Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Proc Derm Revision > Chemical peels (incl JAAD CME Aug 2019) > Flashcards

Chemical peels (incl JAAD CME Aug 2019) Flashcards

1
Q

In chemical peels, the agent used is usually an acidic solution.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For patients with extensive AKs, superficial peels should be used.

A

F Medium-depth peels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pre-treatment with tretinoin or AHAs is contraindicated prior to chemical peels.

A

F

recommended for 4-6 wks prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Superficial peels penetrate to the epidermis/papillary dermis.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Medium peels can penetrate to the mid-reticular dermis.

A

F

Upper reticular dermis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Deep peels can penetrate to the deep-reticular dermis.

A

F

mid-reticular dermis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

UVA radiation penetrates deeper in the skin than UVB

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Topical tretinoin pre-treatment prolongs wound healing after medium-depth and deep-depth chemical peels.

A

F

Accelerates wound healing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AHAs exert their epidermal effect at the level of the stratum corneum and granulosum junction.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AHAs can reverse the histologic signs of photoageing.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sunscreens should be used regularly for 3 months prior to a chemical peel and continued indefinitely after the peel.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hydroquinone should not be used prior to chemical peels.

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prophylactic antivirals are not needed prior to chemical peels.

A

F

Start day prior to peel, continue 10-14days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risks of chemical peels include stinging, burning sensation, visible peeling, scaling, milia formation, pigmentary changes, persistent erythema, infections and rarely scarring.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Persistent erythema is a sign of impending scarring

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The use of AHAs has been shown to reverse histologic signs of photoaging

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Used regularly for 3/12 AHAs showed a 25% increase in epidermal and papillary thickness, increase in mucopolyaccharides, improved quality of elastic fibres and increased collagen density

A

F

6/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Active viral, bacterial or fungal infection preclude chemical peeling until there is complete resolution.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

It is safe to perform a chemical peel if isotretinoin has been taken anytime prior to the procedure.

A

F

Must wait 6-12 months (impaired wound healing, increased risk of scarring).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The AHAs have been used as an adjunct to tretinoin therapy without increasing adverse sequelae

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patients who’ve had prior facial XRT are at higher risk for scarring after chemical peels.

A

T

Due to diminished adnexal structures (from where re-epithelialisation originates).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

There is no need to delay chemical peels after facial surgery.

A

F

Should wait 6 months or more.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Smokers have increased rates of infection after chemical peels.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Superficial chemical peels work by exfoliating all or part of the epidermis, which leads to mild stimulation of collagen formation in the superficial papillary dermis.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Melasma, ephelides and post-inflammatory hyperpigmentation are not indications for superficial peeling.

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Acne vulgaris is an indication for superficial chemical peel

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Photoaging and fine rhytides are an indication for superficial chemical peel.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

There is usually a significant effect noted after one superficial chemical peel.

A

F

Usually need 3-6 peels, in conjunction with topical home regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Multiple superficial peels will produce the same result as one deeper chemical peel.

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Tretinoin should not be used topically for 2-4 days prior to a superficial chemical peel

A

T

To ensure intact epidermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A bleaching agent should not be used in patients with darker skin types or pigmentary disorders until after the chemical peel.

A

F

Best to start prior to peeling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Without topical agents, the skin will return to before-peel condition within 2 years.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Superficial chemical peels can be used on all Fitzpatrick skin types.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Glogau’s classification is a measure of photoageing.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Sebaceous gland density does not effect the depth of a peel.

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The area treated does not effect the depth of a peel

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

The technique of application is a significant determinant of the depth of a peel

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The sable brush has been shown to deliver the greatest quantity of solution when used as a peel applicator.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

The response to a chemical peel is not affected by pressure or rubbing during application

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

The condition of the skin and the skin preparation technique can influence the depth of peeling

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Seborrhoeic dermatitis may cause a peeling solution to penetrate less deeply

A

F

More deeply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Thicker and more sebaceous skin is less susceptible to the peeling agent.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Non-facial areas can be treated with peeling agents of any depth

A

F

Should only use superficial peeling agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

When peeling with AHA agents, the concentration of the solution is increased and the length of time that the acid is left on is reduced

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Hand-held fans can be utilised effectively to minimise discomfort during a chemical peel.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Trichoroacetic acid 10-50% is a commonly used superficial peeling agent.

