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aRTicLe | chemicaL peeLs | n Age 1


2 3 4 5 6 7 8 9


Table 1 Patient demographics and validated hand grading scale Gender Validated hand grading scale


(years) 33 51


59 60 60 67 70 71 73


10 76


Female Female Female Male Male


Female Female Male


Female Female


Before treatment Treatment end 2 3 4 4 3 3 4 4 4 4


1 1


2 1


2 2 2 3 3 2


n 1


2 3 4 5 6 7 8 9


10


Table 2 Improvement of clinical hand assessment by treatment Age


Gender


(years) 33 51


59 60 60 67 70 71 73 76


Female Female Female Male Male


Female Female Male


Female Female


Clinical hand assessment A


1 1 1


2 1


2 2 2 2 2


B 2 2 2 3 2 3 2 3 3 2


4 4 4 6 4 6 5 6 6 5


C Sum 1 1 1 1 1 1 1 1 1 1


A=skin firmness and elasticity; B=visible skin roughness, skin dryness, and atrophic crinkling; C=subcutaneous volume and skin thickness, and skin ‘transparency’ with visible veins and tendons


hand rejuvenation were recruited from the outpatient


department. contraindications for treatment with superficial peels — such as active bacterial, viral or fungal infection; tendency to keloid formation; facial dermatitis; taking photosensitising medications; pregnancy and/or lactation; and unrealistic expectations — excluded patients from the study during pre-treatment counselling. all patients were caucasians with Fitzpatrick skin


types i or ii. There was no exclusion of other skin types, but no patients of Fitzpartick iii or higher asked for such a treatment. Three patients suffered from multiple actinic keratoses of the dorsum of the hands, seven had pigmentary spots, and all 10 patients showed wrinkling. capryloyl salicylic acid (csa) peeling was performed


using the Biomedic Lha™ (Lipo-hydroxy-acid) procedure kit (La Roche posay) according to the treatment protocol in the product leaflet. patients had a 2-week preparation stage using Biomedic Lha™-cleansing Gel and Biomedic Lha™-serum pro-desquamating at home.


18 ❚ September 2011 | prime-journal.com a degreasing wipe was used to remove any impurities


and excess oil from the skin’s surface. The 10% csa solution (Biomedic Lha™-peel 10%) was applied using a disposable peel applicator for the entire dorsum of the hands. The application time was 15–20 minutes until a pseudofrost formed on crystallisation of the salicylic acid. patients were advised to wash the treated area with pure water 1hour later to remove the whitish pseudofrost from the skin’s surface. The peeling was repeated twice per month for a total


of between four and six treatments. all patients were advised to use sunblock (sun protection factor 20) and avoid sunbathing or sunbeds during the treatment time9 The effect of the treatment was photo-documented,


.


and a patient’s and physician’s global assessment performed, which included: ■ contentment with the outcome ■ Fulfilled expectations ■ safety. The three items were scored from 0–3 (0=bad,


3=excellent), with a maximum score of 9. an excellent patient or physician global assessment was defined as ‘excellent’ when the total score was 8–9, ‘good’ at 6–7, and medium at 4–5. For the assessment of hand ageing, the validated hand grading scale was used10


. The validated hand scale is a


five-point photonumeric rating scale: ■ 0=no loss of adipose tissue ■ 1=mild loss of adipose tissue and slight visibility of veins ■ 2=moderate loss of adipose tissue and mild visibility of veins ■ 3=severe loss of adipose tissue and moderate visibility of veins and tendons ■ 4=very severe loss of adipose tissue and marked visibility of veins and tendons.


improvement in appearance following treatment was


further validated using the Williams clinical hand assessment11


, which is a seven-point scale with three capryloyl


salicylic acid (csa) peeling was performed using the biomedic Lha™ (Lipo‑ hydroxy‑acid) procedure kit (La Roche Posay) according to the treatment protocol in the product leaflet.


parameters: ■ skin firmness and elasticity ■ Visible skin roughness, skin dryness, and atrophic crinkling ■ subcutaneous volume and skin thickness, and skin ‘transparency’ with visible veins and tendons


adverse effects were documented. however, these


were only temporary and did not necessitate further treatment. all patients reported mild burning and stinging sensations on day 1 to 2 after the peels. There was some degree of redness during this time, followed by scaling. No other adverse effects were noted or reported.


Results Table 1 provides a summary of patients and the improvement seen with regard to the validated hand grading scale. The very first results were seen after two peelings, with a partial improvement of skin symptoms. skin lightening was observed in all patients, and the improvement of pigmentary spots was noted after two or three treatments, with further improvement thereafter.


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