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Possibly the most common skin problem in the world, acne is the inflammation of the skin pores when excess oil and dead skin cells clog them. Acne can manifest in many forms such as blackheads and whiteheads, and papules among others. More than the acne, the scars they leave behind tend to cause the most grief as they look quite unsightly. There are multiple modern dermatological treatments which can help you resolve this problem. Some of the treatments that are commonly used are mentioned below –
Chemical Peels: This is one of the most common methods used for the treatment of acne scars. Specially mixed chemical formulations are used to dissolve away the top layer of the skin which contains most of the scars. Once the top layer goes away, the new layer of skin which regenerates doesn’t have the scars.
Light Therapies and Laser Treatments: There are many types of laser and light therapies which use a focused light to burn away the top layer of the skin to regenerate it and reduce the scar. Certain specialized lasers use high-intensity pulses to treat raised acne scars specifically.
Dermabrasion and Microdermabrasion: One of the most popular and commonly found treatments, is dermabrasion. This method uses an electrical machine that removes the top layer of skin which is akin to sanding. However, this is a fairly invasive option and will require some time for recovery. A less invasive procedure is microdermabrasion which uses finer instruments for this purpose and tends to have lesser downtime.
Dermal Filler Injections: These injections are used to plump up certain areas of skin which need to be treated. Most of them work on the principle of boosting collagen which is responsible for healing the skin. Once boosted, collagen works to fill gaps and regenerate new skin. However, most of these are temporary and only last for about a year or so.
Incisions Under the Skin: Sub-cision or subcutaneous incision uses a tuned surgical probe to separate the scar tissues of acne from the normal skin. This will result in the skin to rise and thus flatten the dent of the acne scar.
Autologous Fat Transfer: A form of therapy which is becoming popular very quickly, this method uses fat taken from one area of your body and injected into the scar area. This results in raising the depressed areas of the skin and flattening the scars. However, fat is easily absorbed within the body and thus the effect may diminish within some time. You may be needed to redo the procedure over regular periods.
Cryotherapy: The area around the scar is frozen in a targeted manner which results in the scar tissue falling over and exposing newer skin which is smooth and devoid of scarring.
Topical Creams: These are the most commonly available over the counter solutions for acne scars which help reduce their appearance. If you wish to discuss about any specific problem, you can consult a dermatologist and ask a free question.
I want to smooth and clean my skin but still he rough. I do anything about it but I am not satisfied please suggest me about it.
I having 35 kg weight only I am 23 years old weight is lasting. Also quantity of eating food is less, Thin body. Also due to sun burn sun rashes is occurring in my hand a white mark is present in my both hand. How can I recover from this? And increase my weight?
I am facing a skin problem over my face under my eyes some dark circles and dark patch under my eye. Pls tell me the solution.
Reason of hair fall (21-years male) at so early age, which generally starts at the age of 35-36 yrs. Please advise to stop further hair-fall & how to recover. Thanks.
I have skin problem from my childhood in winter its become very dry and gets cracks. In full body the skin become so bad looks like old people but I am 21.
I am 24 years old there a problem other base of my penis it itching so much and get burn and skin crack I have butter cream that is m clop but it dosnt cure for permanent.
I am suffering with skin problems I don't know what those are they are pimples on my back and shoulders in head also and body also itching in head too.
I losing am my hair continuous and I am worried about that please give me advised that how I can maintain my hair smooth.
Hi. I'm suffering from pimples since past 6 months. I have used many ointments and soaps like acne on few doctor suggestions .I have avoided eating oil food, non veg, sweets and junk food. Still I am suffering from pimples. Can you please help me in getting out of this problem. Thanks in advance.
Chemical peeling is a medical procedure which includes application of a chemical agent to the skin, causing controlled destruction of the epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. In simple words chemical peeling or chemical rejuvenation is procedure where a chemical agent or combination of agents of defined strength are applied the skin causing a controlled destruction of layers of the skin. This is followed by regeneration and remodeling leading to improvement of texture and surface abnormalities. It is a safe, effective and affordable option for improving skin ageing and imperfections.
Skin is considered the largest organ of the body and has many different functions. The skin is divided in two main regions, the epidermis and the dermis. The dermis is attached to an underlying hypodermis also called subcutaneous connective tissue.
Epidermis: It is the most superficial layer of the skin. The first barrier of protection from the invasion of foreign substances. The epidermis is divided into four layers – stratum corneum, stratum granulosum, stratum spinosum and stratum basalis(basal layer).
Dermis: It is composed of fibroblasts which are responsible for secreting collagen, elastin and ground substance that gives support and elasticity to skin. It supplies the epidermis with nutrients and has its role in thermoregulation. The dermis is subdivided into two zones, upper papillary and lower reticular layer.
Classification of peels according to histological depth
- Very superficial peel – Exfoliation of the stratum cormeum, without any epidermal necrosis.
