| PRIME PRoMotIon
Table 2. Homecare peeling treatment programmes Superficial peel
Medium peel Morning High concentrated vitamin C and
antioxidant cream (Serum C25) with sun protection factor (SunCeutic SPF 50)
High concentrated vitamin C and
Specific spot peel
antioxidant cream (Serum C25) with intense antioxidant cream (Serum C25) with repair cream and built-in sun protection factor (K Ceutic SPF 40)
protection factor (K Ceutic SPF 40) Evening
Glycolic acid at concentration between 8% Glycolic acid at concentration between 8% Idebenone, emblica, mandelic acid and 15% with or without phytic acid (Turnover 15) or (Light Ceutic) or (Spot Cream)
and 15% with or without Phytic acid (Turnover 15) or (Light Ceutic) or specific spot cream (Spot Cream)
frequency of applications if irritation occurs. Under normal circumstances, patients begin with applications at night and use sunscreen in the morning. The patient is usually seen 21 days after the initial
treatment. If all marks have disappeared, which occurs in 20% of cases, the same local treatment can be continued. If a ‘shadow’ edge remains, one or two layers of SpotPeel™ are applied to the marks. The after- effects of this application are always less rubefacient and less exfoliating.
How can these techniques be modified? During the first consultation, the nature of the pigmentation needs to be determined. If senile lentigo or actinic keratosis — even slight
keratosis — are identified, then a medium or deep peel should immediately be suggested, depending on the heliodermal situation and the additional need to treat wrinkles.
If melasma or post-inflammatory pigmentation are identified, the following programme should be suggested from the first consultation: ■Firstly, a number of MilkPeel™ treatments combined with treatment at home (NB. treatment at home is essential, firstly as a preparation before the peel, then between peels, and finally as long-term maintenance. It is this regular treatment that evens out the different cellular populations in the skin and which accelerates its turnover) ■Evaluation of results after three peels, which is usually at 6 weeks
■The decision is made at this point whether to pursue a programme of superficial peels or to move to specific spot peels. If pursuing the use of a superficial peel, carry out a further two or three treatments as required, then arrange a consultation with the patient every 2 months to ensure that he/she is applying the treatment and protecting his/her skin from the sun. This monitoring should last for 1 year in order to cover a summer period. If moving on to use a specific spot peel, the treatment will rarely entail a need to return to using a superficial peel, but could require further spot peel interventions in the
(Spot Cream)
months that follow. The same length of monitoring is required.
If pigmentation requiring multiple treatments is identified, it should be remembered that melasma treated without success for many years will lead to extracellular melanic deposits. In these cases the suggestion will often immediately be a medium peel or a specific spot peel, and sometimes a deep peel.
New procedure for the use of SpotCream™ Given the effectiveness of the SpotPeel™–SpotCream™ combination, a superficial peel–SpotCream™ variation has been envisaged, which is entirely feasible. The idea is to perform a few MilkPeel™ treatments and then apply the SpotCream™ at home. On the whole, this system would seem to work, but the effects appear more slowly and there is more resistance to treatment than with the SpotPeel™. On the postive side, however, the cost is lessened for both the doctor and the patient, and the MilkPeel™–SpotCream™ combination allows for continuous treatment — even during the summer.
Conclusions Peeling techniques are particularly suited to the treatment of hyperpigmentation, whereas photonic treatments (e.g. intense pulsed light or YAG) are not satisfactory treatments for melasma. For the best results possible, it is paramount to
follow a logical plan when suggesting treatments and to be able to adapt this to the skin’s unique response. With these recommendations more than any other, both doctor and patient must be thorough and persevere.
High concentrated vitamin C and intense repair cream and in-built sun
For further information contact DermaCeutic:
www.dermaceutic.com
prime-journal.com | July 2011
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