultaneous transconjunctival blepharoplasty and deep-depth phenol chemical peel. Successful outcomes have been obtained in patients with Fitzpatrick classification skin types 1 to 5, with a low incidence of complications. Adequate preoperative counseling regarding prolonged erythema and careful postoperative monitoring with, if necessary, medical intervention are essential if both surgeon and patient are to be satisfied with the outcomes.

TCA-based blue peel: a standardized procedure with depth control

BACKGROUND

Trichloroacetic acid (TCA) peels are popular, well known, and widely utilized to correct a variety of skin problems. Different methods exist, ranging from the use of plain TCA to augmented or modified TCA at concentrations ranging from 30% to 50%. However, peel results vary depending upon the physician skill level, patient selection, and patient management.

OBJECTIVES

The purpose of this article is to fill the gap for a peel that is deeper than superficial exfoliative procedures yet lighter than a medium-depth peel, to simplify and standardize the TCA peel, to define depth properly based on intraoperative clinical signs, to implement a color guide that facilitates even application of TCA and avoids skip areas, and to identify and minimize variables that may contribute to inconsistent outcomes.

METHODS

A coating system for TCA application is created by selecting a specific TCA concentration (15% or 20%), TCA volume (4 or 6 ml, respectively), and a standardized body surface area to be peeled (5%), taking into consideration skin thickness and fragility. Multiple coats of TCA are applied to reach the desired endpoints: papillary dermis (light Blue Peel) or the immediate upper reticular dermis (light/medium Blue Peel). Clinical signs guide the depth achieved (frost quality, even blue, pink sign, epidermal sliding) and correlate retrospectively with healing time (7-10 days).

RESULTS

The TCA Blue Peel was found to be a simple and consistent treatment approach for problems related to the epidermis, papillary dermis, and immediate upper reticular dermis. An unexpected benefit was the appearance of skin tightening and a reduction of skin laxity in many cases. This suggests that the papillary dermis and the immediate upper reticular dermis play a significant role in skin tightness.

CONCLUSION

A simple coating system for achieving depth-controlled TCA peels is presented with correlation to intraoperative clinical signs. This method makes it easier to peel skin of all racial backgrounds, including nonfacial skin. This is especially useful for many patients previously excluded from having procedures that penetrate beneath the papillary dermis. Commonly encountered variables in chemical peels are presented which may affect outcome.

Cutaneous laser resurfacing

Cutaneous resurfacing with the new generation of carbon dioxide and erbium lasers has recently come into favor for the treatment of facial rhytides, photodamage, and scarring. The precise control of these resurfacing lasers over the extent of tissue vaporization minimizes thermal damage to the skin while maximizing therapeutic efficacy. Proper use of resurfacing lasers is contingent upon a complete understanding of their clinical, histologic, and ultrastructural effects, as well as an appreciation of the principles of laser safety. An organized approach to the preoperative, intraoperative, and postoperative management of the patient undergoing laser resurfacing will be provided, including a discussion of prevention and treatment of postoperative side effects and complications. (J Am Acad Dermatol 1999;41:365-89.)

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be familiar with the clinical, histologic, and ultrastructural effects of resurfacing lasers and be able to discuss the preoperative, intraoperative, and postoperative management of patients undergoing laser resurfacing.

Electrosurgical skin resurfacing: a new bipolar instrument

BACKGROUND

Numerous modalities may be used for skin resurfacing, including chemical peels, dermabrasion, and lasers. Each of these methods is associated with significant disadvantages.

OBJECTIVE

The purpose of these initial studies was to determine the efficacy and safety of a new electrosurgical resurfacing system. Depth of cutaneous injury was also evaluated.

METHODS

Postoperative scar resurfacing was performed on six patients in the initial feasibility study. Patients were evaluated with questionnaires, physician observations, and photographs. The histologic investigation evaluated depth of injury after resurfacing at various power settings and number of passes.

RESULTS

Appearance of postoperative scars in all 6 patients was improved by electrosurgical resurfacing. The overall injury, residual thermal damage plus ablation, for all power levels and passes was 114.1 micrometer (mean) with a standard deviation of 60.7 micrometer.

CONCLUSION

Electrosurgical resurfacing may become an effective and safe alternative to current resurfacing modalities.

