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Chemical peels
Chemical peels
The aged appearance of the hand can be improved with chemical peeling, though there are few reports in the literature. Much like the concerns noted for laser therapy, the reduced number of pilosebaceous units and decreased vasculature can often lead to impaired wound healing.54 Chemical peels are classified as superficial, medium, or deep based on their depth of penetration into the epidermis and dermis. In general, a light or medium depth peel should be employed to minimize the risk of postprocedure complications. Swinehart employed a 50% salicylic acid paste for photoaging on the forearms and hands in a cohort of 11 patients.72 Maceration and desquamation followed, and recovery took up to 4 weeks. While rare, salicylism is a potential side effect when treating large areas. The process should be employed conservatively, and patients should be warned that numerous treatment sessions may be required before the gradual and mild improvement in skin texture is noticeable.
Superficial chemical peels penetrate to the level of the epidermis and include 70% glycolic acid, salicylic acid, 50% resorcinol, Jessnerโs solution, solid CO2 slush, and 10% to 25% trichloroacetic acid (TCA) peel. Medium-depth peels penetrate through the papillary dermis and include TCA peels at concentrations greater than 30%. The results of the chemical peels vary greatly, and are dependent on the concentration, contact time, and the manner in which the skin is prepared. Though more likely with deeper peels, all chemical peels confer a risk of dyschromia, prolonged erythema, a discrete line at the treatment border of the arm and hand, and scarring. Cox reported the development of multiple keratoacanthomas following a 70% glycolic acid gel and 40% TCA chemical peel to the forearms.73