Commentary on 3 chemical peeling letters
2020; Elsevier BV; Volume: 82; Issue: 6 Linguagem: Inglês
10.1016/j.jaad.2020.02.063
ISSN1097-6787
Autores Tópico(s)Surgical Sutures and Adhesives
ResumoTo the Editor: Standardization of any resurfacing procedure is crucial for reproducibility and communication. These 3 articles, “Reviving the Call for Weight by Volume Standardization of Trichloroacetic Acid Peel Solutions” by Lee et al,1Lee K.C. Wright M. Kulesza J. Brody H.J. Wambier C. International Peeling SocietyReviving the call for weight by volume standardization of trichloroacetic acid peel solutions.J Am Acad Dermatol. 2020; 82: 1542-1544Abstract Full Text Full Text PDF Scopus (3) Google Scholar “Depth of Injury of Hetter's Phenol–Croton Oil Chemical Peel Formula Using 2 Different Emulsifying Agents” by da Silvo Justo et al,2da Silvo Justo A. Mikulis Lemes B. Nunes B. et al.Depth of injury of Hetter’s phenol–croton oil chemical peel formula using 2 different emulsifying agents.J Am Acad Dermatol. 2020; 82: 1544-1546Abstract Full Text Full Text PDF Scopus (2) Google Scholar and “Clinical Preliminary Evaluation of PEG-80 sorbitan laurate (Novisol) Versus Triclosan (Septisol) in Deep-Peeling Hetter Formulas” by Kass et al3Kass L.G. Rullan P.P. Brody H.J. Clinical preliminary evaluation of PEG-80 sorbitan laurate (Novisol) versus triclosan (Septisol) in deep-peeling Hetter formulas.J Am Acad Dermatol. 2020; 82: e255-e256Abstract Full Text Full Text PDF Scopus (2) Google Scholar scientifically underline crucial factors within the medium- and deep-peel spectrum that further advance the body of scientific knowledge within chemical peeling. These articles are directly applicable for safe and effective international standards for the immediate future. With regard to the first of these letters,1Lee K.C. Wright M. Kulesza J. Brody H.J. Wambier C. International Peeling SocietyReviving the call for weight by volume standardization of trichloroacetic acid peel solutions.J Am Acad Dermatol. 2020; 82: 1542-1544Abstract Full Text Full Text PDF Scopus (3) Google Scholar the mixing instructions for both trichloroacetic acid solutions and phenol/croton oil formulas have been published for more than 60 years. In the last 35 years, the dermatologic literature has emphasized the weight-by-volume (w/v) preparation of trichloroacetic acid in the United States.4Resnik S.S. Chemical peeling with trichloroacetic acid.J Dermatol Surg Oncol. 1984; 10: 549-550Crossref PubMed Scopus (43) Google Scholar Outside of the United States, some countries still use the weight-by-weight (w/w) compounding method. Use of the w/w compounding method, which results in a given solution that is actually almost 5% more concentrated compared with the w/v solution, can inadvertently produce clinical scarring. The physician and pharmacist share responsibility in re-emphasizing the standard of the w/v solution. Regarding the other 2 letters,2da Silvo Justo A. Mikulis Lemes B. Nunes B. et al.Depth of injury of Hetter’s phenol–croton oil chemical peel formula using 2 different emulsifying agents.J Am Acad Dermatol. 2020; 82: 1544-1546Abstract Full Text Full Text PDF Scopus (2) Google Scholar,3Kass L.G. Rullan P.P. Brody H.J. Clinical preliminary evaluation of PEG-80 sorbitan laurate (Novisol) versus triclosan (Septisol) in deep-peeling Hetter formulas.J Am Acad Dermatol. 2020; 82: e255-e256Abstract Full Text Full Text PDF Scopus (2) Google Scholar only in the last 20 years have the phenol/croton oil formulas been revised to emphasize increased safety and reduced concentration and absorption of phenol in the seminal articles of Gregory Hetter.5Hetter G.P. An examination of the phenol-croton oil peel: part II. The lay peelers and their croton oil formulas.Plast Reconstr Surg. 2000; 105: 240-248Crossref PubMed Scopus (36) Google Scholar,6Wambier C. Lee K. Soon S. et al.Advanced chemical peels: phenol-croton oil peel.J Am Acad Dermatol. 