Download Patient Selection for Chemical Peels and Microdermabrasion

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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.
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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
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Source: Rubin M. Chemical peels. Rubin M, et al, eds. Philadelphia, Pa.: Elsevier Saunders; 2006.
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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