Randomized clinical efficacy of superficial peeling with 85% lactic acid versus 70% glycolic acid / Estudo randomizado da eficacia clinica dos peelings superficiais de acido lactico 85% versus acido glicolico 70%

BACKGROUND: Peeling is a procedure which aims to accelerate the process of skin exfoliation. OBJECTIVES: Development of formulations containing lactic acid at 85% or glycolic acid at 70% and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles. METHODS: Preliminary stability tests were carried out and an in vivo study was performed with three groups with 9 representatives each. One was the control group, which used only sunscreen; another one used lactic acid+sunscreen, and the last group used acid glycolic+sunscreen. Clinical efficacy was assessed with a CCD color microscope, through the digitization of images before and after treatment. The applications were carried out by a dermatologist, once a mont h every 30 days, during 3 months. The area with wrinkles was calculated by planimetry point counting, in accordance with Mandarin-de-Lacerda. RESULTS: The formulations were stable in the visual and Ph evaluation. There was no improvement in the control group; for lactic acid, there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye. For the glycolic acid group, there was significant improvement in the outer lateral area of the left eye after the first application, and of the right eye region, after three applications. The formulations used must be kept under refrigeration and should be manipulated every 30 days. CONCLUSIONS: Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications (p≤0.05%). It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye, relative to the speed of skin improvement. .

FUNDAMENTOS: Peeling visa a acelerar o processo de esfoliação da pele. OBJETIVOS: Desenvolver formulações contendo ácido láctico a 85% ou ácido glicólico a 70% e avaliar sua eficácia clínica na redução de rugas finas. MÉTODOS: Testes preliminares foram efetuados e estudo in vivo foi realizado em três grupos com nove representantes cada, separados de forma randomizada. Um grupo foi controle, utilizando apenas fotoprotetor; outro utilizou ácido láctico e fotoprotetor; o último usou ácido glicólico e fotoprotetor. Para eficácia clínica, empregou-se microscópio CCD color, digitalizando-se as imagens do pré e do pós-tratamento. As aplicações foram realizadas por médica dermatologista uma vez por mês, a cada 30 dias, durante três meses. A área com traços de ruga foi calculada pela planimetria por contagem de pontos. RESULTADOS: As formulações foram estáveis na avaliação visual e de pH. Não houve melhora no grupo controle; para o grupo do ácido láctico, houve melhora significativa após a segunda aplicação do peeling na região lateral externa do olho direito e após a terceira aplicação na região lateral externa olho esquerdo. Para o grupo do ácido glicólico, houve melhora significativa na região lateral externa olho esquerdo após a primeira aplicação e, depois de três aplicações, na região lateral externa do olho direito. As formulações magistrais empregadas no estudo devem ser mantidas sob refrigeração e manipuladas a cada 30 dias. CONCLUSÕES: Tanto o peeling de ácido láctico quanto o de ácido glicólico foram eficazes na diminuição de rugas finas da região lateral externa dos olhos após ...

Standard guidelines of care for chemical peels.

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.

Preparation and evaluation of cosmetic patches containing lactic and glycolic acids.

BACKGROUND: Alpha-hydroxy acids such as glycolic acid (GA) and lactic acid (LA), are used in cosmetic patches. The important fact in cosmetic patches is its suitable adhesion and peel properties. AIM: The objective of this study was to prepare LA- and GA-containing cosmetic patches and evaluate in-vitro/in-vivo correlation of adhesion properties. METHODS: Pressure-sensitive adhesives with different concentrations of GA and LA were cast on a polyethylene terephthalate film. The patches were evaluated for peel adhesive strength. On the basis of in vitro adhesion properties the patches were selected for wear performance tests and skin irritation potential. RESULTS: The adhesion properties (adhesion to steel plate and skin) and cohesive strength tests indicated the substantial influence of GA and LA concentrations. Based on in vitro adhesion studies the patches containing 3% (w/w) GA were selected for in vivo studies. In vivo studies show that a formulation containing 3% GA displays good adhesion on the skin, but it leaves little residues on the skin. Skin Irritation studies on healthy human volunteers showed negligible erythema at the site of application after 48 h. CONCLUSION: The noninvasive patch test model was found useful for detecting irritant skin reactions to the cosmetic patch containing GA. Our results demonstrated a strong correlation between the adhesion to steel plate and adhesion to skin. But a weak correlation between the degree of adhesive residue on the skin in in vitro and in vivo tests was observed for the formulation containing 3% (w/w) GA.