- Superficial peel – Destruction of the full epidermis, up to the basal layer
- Medium peel – Destruction of the epidermis, papillary dermis and upto the upper one third of the reticular dermis.
- Deep peel – Necrosis of the entire epidermis and papillary dermis with inflammation extending to the mid reticular dermis.
Classification of chemical peeling agents
Very superficial Peel:
- Glycolic Acid 30-50% applied for 1-2 minutes
- TCA* 10% applied as one coat
- Jessner’s solution 1-3 coats
- Glycolic acid 50-70% applied for 2-10 mins (depending on the type and thickness of the skin)
- TCA 10-30%
- Jessner’s solution 4-10 coats
- Very superficial and superficial Peels are the mildest form and often called, “the lunchtime peel.” These peels break down corneocyte adhesion, causing dead skin cells to shed off to reveal the fresh, healthy underlying skin. These peels address minor skin irregularities like discoloration, acne, surface scarring, fine lines, and sun spots.
- Glycolic acid 70% applied for 3-30 mins (depending on the type and thickness of the skin)
- TCA 35-50%
- Glycolic Acid 70% plus TCA 35%
- Jessner’s solution plus TCA 35%
- Phenol 88%
- Baker Gordon phenol formula
- Medium and deep peels increase the collagen and glycosaminoglycans content, cause collagen remodeling and increase dermal thickness to improve the clinical appearance of the skin with reduced wrinkles, skin tightening and pigmentary dyschromia.
Reason behind chemical peeling:
- Wound healing process is an important reason for rejuvenation. The phases of wound healing after chemical exfoliation are apparent:
- Inflammatory phase (1-5 days) – This phase is evident after peeling as erythma and swelling on the skin
- Proliferative phase (2-21 days) – In superficial peels, the basement membrane is intact, hence normal epidermis is restored in 2 to 3 days. In medium to deep peels, wound is below basement membrane and re-epithelialization takes time.
- Remodeling phase (3 weeks to 2 years) – collagen remodeling is the main reason that chemical peels cause rejuvenation and reduce wrinkles.
Indications for peels:
1. Pigmentary disorders
- Resistant melasma
- Pigmented cosmetic dermatitis
- Post inflammatory hyperpigmentation
- Comedonal acne
- Post acne scars
- Acne cosmetic
- Acne excoriee
- Fine wrinkling
- Skin glow and rejuvenation
- Oily to rough skin
- Actinic keratosis
- Keratosis pilaris
- Macular amyloidosis
- Dilated pores
- Seborrheic keratoses
- Active bacterial, viral and fungal infection and open wounds
- Oral isotretinoin use within the past three months
- Pregnancy and breast feeding
- History of keloid formation
- History of taking oral contraceptive and photosensitive drugs
- Unrealistic patient expectation
- Uncooperative patient, eg. Patient is careless about sun exposure or application of medicine
- For medium depth and deep peels, history of abnormal scarring, atrophic skin and isotretinoin use in the last six months.
How to choose a patient:
A patient should be chosen depending upon 4P’s:
P – Pathology
P – Point of depth required
P – Patients skin
P – Previous peeling agents
Many peels like mandelic acid, kojic acid, lactic acid, citric acid and many more have been introduced in the market which are also available in combination. These peels are not only more skin friendly but also more patient friendly. They have buffering agents like licorice extract and willow bark extract to minimize irritation to skin and antioxidants to infuse the skin with restorative nutrients. The change in the skin often occurs at cellular level and are not apparent to the naked hence making it more popular amongst busy patients who are seeking effective treatments quickly with little or no downtime.
Benefits of chemical peels:
The skin becomes noticeably smoother and rejuvenated.
- It reduces pigmentation, improves dull and uneven skin tone, reduces signs of photoagaeing, acne and enlarged pores.
- Removes dead and damaged skin cells and improves skin texture
- Helps in removal of tan
- Skin becomes brighter and more vivid because chemical peels not only cause re-epithelialization of the epidermis but also collagen remodeling.
Pre peel and post peel precautions:
- Patient has to be motivated enough to get multiple sittings of the peel ( 4-8, depending on the indication and type of peel) every 2-3 weekly to get the desired result.
- Patient should not wax, bleach, scrub, shave(the same day) or get any other aesthetic procedure like microdermabrasion, ipl, derma-roller one day before the chemical peel procedure. A gap of at least 7 days before and after the peel should be maintained.
- Patient should use a mild soap/ non soap cleanser after the peel
- Broad spectrum sunscreen and moisturizer should be used liberally, at least 2-3 times a day and sun exposure should be avoided.
- Patient should be strictly prohibited from scratching, picking or scrubbing the skin.
Take home message:
Chemical peeling is a simple office procedure for the treatment of acne, pigmentation, skin rejuvenation and photo ageing. These are not one time procedures but require 6-8 sessions and maintenance peels to achieve maximum improvement and prevent recurrences. The newer peels are safer and effective. If you wish to discuss about any specific problem, you can consult a Dermatologist.