Diagnosis and treatment of postoperative complications after skin resurfacing

Chemical peel, dermabrasion, and laser skin resurfacing are alternative methods to achieve skin resurfacing for reconstructive or cosmetic applications. The potential postoperative complications are similar with all of these techniques. These postoperative complications and their therapy are reviewed.

Multi-electrode radio frequency resurfacing of ex vivo human skin

BACKGROUND

A novel radio frequency multi-electrode surgical (MES) device has produced minimal residual thermal collagen damage (RTCD) and rapid healing in treating articular cartilage.

OBJECTIVE

To assess the immediate tissue effects of the MES device on human skin.

METHODS

Specimens of ex vivo human skin were subjected to 1 to 3 passes of the device at 3 voltage settings, then processed for routine and polarized light microscopy. The degree of tissue ablation, amount of RTCD, and level of follicular injury were assessed.

RESULTS

Epidermal ablation did not occur; epidermal removal correlated with manual debridement after the first passes. Dermal ablation was not readily discernable even after 2 or 3 passes. The thickness of RTCD tended to increase with increased pass number. The mean thickness of this zone of damaged collagen measured 24-53 micro after 1, 63-83 micro after 2, and 80-97 micro after 3 passes, respectively. For a given number of passes, the thickness of the zone of RTCD did not consistently change with increasing voltage applied (86, 108, and 139 V). The small number of samples did not enable meaningful statistical analysis of these observations. In samples with pilosebaceous units, the electrosurgical keratinocyte injury extended down the follicular epithelium, but never beyond the level of the infundibulum.

CONCLUSIONS

These findings suggest the MES device produces immediate tissue effects favorable for effective cutaneous resurfacing and rapid postoperative wound healing.

Report of phenol peel for Asians

With the advancement of trichloroacetic acid peel technology and wound care, trichloroacetic acid peeling has become very successful in Korea. Its success has opened studies on the possibility of using phenol on Korean skin. Dr. Mee's phenol formula (molding mask technique) was chosen for experiments on Korean skin because of the presumed safety of use on non-Caucasian skin. Between January of 1996 and January of 1998, 30 cases of significant small pox scars were treated with phenol at the Korea University Anam Hospital. The age range was from 43 to 60 years, with a mean of 49 years. The average follow-up period was 13 months, ranging from 1 month to 2 years. All of the procedures were performed in the operating room while the patient was under deep i.v. sedation. After the entire face was peeled, it was covered with an occlusive tape mask. During the recovery period, the patients underwent a post-peel skin care program. All 30 patients showed significant improvement of the severe pox marks with a marked rejuvenation effect. There was no sign of hypopigmentation or hyperpigmentation. As a complication, two patients developed hypertrophic scars on the perioral area, which responded well to steroid injections. Another pair of patients had herpetic infection, which left minimal scarring. Five patients developed cardiac arrhythmia with this rapid technique, but this was safely managed by an anesthesiologist during the procedure. Korean skin belongs to Fitzpatrick types IV and V and occasionally to type III or VI. It is common knowledge that performing chemical peeling on the latter types of skin is dangerous, but in this report, excellent results were obtained from all 30 patients, even though the peeling itself was very deep. With more knowledge and experience, phenol peel can be safely conducted on Asian skin.

Alabaster skin after carbon dioxide laser resurfacing with histologic correlation

BACKGROUND

Carbon dioxide laser resurfacing has gained popularity as a relatively safe and effective method of facial rejuvenation. Original reports describe mostly reversible side effects and a low incidence of scarring. Only very recently have reports of delayed hypopigmentation surfaced. This effect is not visible until several months after resurfacing, and most likely represents a permanent change.

OBJECTIVE

To provide an additional clinical description of the complication of delayed hypopigmentation along with the first published histologic correlation.

METHODS

Clinical records along with a preprocedure and 7-month postprocedure full-thickness skin biopsy were used for this report.

RESULTS

This patient experienced a striking leukoderma 6 months after a full facial carbon dioxide laser resurfacing procedure done for widespread actinic keratoses. There was a zone of dermal fibrosis extending approximately 0.4 mm on the postprocedure biopsy. Comparison of the preprocedure and postprocedure biopsies revealed no difference in the number of melanocytes by MART-1 immunohistochemical staining, but there was a significant decrease in epidermal melanin as determined by Fontana-Mason staining.

