| PRIME PRoMotIon
Table 1. Identifying dermal pigmentations Clinical aspect
Freckles
Simplex or solar lentigines Actinic keratosis Senile lentigo Melasma
Post-inflammatory pigmentation
Dermal? No
Dermal melanophages No
Dermal melanophages
Increase in melanin and melanocytes in the basal suprabasal layers with dermal melanophages
Increase in epidermal melanin with or without dermal melanophages
combination of these active ingredients raises the concern of over-peel, but this is actually extremely rare, even more so than with a glycolic peel. The preparation containing these three acids is
MilkPeel™. MilkPeel™ is usually used for the regulation of seborrhoea and the treatment of acne. Its nature is a result of its composition: salicylic acid for its specific tropism for the sebaceous glands; lactic acid for its emollient effect promoting hydration of the epidermis; and glycolic acid for the dissociation of keratinocytes and stimulation of the dermis. MilkPeel™ has, for a number of years, been the author’s first choice of superficial peel. When using a superficial peel, it is important to remember that:
■Pigmentation that responds well to superficial peels is usually recent and not particularly dense ■The most suitable peel is — as far as this article is concerned — the salicylic, lactic, and glycolic acid combination ■It is not necessary to go below a pH value of 1.6 ■It is imperative that a home treatment is also used (e.g. glycolic acid, vitamin C) (Table 2) ■Peels must be repeated every 8–15 days, with a total of 4–5 peels ■The first signs of pinkness should be the signal for the neutralisation or rinsing of the pigmentogenic area.
Medium peels
Trichloracetic acid peels Trichloracetic acid (TCA) remains the benchmark for a medium peel. The risk of post-peel pigmentation is common with this product, therefore it is necessary for careful pre- and post-peel management for 2 to 3 weeks using products such as SpotCream™, to stabilise
Figure 1 Before (top) and after (bottom) results of using the Spot Peel. After one Spot Peel in the clinic, plus 1 month Spot Cream followed by 1 month Yellow Cream (homecare)
prime-journal.com | July 2011
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