2019; 81: 327-336Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Triclosan replaced hexachlorophene in the original Septisol formulas (Steris Corp, St. Louis, MO) in phenol/croton oil peeling as a surfactant approximately 35 years ago because of its toxicity. In 2020, the US Food and Drug Administration prohibited the use of triclosan in hand washes and soaps because of lack of evidence of its effectiveness and safety.7US Food and Drug Administration Antibacterial soap? You can skip it, use plain soap and water.fda.govDate accessed: May 16, 2019Google Scholar The scientific investigation in this publication of Novisol as a substitute for Septisol is timely and necessary. As in any investigative study using pigs, the applicability for use in humans is still approximate. It is encouraging to use a product in a formula that does not separate in the same way and is more miscible than triclosan; however, clinically in humans, the actual results by comparison may be assessed only by forthcoming clinical experience with the use of Novisol. The letter by Kass et al3Kass L.G. Rullan P.P. Brody H.J. Clinical preliminary evaluation of PEG-80 sorbitan laurate (Novisol) versus triclosan (Septisol) in deep-peeling Hetter formulas.J Am Acad Dermatol. 2020; 82: e255-e256Abstract Full Text Full Text PDF Scopus (2) Google Scholar illustrates that the clinical endpoint for using Novisol in the formula is different than the Septisol endpoint. The uniform white to light gray color is not seen, but it presents instead more as a gray edema. Also, the lower concentrations of croton oil up to 1.1% may not always penetrate the most severe Glogau IV wrinkles in toto. Therefore, clinical experience in the future will allow us to judge the highest ideal concentration of croton oil for Novisol for patients with extremely sun-damaged skin. Evaluation in a series of severe perioral wrinkles would be valuable, as would assessment of the proper aggressiveness of application. Other surfactant soaps can be tested through the fine template work of the authors. All of these letters continue the ongoing phase of chemical peeling investigative science. The efforts of the International Peeling Society and International Peeling Society–USA are satisfying the quest for new knowledge and education. This need is inspired by the positive cost-benefit ratio of chemical peeling and by the perioral superiority for severe wrinkle correction compared with other resurfacing methods. Clinical preliminary evaluation of PEG-80 sorbitan laurate (Novisol) versus sodium C14-16 olefin sulfonate & triclosan (Septisol) in deep-peeling Hetter formulasJournal of the American Academy of DermatologyVol. 82Issue 6PreviewTo the Editor: The phenol/croton oil Hetter formulas contain phenol, croton oil, water, and triclosan (Septisol, Steris Corp, Mentor, OH) and are accepted in chemical peeling because of their lower concentration of phenol (33%) in the formulas and lower concentrations of croton oil (up to 1.6%,) which provides less risk of toxicity than the original Baker/Gordon formula (49% phenol/2.1% croton oil).1 Full-Text PDF Reviving the call for weight by volume standardization of trichloroacetic acid peel solutionsJournal of the American Academy of DermatologyVol. 82Issue 6PreviewTo the Editor: Chemical peels rank among the top 5 nonsurgical aesthetic procedures performed in the United States.1 These solutions are produced by compounding pharmacies or manufacturers by dissolving a solute, such as anhydrous crystals of trichloroacetic acid (TCA), into a solvent, such as water. Pharmacies use varying methods to create a TCA solution. When the weight of the solute is dissolved into the total volume of the solution, this method is referred to as weight by volume (w/v). When the weight of the solute is dissolved into the total weight of the solution, it is referred to as weight by weight (w/w). Full-Text PDF Depth of injury of Hetter's phenol-croton oil chemical peel formula using 2 different emulsifying agentsJournal of the American Academy of DermatologyVol. 82Issue 6PreviewTo the Editor: Deep chemical peels consist of the application of a mixture of phenol, croton oil, water, and, historically, a handwash soap containing triclosan and sodium C14-16 olefin sulfonate as the emulsifying agent (Septisol [SEP], Steris Corp, Mentor, OH).1 Because of the US Food and Drug Administration's final rule on hand sanitizers,2 which prohibits the use of triclosan, SEP was discontinued. The classic Baker-Gordon's formula3 (2.1% croton oil/49.3% phenol) and Hetter's standardized formulas (0.1%-1.6% croton oil/35% phenol) contained 5% SEP, which generated a very unstable emulsion1 that spontaneously separated into 2 distinct layers (an upper and a lower layer) within minutes (Fig 1, A-D, right). Full-Text PDF
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