Perhaps the most important part of this discussion is about the levels of penetration that are reached through chemical peels and how to discern each level ( Fig. Type V: Rarely burns, tans well, sun insensitive skin. government site. Asians tend to have more melanin than Caucasian skin and as a result, Asian skin is more prone to skin discoloration. However, it was during this study that many side effects were seen such as cardiac arrhythmia. Traditional CO2 laser resurfacing is totally ablative, removing progressive amounts and layers of skin. Beta hydroxy acid peels such as salicylic acid appear to have more penetration into pores than the fruit-acid peels and can decrease sebum production; they are often formulated in skin products to treat acne. A gray background indicates a peel that has gone to the papillary reticular dermis junction depth and this is to be avoided because the risk for scarring increases at this level. Handog EB, Macarayo MJ, Gabriel MT. 31.3). Intravenous sedation is perhaps more effective. The site is secure. Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. In addition to this, GA improved pigmentation from acne and the procedure. Chemical peeling is a widely used procedure in the management of acne and acne scars, but there are very few studies on Asian populations who are more prone to develop hyper pigmentation. Goh CL, Akarapanth R. Epidemiology of skin disease among children in a referral skin clinic in Singapore. Stay up-to-date with the latest beauty and wellness news straight to your inbox. Glycolic acid versus Jessner's solution: Which is better for facial acne patients? National Library of Medicine Yoon ES, Ahn DS. winslow carmel Acne scars: Classification and treatment (Series in dermatological treatment). [10], Several studies have been done regarding the epidemiology of acne in the Philippines, where the majority of citizens have Fitzpatrick skin types III-V. A survey done in 2002 by Roa et al. The authors of both studies concluded that 100% TCA was safe and effective in treating ice pick acne scars in patients with Fitzpatrick skin types IV-V. An open label study evaluated the combination of two peeling agents to achieve a medium depth peel for treatment of acne scars. [13] Another benefit of SA is its lightening effect on post-inflammatory pigmentation due to acne. We conducted a search on PubMed using the terms acne, acne scars, chemical peels, glycolic acid, salicylic acid, Jessner's solution, trichloroacetic acid, resorcinol, phenol, Asians, Chinese, Japanese, Koreans, Indians, ethnic skin, and dark skin. All prospective clinical trials or case series from 1990 to 2011, with Asians as subjects, were included and grouped according to the peeling agent used and the indication, being acne or acne scars. The goal is pink, raw skin. It has been advocated that 1 to 3 drops of solution should be left in the applicator for each application. [13,14], Acne scars, on the other hand, correlate with the duration of acne, the severity of the lesions and the delay in treatment. The existing studies support the use of chemical peels in the treatment of acne and acne scars in Asians. official website and that any information you provide is encrypted Type II: Always burns easily, tans minimally, very sun sensitive. There was also an overall brightening of the skin appreciated after the peelings were concluded. With the fluence from 5 to 7 J/cm2, the CO2 laser can provide clean and efficient tissue ablation with much of the heat dissipated in the plume/smoke of the tissue (fluence is measured in joules/centimeters squared). Acne, acne scars, asians, chemical peel, glycolic acid, salicylic acid, trichloroacetic acid. Below, youll find our recommendations for the safest, most effective treatments, many of which are offered at Illuminate Plastic Surgery in Palo Alto, CA. Dainichi T, Ueda S, Imayama S, Furue M. Excellent clinical results with a new preparation for chemical peeling in acne: 30% salicylic acid in polyethylene glycol vehicle. Compared to newer machine-based technologies for acne and acne scars, chemical peeling is affordable and with minimal downtime, and can be performed in any dermatologist's office. Learn more The onset is slow, however, requiring 30 minutes to more than an hour to reach an effective state. Taub AF. It is a useful peel for patients with acne because of its salicylic acid and resorcinol components. Sharad J. The variation of skin types within these countries is between Fitzpatrick skin types III to V. In general in the United States, the Asian American population has been listed as 4.8%. There was a higher prevalence among the 15-20 year age group as compared to the 21-25 year age group, the latter being 43.5% as compared to 55.8%. 31.2 can be whiter in the operating room. Procedural treatments for acne vulgaris. The Asian patient has a tendency to form pigmentary disorders versus wrinkling.
