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Thank you for entrusting in the compounding services at MD Custom Rx to help meet the unique medication needs of your patients. We are excited to share with you our monthly newsletter and look forward to continuing to be your medication problem solvers. Please don't ever hesitate to let us know how we can be of further assistance to you and your practice.
Sincerely,
John, Dan and Monica |
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Alpha-hydroxy Chemical Peels
Alpha-hydroxy peels, also known as fruit peels, are a popular dermatologic procedure. Glycolic acid peel is the most common alpha-hydroxy acid peel because it is simple, inexpensive, and has no downtime. Uses include acne, acne scars, melasma, post-inflammatory hyperpigmentation, photoaging, and seborrhea. A careful review of the patient's medical history, examination of the patient's skin, and pre-peel priming of skin (with suitable topical agents like hydroquinone or kojic acid) are important before every peel. Proper patient selection, peel timing, and neutralization on-time will ensure good results without side effects. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the time for which it is applied. Hence, it can be used as a very superficial peel, or even a medium depth peel. Glycolic acid peel has been found to be very safe with Fitzpatrick skin types I-IV. |
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Treatment of Melasma with Topical Preparations and Chemical Peels
Melasma is an acquired disorder of hyperpigmentation occurring on the face and predominantly affecting women of childbearing age. It is a chronic, often relapsing condition with a negative impact on quality of life.
In spite of tremendous research, treatment of melasma remains frustrating both to the patient and the treating physician. A systematic literature search yielded 40 randomized controlled trials which had a total of 2,912 participants. Three different therapeutic modalities were investigated: topical agents, chemical peels, and laser and light therapies. Topical depigmenting agents were found to be most effective in treating moderate-to-severe melasma, with combination therapies, such as triple-combination therapy (hydroquinone, tretinoin, and fluocinolone acetonide), yielding the best results. Adverse events associated with treatment were mild and transient and included skin irritation, dryness, and burning, with approximately 40 % of patients develop erythema and peeling. Chemical peels and laser and light therapies produced mixed results, with increased risk of irritation and subsequent hyperpigmentation, particularly in darker-skinned individuals.
The efficacy of a topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) in combination with serial glycolic acid peeling was assessed in the treatment of melasma in Indian patients. The group receiving the glycolic acid peel with topical regimen showed faster and greater improvement than the group which was receiving topical regimen only.
Dark skin types (Fitzpatrick types IV to VI) are especially difficult to treat due to the increased risk of post-inflammatory hyperpigmentation (PIH). Although peels are a well-known modality of treatment for melasma, having shown promising results in many clinical trials, in darker races, the choice of the peeling agent becomes relatively limited, and there is the need for priming agents and additional maintenance peels. Traditional glycolic peels seem to be the best in terms of both safety and efficacy for patients with dark skin.
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Combination Therapy and GA Peels in the Management of Atrophic Acne Scars
Atrophic acne scars are difficult to treat. The demand for less invasive but highly effective treatment for scars is growing. A study assessed the efficacy of combination therapy using subcision, microneedling and 15% trichloroacetic acid (TCA) peel in the management of atrophic scars. Fifty patients with atrophic acne scars were graded using Goodman and Baron Qualitative grading and then subcision, dermaroller and 15% TCA peel were performed alternatively at 2-weeks interval for a total of 6 sessions of each. Grading of acne scar photographs was done pretreatment and 1 month after last procedure. Each patient's own evaluation of improvement was assessed. Out of 16 patients with Grade 4 scars, 10 (62.5%) patients improved to Grade 2 and 6 (37.5%) patients improved to Grade 3 scars. Out of 22 patients with Grade 3 scars, 5 (22.7%) patients were left with no scars, 2 (9.1%) patients improved to Grade 1 and 15 (68.2%) patients improved to Grade 2. All 11 (100%) patients with Grade 2 scars were left with no scars. There was high level of patient satisfaction. This combination has shown good results in treating not only Grade 2 but also severe Grade 4 and 3 scars.
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Clinical Evaluation of Glycolic Acid Chemical Peeling for Acne Vulgaris
Glycolic acid (GA) peels are frequently performed as adjuvants to the treatment of facial acne. There have been few clinical trials reported of GA peels for acne in people with darker skin. To determine the safety and efficacy of GA peels in the treatment of moderate acne vulgaris in Asian skin, a prospective, randomized, double-blind, placebo-controlled, split-face clinical trial was conducted. Twenty-six patients with moderate acne were treated with 40% GA (pH 2.0) on half of the face and placebo on the other half. The procedure was performed five times at 2-week intervals. The GA sides had statistically significant reductions in acne lesions at each time point from baseline values. There were statistically significant differences between the GA and placebo sides. The GA sides had better responses for non-inflammatory lesions than for inflammatory lesions. GA 40% peels significantly improved moderate acne in this study, and the treatment was determined to be effective and safe in Asians.
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Spot Peel in the Treatment of Freckles
A prospective split-face comparative study evaluated the efficacy of trichloroacetic acid (TCA) 70% and phenol 80% in the treatment of freckles on the face in 20 patients of Fitzpatrick type II-IV. The freckles on the right side of the face were treated with TCA and those on the left side of the face were treated with phenol. The skin was cleansed with ethyl alcohol. TCA and phenol were applied as spot peels on the freckles with the help of a toothpick. Freckles on the left side of the face were treated with phenol (80%), while those on the right side of the face were treated with TCA (70%), in all patients. Frosting of the skin was taken as the end point of the treatment. The patient was instructed to wash the face with water after six hours and not to pick the scabs. The patients were reviewed at weekly intervals for three weeks. Evaluation of the results was done photographically, subjectively, and objectively. Out of the 20 patients, 15 came for regular follow-up. Among these patients, 10 were of fair complexion (Skin type III), while five were of wheatish complexion (Skin type IV). Out of a total of 15 patients, 11 (who had very fair skin) had complete clearance of the lesions (90 - 100% lightening) on both the sides. One patient had only 20 - 50% lightening of the lesions on the right side, with clearance of lesions on the left. One noted a recurrence on the side where TCA was applied. Two patients (darker skin types) developed post-inflammatory hyperpigmentation on both sides. TCA and phenol were found to be equally effective in the treatment of freckles in fair skin.
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