CONCLUSION

This patient experienced a profound expression of an increasingly recognized and reported complication of carbon dioxide laser resurfacing. Histologic correlation is similar to the results previously reported after phenol chemical peels, demonstrating a normal number of melanocytes but a decrease in epidermal melanin.

Care before and after laser skin resurfacing. A survey and review of the literature

BACKGROUND

The extent of the wound healing period and the final outcome of cutaneous laser resurfacing are influenced not only by the treatment protocol and type of laser used but also on care of the skin before and after the procedure.

OBJECTIVE

This project was conducted to determine the pre- and postresurfacing care protocols currently in practice and to research the literature in an effort to clarify which interventions can accelerate wound healing and improve efficacy of the treatment.

METHODS

Three hundred thirty-nine questionnaires were mailed to all dermatology and plastic surgery members of the American Society for Laser Medicine and Surgery (ASLMS). Questionnaires were completed anonymously to decrease respondent bias. Statistical analysis included calculation of percentages and means of the data.

RESULTS

Survey results are discussed and compared with data from the literature for the following interventions: tretinoin cream, glycolic acid cream, hydroquinone, oral prophylactic antibiotics, oral prophylactic antivirals, hydrogel dressings, semiocclusive ointments, topical antibiotics, topical corticosteroids, oral corticosteroids, and dilute acetic acid soaks.

CONCLUSIONS

Many options are appropriate, based on data from past studies, for pre- and postresurfacing skin care. Approximately 73% of the results of the survey correlate with information from the literature. Past studies do provide information to help us select interventions that can improve wound healing and the final cosmetic outcome. Further studies involving resurfacing patients may clarify some of the more complex wound care issues, such as oral prophylactic antibiotics, hydroquinone, and topical vitamins C and E.

Pharmacology of agents used in the management of patients having skin resurfacing

Many medications are used in the preparation, operative, and postoperative phases of skin resurfacing. This article reviews those medications that impact on laser, chemical peel, and dermabrasion surgery. Facial cosmetic surgeons must fully appreciate the "chemistry" of skin resurfacing.

The CO2 laser in oculoplastic surgery

The introduction of a new generation of carbon dioxide (CO2) lasers has permitted the development of new approaches toward certain oculoplastic disorders and procedures. The high absorption of this infrared laser by tissue water assists oculoplastic surgeons in performing incisional and excisional procedures precisely and with relatively good hemostasis. The development of new scanned continuous-wave or pulsed delivery systems has facilitated controlled tissue ablation with decreased collateral thermal injury during cutaneous resurfacing procedures. The unique characteristics of the CO2 laser mandate special attention to protection of the patient and surgical team, and careful preparation and training will help the prospective laser surgeon to successfully address the learning curve associated with this new technology. Although long-term follow-up is limited, results reported to date suggest that the CO2 laser represents an important addition to the armamentarium of the oculoplastic surgeon.

Cutaneous resurfacing

Cutaneous resurfacing can be accomplished with application of acids, abrasive modalities, or the new generation of carbon dioxide lasers. Ultimately, the universal goal is removal and replacement of the epidermis and dermal collagen remodeling. The indications range from therapeutic and reconstruction to the treatment of the stigmata associated with senescence. The indications are not technique-specific, and the art of cutaneous resurfacing is identifying the cutaneous defect and selecting the appropriate tool or tools to realize the optimal clinical results.

The effect of glycolic acid on the treatment of acne in Asian skin

BACKGROUND

Glycolic acid has become important and popular for treating acne.

OBJECTIVE

To evaluate the efficacy and safety of serial glycolic acid peels with glycolic acid home care products on facial acne lesions and other associated skin problems.

METHODS

We collected 40 Asian candidates with moderate to moderately severe acne. They were divided into two groups according to the degree of greasiness of their facial skin. The two groups' members were treated with four series of 35% and 50% glycolic acid peels, respectively. They also used 15% glycolic acid home care products during this study period. The improvement of acne as well as other associated problems were assessed by both the physicians and the patient themselves.

RESULTS

Significant resolution of comedones, papules, and pustules was found. The skin texture of each candidate was dramatically rejuvenated. Consistent and repetitive treatment with glycolic acid was needed for the apparent improvement of acne scars and cystic lesions. The follicular pores also became comparatively smaller. Furthermore, most of the candidates had much brighter and lighter looking skin. Only small percentage of patients (5.6%) developed side effects.

