Peeling Preparations

A detailed history and cutaneous examination is performed in all patients prior to chemical peeling. The peeling procedure should be explained in depth to the patient including a discussion of the benefits, as well as the risks of the procedure. In addition, standardized photographs are taken of the areas to be peeled, including full frontal and lateral views.

The author has never observed a flare of Herpes following a superficial chemical peel. Hence, pretreatment with antiviral therapy is usually not indicated. However, one can proph-ylactically treat with antiviral therapies including valacyclovir 500 mg bid, famciclovir 500 mg bid or Acyclovir 400 mg bid for 7-10 days beginning 1 or 2 days prior to the procedure.

Use of topical retinoids (tretinoin, tazaro-tene, retinol formulations) for 2 to 6 weeks prior to peeling thins the stratum corneum, reduces the content of epidermal melanin, and expedites epidermal healing. Retinoids also enhance the penetration of the peeling agent. They should be discontinued several days prior to the peeling procedure. Retinoids can be resumed post-operatively after all evidence of

peeling and irritation subsides. When treating conditions such as melasma, post-inflammatory hyperpigmentation, and acne, as well as darker skin types, retinoids should be discontinued one or two weeks before peeling to avoid post-peel complications, such as excessive erythema, desquamation, and post inflammatory hyperpigmentation. The skin is usually prepped for two to four weeks with a formulation of hydroquinone 4% or higher compounded formulations (5-10%) to reduce epidermal melanin. Other topical bleaching agents include azelaic acid,kojic acid, arbutin, and licorice (see photoaging section). Patients can also resume use of topical bleaching agents post operatively after peeling and irritation subsides [7,8].

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