aRTicLe | chemicaL peeLs |
Table 3 Results CSA-peel for hand rejuvenation
Patient’s global assessment Excellent good 8
n 2
Physician’s global assessment Excellent good 7
n 3
medium worsening n/a
n/a
medium worsening n/a
n/a CSA=capryloyl salicylic acid
Table 4 Possible indications for CSA peels of hands
Condition Actinic keratoses Solar lentigines Possible combinations
Laser, intense pulse light, or photodynamic therapy
Sunblock
Wrinkles and elastosis Dermal fillers, fractional laser and/ or radiofrequency CSA= capryloyl salicylic acid
Figure 3 shows a 71-year-old male patient who
presented with severe UV-induced skin damage, with elastosis, hyperigmented spots and multiple actinic keratoses, which did not respond to topical treatment with diclofenac hyaluronic acid gel over 12 weeks (a). after the use of csa peels, the skin texture was normalised, and hyperpigmentation and actinic keratoses were markedly reduced (B). in Figure 4, the 76-year-old female patient of Fitzpatrick
hypertrophic actinic keratoses were responding later. patients with actinic keratoses were satisfied with the outcome, even if remission was incomplete. The change in clinical assessment is shown in Table 2. Both the patient’s and physician’s global assessments demonstrated the efficacy of the procedure (Table 3). a number of clinical examples of hand rejuvenation using csa peels are shown in Figures 1–4. Figure 1 shows the use of a csa peel on the hands
of a 59-year-old female. Note the multiple spots and fine wrinkling of the dorsum of her hands before treatment (a). hyperpigmented spots were almost completely cleared and the fine winkling was reduced by the treatment (B). The skin also showed an improved radiance. Figure 2 displays the use of csa peels in a 60-year-old
male patient. There was wrinkling combined with brown spots before treatment (a). The outcome was excellent, with improved texture, normalisation of pigmentation, and increased radiance of skin (B).
20 ❚ September 2011 |
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Figure 1 Marked improvement of pigmentary spots and fine wrinkling in 59-year-old female. (A) before, and (B) after peel
skin type i suffered from multiple actinic keratoses, fragile skin and loss of subcutaneous volume (a). csa peels improved hyperkeratoses, pigmentation, and wrinkling (B). To restore volume, 1.3 mL of caha with 0.5 mL lidocaine was injected subcutaneously. approximately 2 weeks after this treatment, a markedly improved appearance was achieved (c). all patients described a good to excellent tolerability,
with only some mild tingling sensations. exfoliation was most pronounced 24–48 hours after the peel treatment. Those who also had the csa peel for facial rejuvenation reported less desquamation of the hands compared with the face. None of the patients needed downtime from work, and no post-treatment hyper- or hypopigmentation or scarring was observed.
Discussion salicylic acid peels have been used for a number of years in aesthetic medicine. The use of salicylic acid results in a loss of cornified cells from the horny layer, followed by the activation of the epidermal basal cells and the underlying fibroblasts12
. This affects not only epidermal
thickness, but also improves the connective dermal tissue. salicylic acid peels prevent reactive hyperproliferation and acanthosis in contrast with other peeling agents13
, such as resorcinol or crystalline sulfur. in photo-exposed human skin, immature cornified
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