Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
‹ Dermatology/Aesthetics › photoaging. Each of these tools can assess the patient’s skin and is a key component in determining the appropriate peel.6 Fair-skinned patients or patients whose skin is classified as Fitzpatrick type I or II can be safely treated with all types of chemical peels, while darker-skinned patients or patients with Fitzpatrick type III or IV skin can develop postinflammatory hyperpigmentation with medium-depth peels.6 Patients classified as Glogau type I (no wrinkles) benefit from a superficial peel, whereas patients classified as Glogau type IV (only wrinkles) would benefit from a deep peel.6 Superficial, very light peels reach to the level of the stratum spinosum, whereas deep peels reach to the midreticula dermis.6 Microdermarsion is safe for all skin types. Chemical peels are a method of resurfacing the skin. They vary in intensity and effect from superficial sloughing to deep penetration.6 The depth of the peel determines healing time as well as possible complications. 6 Chemical peels require adequate training to avoid adverse results such as prolonged healing time, infection, postinflammatory hyperpigmentation, postpeel hypopigmentation and, rarely, risk for renal and cardiac toxicity with the systemic absorption of 88% phenol. This substance is typically applied by a physician. The cost of the chemical peel therapies depends on product choice and the peel you will offer. Types of peels include mixtures with hydroquinone, trichloroacetic acid, glycolic acid, retinol and salicylic acid. Prices range from a few hundred dollars for supericial, very light and light peels to thousands of dollars for deep peels, which are done by plastic surgeons. Patients who undergo peels may need local anesthesia, follow-up visits and multiple sessions, so remember this when setting pricing. Microdermabrasion provides mechanical exfoliation. The provider sprays highgrade microcrystals across the skin’s surface through a closed, pressurized stainless steel or glass wand. This procedure can improve many skin conditions, but it should be avoided in patients with rosacea because it is too irritating.7 Incorporating microdermabrasion into your practice requires the purchase of microdermabrasion equipment, whose price tag can range from $2,000 to as much as $20,000. Microdermabrasion creams range Table 3 Patient Selection for Chemical Peels and Microdermabrasion Patient Selection Criteria for Chemical Peels Patient Selection Criteria for Microdermabrasion • Take an extensive medical history including history of herpes simplex virus, HIV status, keloid formation, previous x-ray therapy, nicotine use, history of previous face surgeries, and oral medications. • Determine skin type by using Fitzpatrick’s classification of sun-reactive skin types or Glogau’s classification of photoaging, or both. • Assess and note the sebaceous quality of the skin; some patients may require additional prepeel degreasing. • Assess for any presence of inflammatory disorders, such as seborrheic dermatitis or psoriasis. • Determine the use of sunscreen and topical retinoids. • Patients with risk of postinflammatory hyperpigmentation require preoperative hydroquinone. • Always set realistic expectations. • Take a detailed medical history including topical medications, use of Accutane, recent laser surgery, recent viral infections, eczema, sunburns, rosacea, autoimmune disorders, poor healing, diabetes, keloid formation or excessive scarring. • Determine skin type by using Fitzpatrick’s classification of sun-reactive skin types or Glogau’s classification of photoaging, or both. • Determine the use of sunscreen and sun exposure, as well as other topical creams and medications. • Always set realistic expectations. Conditions That Benefit From Chemical Peels Conditions That Benefit From Microdermabrasion Not all peels treat every condition, and some should be avoided. • • • • • • • • • • • Photoaging and texturally rough skin Acne vulgaris Seborrheic keratoses Melasma Keratosis pilaris Warts Actinic keratoses and actinic cheilitis Rosacea Postinflammatory hyperpigmentation Freckles and telangiectasias Lentigines • • • • • • • • • • • Source: Rubin M. Chemical peels. Rubin M, et al, eds. Philadelphia, Pa.: Elsevier Saunders; 2006. 42 April 2008 • ADVANCE FOR NURSE PRACTITIONERS • WWW.ADVANCEWEB.COM/NP Postacne scarring Acne Superficial lesions Oily skin Enlarged pores Sun-damaged skin Texturally rough skin Uneven pigmentation Fine wrinkles Age spots Telangiectasias kyle kielinski CE