๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Acne โ Part 2
significantly improved rough skin texture, the number of actinic keratoses, and fine wrinkling, as compared to control (P < 0.0001 for all parameters).47 Coarse wrinkling, however, was unaffected. Clinical improvement correlated with changes in biopsy as well, with a more compact stratum corneum and a thicker epidermis with a more prominent stratum granulosum.
Other superficial peeling agents have also been reported to be efficacious in the treatment of mild photodamage. In the original report of 30% salicylic acid peel, the authors describe their experience in a case series of 50 patients with mild to moderate photodamage. The majority of patients experienced subjective improvements in skin texture, light pigmentation, and fine lines.4 A single application of 35% TCA peel has also been compared against a series of five peels with 30% glycolic acid in a split-face study. While the improvements at 3 months were small and not visible to naรฏve judges, patients subjectively reported better outcomes with the 35% TCA peel and an image analysis software detected fewer fine lines on the 35% TCA treatment side.48 While this is not the full Jessnerโs/35% TCA medium depth treatment regimen, this study does show that patients unwilling to undergo a deeper peel may need serial treatments with a superficial peeling agent to obtain a similar result.
For patients with severe photoaging with less tendency toward pigmentation, deeper phenol-based peels are preferred due to their dermal penetration. To โtightenโ wrinkles, the peel needs to penetrate into the reticular dermis so that collagen regeneration can occur.49,50 Of the various phenol-based formulations, the original BakerโGordon solution has the greatest penetration.15 In their 1974 publication, Baker and Gordon et al. followed patients they had previously treated for clinicopathologic correlation. The histologic changes posttreatment that they had reported earlier, including increased dermal collagen and elastic tissue, were visible in patients up to 13 years after treatment, leading the authors to conclude that the architectural and clinical changes induced by deep peels are permanent.51 Since then, modifications in phenol peels have
been used in treating photoaging. In a recent publication, a group of patients were treated with 88% phenol applied focally every 3 mm along fine wrinkles using a punctuated method similar to the CROSS technique. Since the application was limited, the authors reported no downtime and patients were not sedated. The clinical improvement in wrinkle appearance correlated with a thicker dermis, like that seen in a full-face peel, without the associated recovery time and risk profile.52
Phenol peels have also been used as an adjunct to, or a less invasive alternative to, blepharoplasty. In post-blepharoplasty patients treated with a modified phenol formulation, a majority of patients noted improvement in wrinkling and pigmentation. While some wrinkling recurred posttreatment, the authors reported an overall permanent improvement with the treatment.53 In a separate study, phenol peels were used as a less invasive alternative to blepharoplasty, with good clinical outcomes. In a case series of eight patients with Fitzpatrick skin types I to III with mild to moderate upper eyelid ptosis, a BakerโGordon phenol peel was applied to a focal region of excess skin on the upper eyelids followed by 88% phenol to the remaining periorbital skin. The peel was left unoccluded after treatment and healing time was approximately 6 to 8 days, similar to the periorbital areas treated with 88% phenol and 35% TCA applied elsewhere on the face. The authors reported no adverse effects and a significant increase in eyelid gap posttreatment.54โ56