A

F

10-25%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If the frost from TCA is unexpectedly rapid or intense water neutralization may dilute the effect if applied within 1 minute

A

F

Within 30 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

A solution of TCA 25% consists of 25g in 100mL of normal saline

A

F

Distilled water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

With lower concentrations of TCA, mild erythema or whitish speckling may be evident

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Repeated applications of TCA may be made to areas that don’t frost.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

If frosting is rapid or intense after TCA application, the effect can be diluted if water is applied within 2 minutes.

A

F

Within 30 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

If stinging occurs after TCA application, it tends to crescendo for 2 minutes, then subside.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

White frosting produced by TCA resolves within 1-2 days.

A

F

1-2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Light peels can be performed weekly for acne vulgaris at concentrations of 10-15% TCA with minimal downtime.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Applications of 25-35% TCA may take 14 days to heal within darkening of the face for 5-7 days and fine desquamation on days 3-6.

A

F

5-7 days to heal, darkening for 2-3 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Jessner’s solution consists of: resorcinol 14g, salicylic acid 14g, lactic acid 14g, and ethanol 95% per 100ml.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

The salicylic acid in Jessners solution fluoresces under the woods light, which is another method that can be used to ensure even cover

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Frosting usually occurs with Jessner’s solution application.

A

F

Just erythema and white speckling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Jessner’s peels are usually followed by 2-3 days of light white desquamation.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

AHAs are naturally occurring organic acids extracted from fruit, sugar cane, and other foods.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Glycolic acid is the most commonly used AHA in superficial peeling.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

AHAs cannot be used on Fitzpatrick skin type IV-VI.

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Glycolic acid 70% peels have been shown to be equivalent to Jessner’s solution for efficacy in active acne.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

For AHA peels, low pH solutions (pH2) create more necrosis and improve efficacy

A

F

More necorsis without improving efficacy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

70% glycolic acid can be used unbuffered and unneutralised.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

An abrasive skin cleansing regimen should be used prior to AHA peels in order to de-grease the skin.

A

F

Should avoid – can increase depth of penetration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Glyocolic acid should be applied with cotton balls rather than gauze to avoid abrasive effects of rubbing.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

It is unnecessary for the physician to stay in the room during an AHA peel

A

F

Need to observe for ‘hot spot’ erythema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

AHA can be neutralised with a 5% sodium bicarbonate solution with multiple rinses.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Indicators to neutralise the AHA solution include unusual degree of patient discomfort, mild erythema, or adequate time interval.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Time dependency is not a factor in glycolic acid peeling.

A

F

Unique factor must time and neutralise this peel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Salicylic acid can be used solo in 20-30% solutions for superficial peeling.

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Salicylic acid peels can cause white precipitation within 2-3 days.

A

F

White precipitation occurs immediately.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Salicylic acid peels are self-limiting and there is no need for timing or neutralisation

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

There is a tendency for great discomfort immediately following salicylic acid chemical peels

A

F

There is very little discomfort due to the anaesthetic properties of SA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

SA peels may benefit acne more than other peels.

A

T

Because it is also comedolytic.

77
Q

SA peels cannot be used in Fitzpatrick V and VI skin types.

A

F

Can be. Start with 20%, use hydroquinone post Rx

78
Q

SA peels often are prepared with ethanol as a vehicle, which causes redness, stinging and burning.

A

T

Newer polyethylene glycol base less irritant.

79
Q

Solid carbon dioxide can be used as a superficial peel.

A

T

80
Q

Tretinoin cannot be used as a superficial peel.

A

F

Can use 1-5% concentration.

81
Q

Resurfacing techniques are ineffective for the treatment of AKs.

A

F

82
Q

A thin coat of petrolatum or antibiotic ointment should be applied after most peels.

A

T

83
Q

Topical steroid ointment should not be applied after a chemical peel.

A

F

Use if reaction brisk, or type IV/greater skin.

84
Q

Patients should cleanse their face twice daily after a chemical peel and resume their normal skin-care regimen as soon as the skin returns to normal.