There are many options for chemical peeling. A complete CO2 laser resurfacing protocol for safety should be followed, as well as adherence to Accreditation Association for Ambulatory Health Care (AAAHC) standards or other appropriate credentialing institutions required by your state. In: Roenigk RK, Roenigk HH, editors. There was also improvement in the texture and pigmentation as well as the appearance of pores. Type IV: Burns minimally, always tans to moderate brown, minimally sun sensitive. [16,17], An open label, comparative study first evaluated the safety and efficacy the CROSS technique for acne scars in Asians and using two concentrations of TCA, 65% and 100%. Following the aforementioned pilot study, the authors conducted a larger study using the same method described. Other chemical peels that are "epidermal" peels like sal. Nonfacial body parts tolerate CO2 laser resurfacing much the same as the neck and fractional resurfacing is often preferred as a safer option. 
It should however be remembered, that resorcinol may cause post-inflammatory hyper pigmentation in those with Fitzpatrick skin type IV or greater or those who have a tendency to develop dyschromias. This can be achieved with the Jessners peel as well; however, it is better to stay at the first level with the Jessners peel prior to the 30-35% TCA. Lai KW, Mercurio MG. Update on the treatment of acne vulgaris. Also, the pink/red, raw area is the clinical level reached during the actual procedure. Pictures sent daily via text, e-mail, or provided in person can help tremendously. [22], Jessner's solution is a combination of 14% resorcinol, 14% salicylic acid, 14% lactic acid and ethanol. The .gov means its official. In general these settings have been reliable. The second pass with traditional resurfacing is with 90 mJ, and a density of 4. [29], In a split-face, randomized, investigator-blinded trial that compared 70% GA against JS, it was determined that both peeling agents were equally effective in reducing the acne scores. A community-based epidemiological study of acne vulgaris in Hong Kong adolescents. The purpose of this review is to summarize and evaluate the existing studies on the role of chemical peels in the treatment of acne and acne scars among Asians. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Originally, the CO2 laser used continuous applied energy instead of pulses, which often led to adverse outcomes. Most of the available literature on chemical peels focuses on its role in skin rejuvenation and the correction of dyschromias. Contact Illuminate Plastic Surgery in Palo Alto, CA for an evaluation to determine if youre an ideal candidate for a PicoSure procedure. Preoperatively, along with the pretreatment regimen, there are other precautions that should be followed. [8,15,16,26,27,3032], Studies on chemical peels for acne in Asian patients, Studies on chemical peels for acne scars in Asian patients. If you are talking a real chemical peel that reaches the dermis of the skin- the recovery period is 7-10 days. My acne isn't super bad. Chemical peeling is an art and requires experience. [32], In an open label, non-randomized comparative study that evaluated GA against SM, both peels produced equally significant improvement in the number of boxcar scars but had no significant effect on rolling scars and minimal effect on ice pick scars.[8]. Park JH, Choi YD, Kim SW, Kim YC, Park SW. In the largest study, some patients with severely inflamed acne were allowed to take oral antibiotics simultaneously, with no adverse effects reported. acid; glycolic acid, Jessner's or TCA 10% you may or may not peel for 1-3 days. Though the modified phenol peel was found to be safe and effective in treating acne scars in Asians, it was less effective when compared to laser resurfacing. [13] It is an excellent keratolytic agent by way of its ability to dissolve intercellular cement thereby reducing corneocyte adhesion. In: Tosti A, De Padova M, Beer K, editors. Type VI: Never burns, deeply pigmented, sun insensitive skin. rhinoplasty Kim SW, Moon SE, Kim JA, Eun HC. surveyed visits by 74,589 Asians (e.g., Chinese, Malaysians, and Indians) in a Singapore clinic and determined that acne vulgaris was the second most common diagnosis, occurring in 10.9% of the adult patient population and was the eighth most common diagnosis in a paediatric population, occurring in 3.1%. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris. 
