Peeling Preparation

Patients with photodamage can apply a lotion containing 25% glycolic acid for 6 months. In such cases an increase in total skin thickness of approximately 25% was reported, accompanied by an increased thickness of viable epidermis and dermis, an increased content of acid muco-polysaccharides, a greater collagen density and an improved quality of the elastic fibers. This could be defined as self-treatment.

However, a better efficiency in peeling can be achieved with a concentration of 50-70% of glycolic acid and, for maximum benefit, glycol-ic acid peels are combined with retinoids and other antioxidants. Some studies have evaluated the efficacy of a cream containing 4% hydro-quinone and 2% glycolic acid used alone or with salicylic acid in reversing actinic damage on the neck and upper chest for 12 weeks; salicylic acid peelings are performed every 3 weeks. This treatment induces a 33-71% improvement in cases of photodamage (Figs. 2.1a, b and 2.2a, b), hyperpigmentation, texture problems, fine lines, dryness, tone and clarity [9].

Other studies have demonstrated that the application of 50% glycolic acid peels mildly improves photoaging of the skin. Generally, for a light peeling, glycolic acid (50%) was applied topically for 5 min to one side of the face, forearms, and hands, once weekly for 4 weeks. The improvement observed was significant and included decrease in rough texture and fine wrinkling, fewer solar keratoses and a slight lightening of solar lentigines. Histology showed thinning of the stratum corneum, granular layer enhancement, and epidermal thickening. Longer treatment intervals may result in collagen deposition as suggested by the measured increase in mRNA.

Fig. 2.2a, b. Lateral view of the same patient before and after peeling

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