A

T

85
Q

A combination of Q-switched alexandrite laser with concomitant superficial TCA peeling can be used for recalcitrant pigmentary disorders.

A

T

Apply peel before laser.

86
Q

Medium-depth peeling is defined as the application of a wounding agent to the skin, producing a wound at or through the level of the papillary dermis.

A

T

87
Q

The injury of medium-depth peeling is associated with coagulation necrosis of the epidermis only.

A

F

Also papillary dermis + inflammation to the reticular dermis.

88
Q

Medium-depth peels are indicated for AKs, superficial seborrhoeic keratoses, lentigines and other pigmentary dyschromia.

A

T

89
Q

TCA with concentrations above 50% is used to achieve a medium-depth peel to the skin.

A

F

35-50% (although 45-50% can have unpredictable effect so rarely used now)

90
Q

35% TCA can be combined with solid CO2, Jessner’s solution or 70% glycolic acid to achieve a medium-depth chemical peel.

A

T

91
Q

88% phenol and pyruvic acid are medium-depth peeling agents.

A

T

92
Q

Benefits of medium-depth peeling can be seen in patients with severe actinic damage and sallow discolouration of the skin with significant wrinkling.

A

F

Moderate actinic damage, without significant wrinkling.

93
Q

Bichloroacetic acid can be used carefully as a spot treatment for conditions such as trichodiscomas, sebaceous hyperplasia, syringomas and trichoepitheliomas.

A

T

94
Q

The uniformity of the application of a Jessner’s solution peel can be identified with a Wood’s lamp

A

T

SA in Jessner’s fluoresces.

95
Q

It is unnecessary to extend a chemical peel into the hairline or below the jawline.

A

F

Feather into these areas to reduce noticeable lines of demarcation.

96
Q

Coarser, more sundamaged skin reacts faster to TCA peels, thus requiring less heavily applied acid.

A

F

Reacts more slowly, requires more heavily applied acid.

97
Q

TCA will penetrate deeper with a more heavily saturated applicator (eg cotton tip).

A

T

98
Q

Two small dry cotton-tipped applicators should be held at the medial and lateral canthus of the eye to catch any tears that may develop during a chemical peel, preventing ‘wicking’ of the acid into the eye.

A

T

99
Q

Once TCA has been applied, there is no period in which it can be diluted prior to keratocoagulation and the frosted appearance.

A

F

About 30 seconds

100
Q

After a medium-depth peel, the skin should be kept greasy with appropriate ointments until desquamation is complete, generally within 5-7 days.

A

T

101
Q

By 8 hours after a medium-depth peel, the skin has a light brown appearance.

A

F

24 hours.

102
Q

Areas of pigmentary dyschromia and freckling appear darker after a medium-depth chemical peel.

A

T

103
Q

After a medium-depth chemical peel, desquamation begins around the hairline.

A

F

Around mouth and central face. Hairline is last area to peel.

104
Q

Peeling usually starts on day 3 after a medium-depth chemical peel and is complete within 1 week.

A

T

105
Q

After a chemical peel, pts should facilitate the peeling process by gentle scrubbing the skin.

A

F

no scrubbing or picking allowed

106
Q

Patients can wear make-up within 2 weeks post medium-depth chemical peel.

A

F

7-10 days.

107
Q

Erythema usually fades within 1-2 weeks post medium-depth chemical peel.

A

F

2-4 weeks.

108
Q

AHAs may be restarted on week 3 after a medium-depth chemical peel, and tretinoin 4-6 weeks after the peel.

A

T

109
Q

Following an AHA peel a 10% sodium bicarbonate solution with multiple rinses is used to neutralize the AHA agent

A

F

5% in Robinson bt can actually use 5-16%

110
Q

The use of botox 7-10 days before a medium-depth peel is prohibited.

A

F Enhances the results.

111
Q

Laser resurfacing to the deeper perioral rhytides complements medium-depth peeling and should always be performed after the peeling, at the end of the procedure

A

T

112
Q

The ideal patient for a deep chemical peel is a thin-skinned woman with fair complexion and generalised wrinkling.