Histologically the skin of the Asian clientele is characterized by larger melanocytes with increased production of melanin and melanosomes. Sachdeva S. Lactic acid peeling in superficial acne scarring in Indian skin. The prevalence of self-reported acne was 91.3% while there were 52.2% of respondents who had active acne during the time of the interview were reported. As the specks turn into a layer of translucent white with a pink background, you have essentially penetrated the basement membrane and your peel has gone into the superficial papillary dermis. 31.2). At this depth, the peel has reached the deeper layers of the papillary dermis because the vessels are constricted (leading to the disappearance of the pink/red) with further coagulation of the dermal proteins. Salicylic acid at 30% concentration and 35-70% glycolic acid has been shown to be effective in reducing both inflammatory and non-inflammatory lesions of acne in Asian skin. 
and transmitted securely.
Moistened, sterile towels around the field are necessary as well. [1,22], Previous studies have reported that alpha hydroxy acids such as GA, do not possess anti-inflammatory properties, making it inferior to SA in the treatment of acne,[18] despite evidence showing that there was clinically significant improvement of the inflammatory lesions. In terms of chemical peeling, a complete approach to skin rejuvenation can be accomplished in the office with 30 to 70% glycolic peels, Jessners peels, and TCA peels (20, 35%). Al-Waiz MM, Al-Sharqi AI. The Ectropion (outward turning of the lower eyelid), excessively dry eyes, and previous lower blepharoplasty, Koebnerizing diseases (prior radiation therapy leading to a loss of adnexal structures), extensive fibrosis resulting from prior cosmetic treatments (e.g., dermabrasion, deep chemical peels, silicone injections). This provides approximately 50 to 70 m of ablation with about 20 m of surrounding tissue injury.6 With the knowledge of average skin thicknesses,7 one can estimate the depth of resurfacing. Having a simplified approach can markedly ease patient anxiety during the subsequent discussion of options with patients. Glycolic acid was shown to be safe in the treatment of acne even in darker skin types as well as adjunctive therapy for the treatment of acne scars. The effect of glycolic acid on the treatment of acne in Asian skin. Viewing Fig. Expert opinion: Efficacy of superficial chemical peels in active acne management--what can we learn from the literature today? Fig. Before There is also a risk of developing contact dermatitis to resorcinol and this peel should therefore be used with caution along with proper patient selection. With this peel, the Jessners peel is started and two to four passes are done to prepare for the TCA 30-35% peel, which is usually one to two passes but based on the parameters enumerated below: Fig. How much downtime can I expect from chemical peels of different depths? Immunosuppressive disease, including acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection, or use of immunosuppressive medications, Patient history of hormonal or endocrine disorders, such as polycystic ovary syndrome or diabetes, unless under control, History of bleeding coagulopathies, or use of anticoagulants, History of keloid or hypertrophic scarring, Very dry skin or conditions that would create healing issues in postprocedure phase. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. [33] In view of this safety issue, Park and colleagues evaluated the effectiveness of a modified phenol peel also for Korean patients. Applying a proven nonreactive formulation such as Vaseline or other petroleum jelly can prevent unwanted skin reactions that can occur with application of other products with multiple ingredients. A personal perspective is presented along with literature findings4 to help with the discussion. There were six studies for acne and eight studies for acne scars that were identified using our search parameters. Effectiveness of modified phenol peel (Exoderm) on facial wrinkles, acne scars and other skin problems in Asian patients. This is not mandatory but is thought to prepare the skin to heal faster (i.e., rapid re-epithelialization) and allow a more even peel when the deeper treatment is applied. While both groups showed improvement, the number of treatments received was proportional to the degree of improvement and that 100% TCA was more effective than 65% TCA.[16]. Two groups found that Asians developed wrinkling one to two decades later than age-matched Caucasians.2,3 Melasma, ephelides, lentigines, and postinflammatory hyperpigmentation (PIH) are the most common conditions. This very superficial peels help turn over the outer keratin layers of the face, open pores, and improve acne without disturbing the underlying skin pigmentation. If you are going to use at home products. These stronger peels are used for skin tightening but in higher Fitzpatrick skin types, the peel can actually cause a depigmentation or stimulate post-inflammatory hyperpigmentation. You are right to be concerned because asian skin is very sensitive and needs to be treated differently than caucasian skin.