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Objective To observe and evaluate the effect of glycolic acid peels in the treatment of acne and scars,and to approach the indications,process and security.Methods 34 patients with acne were chosen.Glycolic acid of 20 ％,35 ％,50 ％,and 70 ％ concentration was used for chemical peeling therapy for 5 times.The concentration of glycolic acid was increased every three weeks.The efficacy was evaluated by comparison of the lesion counts before and after the course.Patients were assigned to fulfil the questionnaire to assess the follicular orifice,secretion of sebaceous glands,smooths,whiteness,scar,influence to living and satisfaction.Results 34 patients completed the course.4 patients were cured,15 patients were greatly improved,12 patients were improved,and 3 patients had no effectiveness.The efficacy rate was 91.18 ％.After treatment,73.53 ％ of the patients showed improvement in follicular orifice,55.88 ％ of the patients showed that secretion of sebaceous glands was decreased,82.35 ％ of the patients had improvement in smoothness,61.77 ％ of the patients had improvement in whiteness,and 67.65 ％ of the patients had decrease in scar formation.Conclusions Glycolic acid peeling is proved an effective,well accepted,and safe treatment for mild to moderate acne.The follicular orifice,secretion of sebaceous glands,skin smoothness,whiteness and scars could be also improved after treatment.
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Fundamentos: Peelings químicos constituem uma injúria à pele ou uma forma acelerada de esfoliação induzida por agentes cáusticos, com várias indicações. São classifi cados em superfi ciais, médios e profundos. O número de publicações sobre o assunto é elevado, mas há necessidade de análise crítica para conclusões objetivas. Objetivos: Verifi car efi cácia e segurança dos peelings químicos através de revisão sistemática da literatura. Método: No período de 5 de janeiro a 15 de fevereiro de 2009, foram realizadas buscas em três bases de dados: Biblioteca Cochrane, MEDLINE (1966-2009) e LILACS. Foram estabelecidos critérios para seleção dos estudos, com ênfase na qualidade metodológica. Os melhores estudos controlados ou comparativos foram individualmente descritos. Os demais artigos de revisão, descritivos e experimentais, foram analisados em conjunto. Resultados: Detectamos 414 publicações e revisamos 165; 129 ou 78% correspondiam a artigos descritivos (82), de revisão (37) ou experimentais (10). Os outros 36 (22%) eram estudos controlados ou comparativos, sendo 19 ou 53% randomizados e apenas 4 com delineamento ideal, ou seja, controlados com placebo, randomizados e cegos. Os agentes mais referidos foram: ácido glicólico, ácido salicílico, ácido tricloroacético (ATA) e fenol. Poucos estudos avaliaram efeitos histológicos e/ou usaram parâmetros quantitativos para avaliação da efi cácia e segurança. Limitações: Heterogeneidade dos estudos; poucos com boa qualidade metodológica. Conclusões: Não há dúvidas sobre os benefícios dos peelings químicos, demonstrados mais pela experiência prática do que por estudos bem conduzidos e reprodutíveis, que são fundamentais para a elaboração de novos guias de conduta.
Background: Chemical peelings are procedures that employ various agents to produce skin injury and accelerated exfoliation; they are indicated for many conditions and classifi ed as superfi cial, medium-depth, and deep. There are a great number of articles on this matter, but critical analysis is necessary to assure the real benefi ts. Objectives: To evaluate the effi cacy and safety of chemical peelings through a systematic review of the literature. Method: The MEDLINE (1966-2009), LILACS and Cochrane Library databases were searched from January 5 to February 15, 2009. For study selection and assessment of methodological quality, some criteria were established. The best controlled or comparative studies were described. The remaining review, descriptive, and experimental articles were analyzed together. Results: We found 414 articles and 165 were selected for revision; 129 or 78% were descriptive (82), review (37), and experimental (10) articles; 36 or 22% were controlled or comparative, 19 or 53% randomized, but only 4 had the ideal design (placebo-controlled, randomized and blind). The agents more frequently reported were: glycolic acid, salicylic acid, trichloroacetic acid (TCA), and phenol. Few studies evaluated histological aspects or quantitative parameters to assess effi cacy and/or safety. Limitations: Heterogeneity of the studies; few with good methodological quality. Conclusions: There is no doubt about the benefi ts of chemical peelings; nevertheless, these benefi ts have been demonstrated much more by practice than existence of well conducted studies. Therefore, further reproducible studies of high quality are necessary to elaborate new guidelines.
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This study was done to characterize the structural changes in the tretinoin pretreatment on trichloroacetic acid(TCA) chemical peel. In guinea pigs, the right halves pretreated with tretinoin and the left halves treated nothing were compared in their structural changes after TCA chemical peel. Epidermal thickness in the tretinoin pretreated group was almost the same in the first and second week. But epidermis of the TCA group increased continuously. In the first week, mitotic figures in the epidermis were more increased in the TCA group, but those in hair follicles were more increased in the tretinoin pretreated group. In the second week, mitotic figures in the epidermis were almost same in both group, but in hair follicles of the tretinoin pretreated group, mitotic figures were much more increased. In alcian blue staining, glycosaminoglycan was stained much more strongly in dermis of the TCA group in first week, but was more strongly stained in the tretinoin pretreated group in second week. On electron microscopic findings, the fibroblasts in upper dermis were larger and had plentier cytoplasm with more organelles in the tretinoin pretreated group. Conclusively, tretinoin pretreatment on TCA chemical peel sustained the effects of TCA longer and showed synergistic effects of TCA and induced enhanced wound healing.
Subject(s)
Animals , Epidermis/drug effects , Guinea Pigs , Skin/drug effects , Tretinoin/pharmacology , Trichloroacetic Acid/pharmacologyABSTRACT
BACKGROUND: Trichloroacetic acid(TCA) chemical peel has been used for variable skin lesions. However, the effect of TCA chemical peel on acne scars has not been studied. OBJECTIVE: The object of this study is to evaluate the effect of TCA chemical peel on atrop hic acne scars. METHOD: Twenty three patients with atrophic acne scars, who were treated with TCA chemical peel were included. The patieits were interviewed for evaluation of the therapeutic efficacy of TCA chemical peel regarding the number of treatment and satisfaction rates. RESULTS: Those who received treatment for more than 6 times with good or excellent results were 13 out of 15 patients, whereas, those who received treatment for 4 times with good or excellent results were 4 out of 7 patients Thus, chemical peel on acne scars showed that the more often the treatment was carried out, the better the therapeutic effect. There was no significant complication. CONCLUSION: TCA chemical peel is safe and effective for the treatment of atrophic acne scars.