A

T

113
Q

If a deep phenol peel is being considered for the entire face, the patient must have normal hepatorenal and cardiovascular status.

A

T Due to cardiotoxicity of phenol.

114
Q

Deep chemical peels are best suited for facial wrinkles (periocular and periorbital regions), pigmentary dyschromia, AKs and superficial acne scars.

A

T

115
Q

It is not necessary to remove deep facial oils prior to a phenol peel.

A

F

116
Q

A full-face phenol peel should extend over a 30 minute period to avoid cardiac arrhythmias.

A

F 60-90 minutes.

117
Q

No more than 50% of the face should be treated during a 15 minute time period.

A

F 30 minute

118
Q

Cardiac monitoring is not needed during and after a full-face phenol peel.

A

F

119
Q

Upper eyelid peeling should not be carried down below the superior tarsal fold.

A

T

120
Q

Lower eyelid peeling should be done with the patient gazing upward.

A

T

121
Q

It is not necessary to stretch the skin during perioral peeling.

A

F

Allows peel solution to be applied evenly.

122
Q

If deep wrinkles are treated, an open technique is generally better.

A

F

Closed technique of taping – remove at 24hrs.

123
Q

Sun avoidance is recommended for up to 12 weeks after a deep chemical peel to prevent PIH

A

F

Up to 6 months.

124
Q

Skin appears erythematous for up to 12 weeks after a deep chemical peel.

A

T

125
Q

Non-facial skin has decreased adnexal structures, which impairs wound healing.

A

T

126
Q

The ‘Cook total body peel’ consists of applying 70% glycolic acid gel combined with 35% or 40% salicylic acid

A

F
35% or 40% TCA.
NB this peel not in 3rd edition

127
Q

Using the ‘Cook total body peel’ technique, there is no need for neutralisation.

A

F
Neutralise at desired depth with copious 10% sodium bicarbonate solution.
NB this peel not in 3rd edition

128
Q

For the ‘Cook total body peel’, liquid glycolic acid could result in increased scarring.

A

T
Need to use gel – acts as partial barrier to TCA.
NB this peel not in 3rd edition

129
Q

After the ‘Cook total body peel’, the skin flakes for 2-4 weeks.

A

T

NB this peel not in 3rd edition

130
Q

The ‘Cook total body peel’ cannot be used for AKs or DSAP.

A

F

NB this peel not in 3rd edition

131
Q

For mid to deep peels, antiviral prophylaxis should be used in all immunosuppressed patients or those with a history of HSV.

A

T

132
Q

The risks of complications from peels increase proportionately with the depth of the wound.

A

T

133
Q

Lighter peels are more likely to be associated with hypopigmentation and deeper peels with hyperpigmentation.

A

F
Lighter with hyperpigmentation.
Deeper with hypopigmentation.

134
Q

The risk of hyperpigmentation is increased by exogenous oestrogens, photosensitising medications and direct sun exposure during the first 6 weeks after a peel.

A

T

135
Q

Hypopigmentation is an unexpected complication of phenol peels and deeper resurfacing procedures.

A

F

Normal sequela.

136
Q

Accentuation of naevi can occur after peels.

A

T

137
Q

Milia usually occur within the first 1-3 weeks after peels.

A

F

1-3 months.

138
Q

Persistent erythema is closely associated with deeper peels, but may be seen after medium-depth peels and rarely after superficial peels.

A

T

139
Q

Infection is common after chemical peels.

A

F

Rare. Both TCA and phenol are bactericidal.

140
Q

Toxic shock syndrome has been reported in association with phenol-based peels.

A

T

141
Q

Previous medium or deep peels, dermabrasion, or laser resurfacing without waiting 6-12 months can increase the risk of scarring after a chemical peel.

A

T

142
Q

IV hydration during phenol peeling assists in clearing the phenol from the circulation and decreases the likelihood of toxicity.