CONCLUSION

Glycolic acid has considerable therapeutic value for acne with minimal side effects even in Asian skin. It may be an ideal adjunctive treatment of acne.

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.

Treatment of facial rhytides with a high-energy pulsed carbon dioxide laser

Facial rhytides are a common problem that often presents for treatment. Because of the tendency for rhytides to involve delicate tissue areas, traditional treatment modalities have been limited by complications of scarring or pigmentary alterations. With the advent of the new-generation high-energy pulsed carbon dioxide lasers, skin requiring resurfacing can now be treated successfully with minimal risk and side effects. This study included 259 patients with facial rhytides (104 perioral, 83 periorbital, 53 glabellar, and 17 forehead). Each patient received treatment with a high-energy pulsed CO2 laser system, and individual responses were evaluated independently by two blinded assessors at 1, 4, 8, 12, and 24 weeks postoperatively. While clinical response rates were uniformly excellent, they varied in different locations. On average, there was a 90 percent improvement in all areas under study. The periorbital regions responded best, an average 93 percent improvement being seen. The facial rhytides with the lowest response rates (86.8 percent) were those which were most severe and those caused by excessive muscle movement (i.e., frown lines at the glabella). No incidences of scarring were noted, but erythema persisting 1 to 3 months (mean 2.2 months) following laser irradiation was typical. Transient postinflammatory hyperpigmentation of 3 months' average duration was seen in 30 percent of patients and was not limited to those individuals with darker skin tones. The high-energy pulsed carbon dioxide laser is a safe and effective treatment for facial rhytides. Treatment can be delivered in an outpatient setting without the need for general anesthesia, and preliminary evidence suggests long-lasting results.

Prevention of facial herpetic infections after chemical peel and dermabrasion: new treatment strategies in the prophylaxis of patients undergoing procedures of the perioral area

A proposed clinical strategy is offered for the prevention and treatment of facial herpetic infection associated with phenol chemical peel or dermabrasion of the perioral area. A retrospective evaluation of 181 consecutive patients undergoing perioral chemical peel or dermabrasion from 1983 to 1990 was performed. No patients were excluded and the minimum follow-up was 6 to 24 months. All procedures were done at a private practice ambulatory surgery center. Patients with any history of oral herpetic lesions were pretreated with oral acyclovir. The vast majority of these patients received dosages far exceeding previously described regiments. A subset of patients (n = 12) whose procedures predated acyclovir's commercial availability received no prophylactic treatment and allowed for a comparison group. The incidence of postoperative infection was measured to determine the effectiveness of prophylactic acyclovir treatment. In patients reporting previous herpetic infection, postoperative herpetic outbreaks were far more likely to occur (50 percent infection rate) in the absence of prophylactic acyclovir. An 8.3 percent infection rate was noted in patients with a similar history who received standard acyclovir prophylaxis. Once high dose prophylactic treatment was initiated, no further herpetic outbreaks were observed. Even among patients with a negative history of oral herpes (no treatment), 6.6 percent developed postoperative infections. Pretreatment with high dose acyclovir clinically minimizes the incidence and severity of postoperative herpetic infection in patients undergoing perioral chemical peel or dermabrasion. All patients should be treated preoperatively with acyclovir regardless of past history, because even those patients reporting no previous outbreaks of oral herpes may develop postoperative infections.

Glycolic acid modulation of collagen production in human skin fibroblast cultures in vitro

BACKGROUND

Glycolic acid has been used extensively for the treatment of photoaging and wrinkles. Suggestions have been made that glycolic acid may have specific dermal effects, although biochemical studies are limited.

OBJECTIVE

This study's purpose was to examine the effect of glycolic acid on the radioactively labeled collagen production in human skin fibroblasts in culture.

METHODS

Normal dermal fibroblasts were grown to semi-confluence and incubated in the presence of glycolic acid for 24 hours. Radioactive proline was added to the cultures. Using a specific amino acid assay, the amount of radioactive hydroxyproline was measured and was used as an accurate index of collagen production.

RESULTS

Results show that glycolic acid caused an elevated collage production in the fibroblasts.

CONCLUSION

These results demonstrate a specific stimulatory effect by the glycolic acid and could explain some of the positive benefits from the clinical use of glycolic acid.

