Depth Map for Face and Neck Deep Chemical Peel Resurfacing.

BACKGROUND: Chemical peels are applied to the face and neck to improve rhytides and the photoaged appearance of the skin. Peels can be applied to different skin depths depending on the types of chemicals, the volume of solution, and the amount of pressure or friction applied. If a peel is applied too superficially, rhytides will not be removed. If a peel is applied too deeply, scarring or hypopigmentation could occur. OBJECTIVE: To create face and neck depth maps for chemical peeling, which can guide safety when removing rhytides and improving the skin's appearance. MATERIALS AND METHODS: A multicenter retrospective review of records was conducted of patients who underwent phenol-croton oil peeling, from January 1, 2018, to December 31, 2018. Information was collected on facial and neck cosmetic units peeled, peel formula and strength used, outcomes, and complications. RESULTS: A total of 410 patients received deep peels. Two depth maps were created that corresponded to the most common patterns of deep chemical peel applications. CONCLUSION: Different areas of the face and neck are treated with different chemical peel application depths to safely improve rhytides and appearance. Depth maps are created to balance safety and efficacy.

Advanced chemical peels: Phenol-croton oil peel.

Once considered the standard for deep facial resurfacing, the classical Baker-Gordon phenol-croton oil peel has largely been replaced by formulas with lower concentrations of phenol and croton oil. The improved safety profile of deep peels has ushered in a new era in chemical peeling. Wrinkles can be improved and skin can be tightened with more subtle and natural results. No longer does a deep peel denote "alabaster white" facial depigmentation with complete effacement of wrinkles. Gregory Hetter's research showed that the strength and corresponding depth of penetration of the phenol-croton oil peel can be modified by varying the concentration of croton oil. This second article in this continuing medical education series focuses on the main historical, scientific, and procedural considerations in phenol-croton oil peels.

Basic chemical peeling: Superficial and medium-depth peels.

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.

Micropunch blepharopeeling of the upper eyelids: a combination approach for periorbital rejuvenation--a pilot study.

BACKGROUND: Upper eyelid skin excess is commonly treated using a surgical excision that is then sutured, resulting in a linear scar. Deep chemical peeling of the upper eyelids using the Baker Gordon formula has been described as a nonsurgical alternative to tighten upper eyelid skin with the advantage of lessening periorbital rhytides, although prolonged healing and hypopigmentation are risks. The goal of this study was to show the benefits of a less-invasive approach to periorbital rejuvenation that combines 89% phenol peeling with small, nonlinear excisions that heal by secondary intention. METHODS: Eight patients were chosen (mean age 59.6). All patients had thin to medium-thick skin, diffuse periorbital rhytides, and mild to moderate upper eyelid skin excess. Their eyelids were peeled using 89% phenol. Immediately after peeling, a scissor was used to make multiple small nonlinear excisions of upper eyelid skin that healed by secondary intention. RESULTS: Patients were satisfied with the results, and no complications or scarring occurred. CONCLUSIONS: Eighty-nine percent phenol peeling combined with multiple small upper eyelid skin excisions effectively tightens upper eyelid skin excess and lessens periorbital rhytides. The procedure has the advantage of not creating a linear scar and decreases the risk of prolonged healing and hypopigmentation, which is more likely with deeper peels.

Acne keloidalis: a novel presentation for tinea capitis.

Acne keloidalis is characterized by firm skin-colored papules on the surface of the neck and scalp. We report a case of tinea capitis in 60-year-old female which mimicked acne keloidalis. The lesions resolved following oral antifungal medication.

Prolonged survival of angiosarcoma on the nose: a report of 3 cases.

The nose is a rare site for presentation of angiosarcoma. Although this presentation if difficult to study because of its rarity, previous authors have suggested improved survival in patients with angiosarcoma on the nose compared with other anatomic sites. If true, improved survival may be a result of early detection, small tumor size at time of presentation, and increased likelihood of combined surgery and radiation treatment. We report the cases of 3 patients who presented with nasal angiosarcoma and then survived 7, 7, and 4 years to date.

Office accreditation in dermatology.

Health care accreditation is a process of demonstrating compliance with nationally-recognized standards of excellence. Compliance with standards is verified during an on-site survey by specially-trained surveyors. Office-based surgery accreditation is available to dermatologists through the Accreditation Association for Ambulatory Health Care (AAAHC), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The painful purple digit: an alarming complication of Candida albicans antigen treatment of recalcitrant warts.

Candida albicans (CA) antigen immunotherapy for recalcitrant warts is a novel treatment that has had much success in the recent past. Although several side effects are well documented in the literature, we report a new adverse reaction to CA antigen immunotherapy for verruca vulgaris of the distal fingertip. Our patient received an intradermal injection of CA antigen solution into periungual warts located on the distal left thumb and distal subungual area of the left index finger. Within 24 hours, the patient reported pain, edema, and a purple hue to only the index finger. Incision of the finger demonstrated no hematoma or compartment syndrome. Although the etiology is unknown, we believe the condition was most likely due to edema and vascular compromise secondary to a vigorous delayed-type hypersensitivity reaction, possibly leading to cyanosis of the distal index finger. We report this case to make physicians who use intralesional CA antigen aware of a new possible complication at this anatomic location.

Dioxin toxicity and chloracne in the Ukraine.

Dioxin toxicity can lead to severe cutaneous and systemic disease. The poisoning of Ukrainian President Viktor Yushchenko dramatically illustrates the damage dioxin can inflict. The hallmark of dioxin toxicity is chloracne and should alert the clinician to this diagnosis, which can be confirmed by blood tests. Olestra, a non-absorbable, non-digestible fat substitute is a promising new treatment to lower systemic dioxin levels.