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Dermatology Board Prep > DERM (22) Cosmetic Surgery > Chemical and mechanical skin resurfacing > Flashcards

Chemical and mechanical skin resurfacing Flashcards

1
Q

What Fitzpatrick skin types can safely receive microneedling for acne scars?

A

This has been studied with all Fitzpatrick skin types and has been shown to be safe

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2
Q

What things has microneedling been used to treat in skin of color?

A

Melasma, acne vulgaris, primary hyperhidrosis, and scarring

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3
Q

What peels can be used to safely treat acne in skin of color?

A

Salicyclic acid (up to 30% concentration), glycolic acid (up to 50%)

While TCA peels up to 10-30% would be a deeper superficial peel, and can be used cautiously in the skin of color, it is not used for acne treatments

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4
Q

Which chemical peel is a beta-hydroxy acid?

A

Salicylic acid

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5
Q

What is the depth of a salicylic acid peel?

A

Superficial (papillary dermis)

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6
Q

What are the uses of a salicylic acid peel?

A

Acne, photoaging

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7
Q

Does salicylic acid peels require neutralization?

A

No

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8
Q

What frost level is generated from a salicylic acid peel?

A

minimal

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9
Q

Are salicylic acid peels safe in Fitzpatrick V and VI skin?

A

Yes

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10
Q

What is the mechanism of salicylic acid peels?

A

They are keratolytic and comedolytic (hence why good for acne)

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11
Q

What is a potential side effect of salicylic acid peels?

A

Tinnitus

Pregnancy class C

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12
Q

Which chemical peel is an alpha-hydroxy acid?

A

Glycolic acid

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13
Q

What is the depth of a glycolic acid peel?

A

Superficial (papillary dermis)

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14
Q

What things are glycolic acid peels used for?

A

Fine wrinkles, melasma, dyspigmentation

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15
Q

Do glycolic acid peels require neutralization?

A

Yes, with sodium bicarbonate

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16
Q

What is used to neutralize glycolic acid peels?

A

Sodium bicarbonate

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17
Q

What level of frosting is generated from a glycolic acid peel?

A

None, no peeling

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18
Q

To what depth do the different concentrations so TCA peel affect?

A

TCA 10-25% = Superficial (Papillary dermis)

TCA 35-50% = Medium (Upper reticular dermis)

TCA >50% = Deep (Mid–reticular dermis)

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19
Q

What things can a TCA 10-25% peel be used for?

A

Fine wrinkles, dyspigmentation, melasma, and acne

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20
Q

What level of frosting occurs with TCA 10-25% peels?

A

Frosting usually only occurs w/ concentrations >25%

21
Q

What chemical peels can be used for melasma/dyspigmentation?

A

Glycolic acid, TCA 10-25%, Jessner’s peel, and TCA 35-50%

22
Q

What chemical peels are superficial (go to the papillary dermis)?

A

Salicylic acid, glycolic acid, TCA 10-25%, Jessner’s Peel

23
Q

What are the medium depth chemical peels?

A

TCA 35-50%

24
Q

Which chemical peels are deep chemical peels?

A

TCA >50%, Baker-Gordon peel (Phenol, septisol, tap water, croton oil)

25
Q

What peels can be used for acne?

A

Salicylic acid and TCA 10-25%

26
Q

What is in Jessner’s Peel?

A

Salicylic acid, lactic acid, and resorcinol ethanol

27
Q

To what depth does Jessner’s peel affect?

A

Superficial (papillary dermis)

28
Q

What side effects can occur in Jessner’s peel and what causes them?

A

Tinnitus = Salicylic acid

Syncope and hypothyroidism = Resorcinol

29
Q

What peels can be used to treat actinic keratoses?

A

Jessner’s peel + TCA 35-50% or TCA 35-50% by itself

30
Q

To what depth does TCA 25-50% peels affect?

A

Medium depth, to the upper reticular dermis

31
Q

What things can TCA 35-50% peels be used for?

A

Fine to medium wrinkles, actinic keratoses, dyspigmentation, seborrheic keratoses

32
Q

Does frosting occur with TCA 25-50% peels?

A

Yes, usually within 2-3 minutes and self resolves in 15-20 minutes

33
Q

How long can post-peel erythema last after TCA 25-50% peels?

A

1 month

34
Q

To what depth does the TCA >50% peel affect?

A

Deep (mid-reticular dermis)

35
Q

What things do TCA 50% peels address?

A

Fine to dep wrinkles, warts

36
Q

What is the most common side effect of TCA >50% peels?

A

Depigmentation

37
Q

What is the most serious side effect of >50% TCA peels?

A

Scaring (common!)

High concentration TCA peels are not usually recommended, phenol peels are more recommended for deep peels

38
Q

What is in the Baker-Gordon peel?

A

Phenol, septisol, tap water, croton oil

39
Q

To what depth does the Baker-Gordon peel affect?

A

Deep (mid-reticular dermis)

40
Q

What types of things are Baker-Gordon peels used for?

A

Fine to deep wrinkles

41
Q

What are some contraindications to Baker-Gordon peels?

A

Dark skin types, history of cardiac arrhythmias, history of renal or liver disease

42
Q

What are some common side effects of a Baker-Gordon peel?

A

Hypopigmentation, scarring/milia formation

43
Q

What types of monitoring must be had for Baker-Gordon peels?

A

Cardiac monitoring required during and 1 hr postop due to arrhythmia risk

44
Q

What can be done to decrease arrhythmia risk?

A

Wait 15 minutes between treatments of each cosmetic unit to decrease systemic absorption

45
Q

How can renal toxicity be avoided when performing a Baker-Gordon peel?

A

IV fluids –> adequate hydration reduces risk

46
Q

How long does post-operative erythema last after a Baker-Gordon peel?

A

3 months

47
Q

What component is most important for the Baker-Gordon peel (most related to efficacy)?

A

Croton oil

48
Q

Why is it important to ask about radiation therapy to the head and neck when performing a chemical peel/

A

Because radiation therapy reduces the number of pilosebaceous units –> can worsen healing or increase the risk of scarring

DERM (22) Cosmetic Surgery (6 decks)

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