[Research review] Dermoscopic findings in scabies

scabies

In this short video, Dr Vincenzo Piccolo discusses a novel dermoscopic finding seen in scabies. Scabies is an infectious skin disease which can be diagnosed through dermoscopy.
Continue reading “[Research review] Dermoscopic findings in scabies”

[6 min read] Managing common nail disorders in primary care

nail disorders

Caring for common nail disorders is an important skill for any general practitioner. In this review, we will discuss the most commonly encountered nail conditions that may come to you for consultation. Continue reading “[6 min read] Managing common nail disorders in primary care”

[7 min read] Managing atopic dermatitis in general practice

atopic dermatitis

Atopic dermatitis is a common skin condition that is encountered frequently in general practice. Here is how to recognise and treat atopic dermatitis in your patients in primary care.

Continue reading “[7 min read] Managing atopic dermatitis in general practice”

[Research review] Dermoscopy of ‘COVID toes’

COVID toes

Have you heard of ‘COVID toes’? In this short video, Dr Vincenzo Piccolo discusses the recent phenomenon in which patients exposed to COVID-19 develop chilblain-like lesions on their toes. Continue reading “[Research review] Dermoscopy of ‘COVID toes’”

[Podcast] LED light therapy for wound care and acne | Conversations with Prof David Wilkinson

LED light therapy

Welcome to this podcast series, Conversations with Professor David Wilkinson! In this episode, Prof David Wilkinson (Chief Medical Officer, National Skin Cancer Centres) speaks with Dr Di King (Skin Cancer & Aesthetic Medicine Doctor, National Skin Cancer Centres) about the use of LED light therapy for acne and for wound healing after skin cancer surgery. Continue reading “[Podcast] LED light therapy for wound care and acne | Conversations with Prof David Wilkinson”

[7 min read] Managing patients with hair loss in general practice

hair loss

Adult patients presenting with hair loss may have a variety of underlying aetiologies. The first step to treating patients with hair loss is to identify the most likely cause. This is easier said than done, however, there are several techniques that you can employ in your general practice to aid in diagnosis. Continue reading “[7 min read] Managing patients with hair loss in general practice”

[Research review] Dermoscopy of subungual exostosis

subungual exostosis

Have you seen subungual exostosis in your practice? In this short video, Dr Vincenzo Piccolo discusses the dermoscopic features of subungual exostosis, featuring real patient cases. Continue reading “[Research review] Dermoscopy of subungual exostosis”

[8 min read] Chemical peels in the primary care setting

chemical peels

Chemical peels are the minimally invasive cosmetic treatment that utilises the skin’s natural regenerative potential. Therefore, they work similarly to other popular aesthetic procedures, such as laser skin resurfacing and RF microneedling.

Safe application in primary care requires an understanding of the wound healing process.

Adequate training in this technique enables the practitioners to recognise and manage potential complications. It also provides necessary knowledge about various exfoliating agents.

What are chemical peels?

A chemical peeling procedure uses chemical agents to remove the epidermis and sometimes the dermis as well. The technique helps the skin’s natural regenerative cycle and provokes a healing response. Newly-formed tissue layers usually show improvements in superficial scars, lesions, pigmentary changes, fine lines, wrinkles, and so on.

The procedure

The practitioner applies the appropriate exfoliating agent on clean skin, waits the necessary amount of time and then removes the agent with water or a neutraliser, depending on the acid used.

Post-procedure, the treated skin is temporarily sensitive. However, once the healing process is over, the “new” skin is smoother and tighter. The pores and signs of damage are less prominent too.

Side effects are rare, although harsher chemical agents can cause permanent skin discolouration, scarring, and reactivation of cold sores.

Types of chemical peels

Chemical agents of different strengths exfoliate the skin at different depths. According to this, we differentiate three types of chemical peels:

  1. Superficial peels – Alpha-hydroxy acid (AHA) and salicylic acid gently exfoliate the skin. Such peeling agents do not penetrate deep into the skin. They remove dead skin cells from the surface (stratum corneum) and slightly improve discolouration and skin texture.
  2. Medium peels – Glycolic or Trichloroacetic (<50%) acid exfoliants can improve moderate skin issues, such as age spots, fine lines, freckles, and actinic keratosis. Medium peels affect the epidermis and, rarely, the papillary dermis.
  3. Deep peels – Aggressive peeling agents, such as phenol and Trichloroacetic acid (>50%), reach into the dermis and remove damaged skin cells, improving the appearance of deep scars. Deep peels are done on the face and only once. One session is enough to remove age spots, freckles, and some wrinkles.

Indications

The indications for chemical peels include skin issues commonly treated in both aesthetic medicine and dermatology. These include, but are not limited to:

  • Acne and acne scars
  • Post-inflammatory hyperpigmentation
  • Wrinkles
  • Enlarged pores
  • Surgical scars
  • Melasma
  • Ephelides
  • Solar lentigines
  • Milium
  • Lichen planus
  • Ichthyosis
  • Seborrheic and actinic (solar) keratosis

Pre-treatment assessment

Quality management of patient’s expectations in the best possible way before the procedure is essential. Also, physicians should do a general skin check-up and go through medical history. The no-go signs are too much sun damage, keloid scars, and infections.

Pre-treatment and post-treatment photographs are a must, and getting a signed consent is highly recommended.

Contraindications

Chemical peels are not advisable for pregnant and breastfeeding women and patients with a compromised immune system function. History of keloid scars and radiation therapy is also a contraindication.

Potential side effects

Side effects related to this procedure are rare, but the probability increases with deeper peels. The most common side effects include redness, irritation, and sensitivity.

Other, less common, side effects include:

  • Infections
  • Oedema
  • Erosions
  • Ulcers
  • Pigmentation issues
  • Vesicles
  • Capillary dilation

Scar formation and allergic reactions are also possible.

Recommended aftercare

Quality sun protection is an absolute must, regardless of the peeling type.

A follow-up appointment can help determine if recovery is moving in the right direction. Deeper peels require substantial recovery time and, occasionally, medical attention.

Learn more with the Certificate Courses in Aesthetic Medicine

Aesthetic Medicine Certificate Courses in Australia

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References

  • Samargandy S, Raggio BS. Skin Resurfacing Chemical Peels. 2021 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31613532.
  • Truchuelo M, Cerdá P, Fernández LF. Chemical Peeling: A Useful Tool in the Office. Actas Dermosifiliogr. 2017 May;108(4):315-322. English, Spanish. doi: 10.1016/j.ad.2016.09.014. Epub 2016 Dec 5. PMID: 27931952.
  • Al-Talib H, Al-Khateeb A, Hameed A, Murugaiah C. Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris. A Bras Dermatol. 2017 Mar-Apr;92(2):212-216. DOI: 10.1590/abd1806-4841.20175273. PMID: 28538881; PMCID: PMC5429107.

[6 min read] Managing psoriasis in primary care

psoriasis

Psoriasis is a chronic inflammatory skin condition that affects up to 2% of the world’s population. Psoriasis can not only increase morbidity and mortality in patients but also impacts the quality of life. People with psoriasis have a higher risk of heart disease and metabolic syndrome. Continue reading “[6 min read] Managing psoriasis in primary care”

[Research review] Erosive pustular dermatosis: Why do we miss it?

erosive pustular dermatosis

Why do we commonly misdiagnose erosive pustular dermatosis? In this short video, Dr Vincenzo Piccolo discusses the common features of erosive pustular dermatosis that are similar to skin cancer indicators, and the triggers and treatments for this dermatological disease. Continue reading “[Research review] Erosive pustular dermatosis: Why do we miss it?”