Laser treatment of tattoos in darkly pigmented patients: efficacy and side effects

BACKGROUND

Many modalities for the treatment of tattoos and pigmented lesions produce a greater risk of complications in Fitzpatrick types V and VI skin because of an increased incidence of adverse pigmentary changes and keloidal scarring. In fair-skinned persons Q-switched lasers have proved effective in removing pigmented lesions and tattoos without scarring.

OBJECTIVE

This study was conducted to determine the efficacy and effects of Q-switched lasers on a small series of darkly pigmented patients with tattoos.

METHODS

Four patients of Ethiopian origin with facial and neck tribal tattoos were treated with both the Q-switched ruby and Nd:YAG lasers. One black woman with a multicolored tattoo on the mid chest was treated with the Q-switched ruby laser.

RESULTS

Clearing of all lesions was seen. The treatments did not result in scarring or permanent pigment changes other than the ones intended.

CONCLUSION

Our results indicate that in darkly pigmented patients, Q-switched laser treatment of tattoos can be performed successfully. The longer wavelength Q-switched Nd:YAG laser is recommended when removing tattoos in darker complected persons. A test treatment is advised before treatment of large skin areas.

Ultrapulse carbon dioxide laser removal of periocular wrinkles in association with laser blepharoplasty

Removal of periocular wrinkles is a common yet difficult problem. There are many techniques currently available, all of which have some drawbacks. With the advent of new generation ultrapulse carbon dioxide lasers, skin can now be resurfaced successfully with minimal risk and side effects. In our study of 36 patients we assessed the benefit of using ultrapulse carbon dioxide (CO 2) laser to resurface the periorbital skin in association with transconjunctival lower lid CO 2 laser blepharoplasty. We found that 36/36 (100%) patients had good to excellent results. The incidence of side effects was very low. We also found that 2/36 (5.6%) of patients developed mild clinically insignificant hypopigmentation and 1/36 (2.8%) developed mild scarring, which resolved with one injection of triamanalone 10 mg/ml. No patients had hyperpigmentation. In addition, 1/36 (2.8%) patients developed transient ectropion, which resolved spontaneously in 6 weeks. We conclude that ultrapulse CO 2 laser is an excellent method for treating periocular wrinkle lines and can be readily performed in conjunction with a transconjunctival lower lid blepharoplasty.

Phenol burns and intoxications

Phenol burns and intoxications are life-threatening injuries. Roughly 50 per cent of all reported cases have a fatal outcome. Only a small number of cases have been reported with high serum concentrations after phenol burns who survived. In our own experience a patient with 20.5 per cent total body surface area deep partial skin thickness phenol burns and serum concentrations of 17,400 micrograms/litre survived after immediate and repeated treatment of the scalds with polyethylene glycol (PEG) and silver sulphadiazine. A literature review of experiences with phenol intoxications reveals the advantages of PEG application. Questions on the need for enforced diuresis and haemodialysis as well as the initial treatment procedures are discussed. Advantages of different solutions for local therapy are reported.

Pilot study analysis of the histologic and bacteriologic effects of occlusive dressings in chemosurgical peel using a minipig model

The histologic changes associated with chemosurgery are well documented, but the data concerning the effects of occlusive dressings (adhesive tape, gauze, or ointments) is largely anecdotal. Wide differences of opinion exist as to the best method of phenol application and postpeel wound care regimen. Using a Yucatan minipig as our animal model, we studied the histologic and bacteriologic differences that various commonly used occlusive dressings have upon the initial burn depth and the subsequent healing of peeled skin. We also compared chemical peel with dermabrasion and chemabrasion. Our results showed to statistical difference in peel depth between "wet" versus "moist" phenol application or between occluded versus nonoccluded dressings. Based upon this animal model, we recommend that phenol solutions be applied moist rather than wet and that an occlusive dressing other than adhesive tape be used and maintained for a minimum of four days.

Chemical peeling of eyelids and periorbital area

Chemical peeling promotes formation of new epidermis and new dermal collagen, resulting in skin shrinkage, reduction of wrinkling and crepe paper skin, softening of crow's feet, and, when desired, lightened eyelid color. Chemical peeling may be performed as the only eyelid procedure, simultaneously with CO2 laser surgical blepharoplasty, after healing of cold-steel-scalpel or CO2-laser blepharoplasty, and as a repeated procedure to achieve maximal results.