A

T

143
Q

50% TCA is a medium depth peeling agent

A

T

144
Q

Solid Co2 +35% TCA is a superficial depth peeling agent

A

F

medium

145
Q

Jessner’s solution + 35% TCA is a deep chemical peel

A

F

medium

146
Q

70% glycolic acid +35% TCA is a medium depth peel

A

T

147
Q

88% phenol is a deep chemical peel

A

F

medium

148
Q

Pyruvic acid is a superficial chemical peel

A

F

medium

149
Q

Hypopigmentation is a potential complication of deep peels only

A

T

150
Q

Lighter peels are more commonly associated with hyperpigmentation

A

T

151
Q

Depth of injury superficial vs med depth peel?

JAAD CME Aug 2019

A

Superficial: EpidermisMedium: Into/Through Papillary Dermis

152
Q

List Common Superficial Peels

JAAD CME Aug 2019

A 
Alpha hydroxy Acids (water soluble)
- Glycolic Acid
Beta hydroxy acids (lipid soluble)
- Salicylic Acid
Jessner Solution (14% Resorcinol, 14%SA, 14%LA in 95% EtOH)
Retinoic Acid (all-trans retinoic/tretinoin)
TCA (10-35%)
Alpha-keto Acid
- Pyruvic Acid
153
Q

Which superficial peels require neutralisation (and with what)?

JAAD CME Aug 2019

A

Glycolic and Pyruvic Acid

Neutralise with water (ie to wash off), or with sodium bicarbonate

154
Q

List common medium depth peels

JAAD CME Aug 2019

A

70% Glycolic + 35% TCA (Coleman)
Jessners + 35% TCA (Monheit)
Solid CO2 + 35% TCA (Brody)
88% Phenol

155
Q

What is the specific systemic concern re phenol peels?

JAAD CME Aug 2019

A

Risk of cardiotoxicity.

156
Q

<p>What is the depth of penetration of 50-100% TCA?

JAAD CME Aug 2019</p>

A

<p>Upper reticular dermis.Increased risk of complication (use for focal areas only)</p>

157
Q

<p>T/F tretinoin peel solutions have no measurable pH

JAAD CME Aug 2019</p>

A

<p>T (non-acidic)</p>

158
Q

Typical concentration for tretinoin peel?

A

5-10% eg leave on 6 hours

159
Q

<p>T/F tretinoin peels are typically uncomfortable

JAAD CME Aug 2019</p>

A

<p>F (minimal discomfort during application)</p>

160
Q

<p>Expected reaction of tretinoin peel?

JAAD CME Aug 2019</p>

A

<p>Mild erythema and desquamation approx day 2 postpeel</p>

161
Q

Main indication tretinoin peel?

JAAD CME Aug 2019

A

Acne, though little supportive clinical trial data.(Article notes a study where 0.05% tretinoin cream daily for forearm rejuv was similar to a q2/52 5% peel)

162
Q

T/F Salicylic Acid is an alpha hydroxy acid

JAAD CME Aug 2019

A

F beta (lipid soluble)

163
Q

T/F Salicylic Acid peels are great for comedonal acne

JAAD CME Aug 2019

A

T (lipophilic and comedolytic)

164
Q

T/F Salicylic Acid is ok to use in all Fitz skin types

A

T

165
Q

What can Salicylic Acid be mixed with (typically 20-30%) to produce a pseudofrost on application?

A

Ethanol (hydroalcoholic vehicle)Pseudofrost crystals can be washed off -> cannot penetrate the skin -> self limiting peel

166
Q

<p>What is a complication of Salicylic Acid/Ethanol peels?

JAAD CME Aug 2019</p>

A

<p>Hot spots/areas of overpenetration —> can lead to PIH.</p>

167
Q

<p>What can Salicylic Acid be mixed with (instead of ethanol) to avoid hot spotting/overpenetration?

JAAD CME Aug 2019</p>

A

<p>Polyethylene Glycol (PEG) —> slows delivery and enhances follicular penetration. A study showed 30% SA/PEG to be superior to SA/HA(ethanol). SA/PEG does not give the day 2 desquamation.</p>

168
Q

How is the SA/PEG solution applied?

JAAD CME Aug 2019

A

Left on skin >= 5mins and then washed off (primarily as the PEG is occlusive)

169
Q

Any other rarer side effects/precautions for SA?

JAAD CME Aug 2019

A

SA can cause angioedema/urticaria in patients known to be sensitive to acetylsalicylic acid.

170
Q

T/F TCA Crystallises >70% concentration

JAAD CME Aug 2019

A

F No crystallisation < 90%

171
Q

Name the three levels of frosting assoc with TCA peels?

JAAD CME Aug 2019

A
  1. light reticular frost with background erythema
  2. confluent light white frost with background erythema
  3. solid white frost with no erythema
172
Q

Name four indications for high concentration (>80%) TCA peels.

JAAD CME Aug 2019

A

Mild-Mod Rhinophyma (comparable to electrocoagulation)
CROSS (Chem Recon of Skin Scars - focal icepick/boxcar)
Earlobe Tears (90% TCA - Skin necrosis and secondary intention approximation
Xanthelasma (Macular lesions ~50%, papular lesions 70-100%)

173
Q

At what concentration does TCA start to peel into the papillary dermis?

JAAD CME Aug 2019

A

~35% (Lower Concentrations Epidermal)

174
Q

What is the formula for Jessners Solution?

JAAD CME Aug 2019

A

14% Resorcinol, 14% SA, 14% Lactic Acid in 95% Ethanol

175
Q

What is resorcinol and are there any specific precautions to consider?

JAAD CME Aug 2019

A

Resorcinol is similar to Hydroquinone (meta- and para-dihydroxybenzene).

Risk of contact allergy and possible cross-sensitivity with hydroquinone.

176
Q

T/F, JS + 20% TCA is more effective at Rx of melasma in darker skin types than 20% TCA alone?

JAAD CME Aug 2019

A

T, though with greater immediate discomfort. no difference in PIH.

177
Q

What is the signal to neutralise glycolic or pyruvic acid?

JAAD CME Aug 2019

A

Clinical endpoint of erythema (or 5min if no erythema produced)

178
Q

What can be used to neutralise glycolic or pyruvic acid?

JAAD CME Aug 2019

A

10% Sodium Bicarbonate, water, or wiping with a saline-dampened cloth

179
Q

What is the risk of seeing frosting with a glycolic or pyruvic acid peel?

JAAD CME Aug 2019

A

PIH and scarring

180
Q

What is the purpose of the CO2/Glycolic Acid/JS in the Brody/Coleman/Monheit medium depth peels?

JAAD CME Aug 2019

A

Induce epidermolysis to reduce the risk of uneven penetration, erosions and scarring.

181
Q

What are the stages of histologic change for med depth peels?

JAAD CME Aug 2019

A

Day 3 - full thickness epidermal necrosis, dermal inflammation/oedema
Day 7 - epidermal reepithelialisation
Day 30 - regeneration of homogenised collagen
Day 90 - thickened collagen bundles in the dermis -> Grenz zone (thickness proportional to strength of peel)
Increased Type I Collagen

182
Q

superficial peels have a significant risk of causing PIH in skin types III-VI

A

F
Sup peels had relatively low complication rate in this skin type group
JAAD Sep 18

183
Q

Side effects from superficial peels are less frequent during winter months

A

T

JAAD Sep 18

184
Q

The use of chemical peeling arose from ancient Egyptian traditions using AHAs in animal oils, salt + sour milk

A

T

JAAD Sep 18

185
Q

Mandelic acid is the least ‘safe’ of the AHAs in terms of risk of AEs

A

F
Mandelic acid thought to be safest due to large molecular structure w uniform penetration
JAAD Sep 18

186
Q

SA is lipophilic + has comedolytic effects

A

T

JAAD Sep 18

187
Q

Glycolic acid 70% has been described as a treatment option for Becker’s naevus

A

T
70% applied for increasing time increments (15, 50, 60, 70 mins) with tx every 17-30 days
JAAD Jan 19

188
Q

TCA 35% can be used in patients with active pemphigus vulgaris buccal mucosal lesions

A

F
Reported as option for stable, tx resistant buccal mucosal lesions though (!) - applied every month depending on response

189
Q

chemical peel can be used as an alternative to filler injection for lip augmentation, though effects last < 6 months

A

F
Can be used (phenol 35% + croton oil 0.4-1.6%) as a peel with longlasting effects > 2 years
JAAD May 19

Proc Derm Revision (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions