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Difference between the effect of chemical peeling that can be expected to improve acne and home p...

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Difference between the effect of chemical peeling that can be expected to improve acne and home peeling

Chemical peeling promotes the normalization of turnover, which is the metabolism of the skin, by removing the keratin accumulated on the skin surface using a drug, so it can be expected to activate the original functions of the skin such as moisturizing .

Chemical peeling removes dead skin cells and clogs in pores, so you can expect the effect of acne and lead to skin that is less prone to acne.

Peeling can be done at home, and in addition to cosmetic dermatologists, general dermatologists also treat acne with chemical peels.

However, there are differences between peeling performed at home and acne treatment performed by cosmetic dermatologists and general dermatologists .

Therefore, in order to effectively treat acne, if you know the differences between them, you will not only be able to receive the treatment that suits you, but you will also be able to receive the treatment with peace of mind.

Chemical peeling to normalize turnover

The main action of chemical peels is to apply a peeling agent such as glycolic acid or salicylic acid to the surface of the skin to remove dead skin cells . By peeling off the old keratin, the disorder of the "turnover" cycle, which is the metabolism of the skin, is normalized, and after removing the keratin, a treatment that promotes moisturization is performed to regenerate the new skin.

The turnover cycle affects the skin at the earliest, so it is important to keep it normal .

Chemical peeling is a treatment that chemically melts the skin from the surface and promotes skin regeneration by subsequent wound treatment and the accompanying inflammatory reaction, and is a skin resurfacing method mainly aimed at improving the cosmeticity of the skin. ..

Source : Chemical Peeling / Japanese Dermatological Association Magazine / Volume 110 (2000) No. 14

Disturbances in the turnover cycle cause dullness and blemishes

The skin consists of three layers: the epidermis layer, the dermis layer, and the subcutaneous tissue, and the epidermis consists of the stratum corneum, the stratum granulosum, the stratum granulosum, and the basal layer from the top.

Skin structure Basal cells are regenerated in the basal layer at the bottom of the epidermis, and the basal cells continue to produce keratinocytes (keratinocytes).

Keratinocytes become spinous cells and form the spinous layer, and spinous cells become granule cells and form the granular layer, and are gradually pushed up to the skin surface. Eventually, it transforms into keratinocytes without nuclei and becomes dirt and peels off.

The process from the formation of basal cells to the exfoliation as keratinocytes is called "turnover" and is performed in a cycle of 28 to 40 days, and the cycle becomes longer as we get older .

If this turnover cycle is disturbed, the keratin will not come off and will accumulate . Then, the melanin pigment is not discharged and accumulates, so the skin becomes dull and spots are likely to appear .

Chemical peeling can be expected to improve dullness and blemishes by peeling off old keratin .

For dry skin when the turnover cycle is accelerated

When the turnover cycle is short, undergrown cells are pushed up to the upper layer of the skin, which makes it impossible to prevent external stimuli and causes skin irritation such as dryness.

The faster turnover cycle means faster production of keratinocytes , which in turn accelerates the production of NMF (Natural Moisturizing Factor), a natural moisturizing ingredient that retains water in keratinocytes. This produces NMF, which is less watery than normal, and produces keratinocytes of different shapes and sizes. Keratinocytes of different shapes and sizes create irregularities and gaps in the skin, and the sebum required to keep the skin moisturized and the "keratinocyte lipids" that fill the gaps between the keratinocytes are reduced, and the water evaporates. This will make your skin easier to dry .

The skin is protected from external stimuli such as ultraviolet rays by the moisture of the stratum corneum and the barrier of sebum, but when the moisture is reduced and it dries, the barrier is lowered and it becomes easier to receive external stimuli .

Therefore, after removing unnecessary keratin by chemical peeling, the moisturizing effect of the skin is enhanced by performing "iontophoresis" that delivers the ingredients effective for moisturizing to the skin.

In addition, depending on the peeling agent, hyaluronic acid and collagen, which are the sources of firmness and elasticity of the skin, and elastin, which is an elastic fiber that binds collagen, are promoted, and improvement of fine wrinkles due to drying can be expected.

Causes of faster turnover cycles

Causes of accelerated turnover cycles include lifestyle-related habits such as aging, poor nutritional balance, and vitamin deficiency, as well as external stimuli such as UV rays, pollen, excessive cleansing, and facial rubbing .

Lifestyle and external stimuli accelerate the production of basal cells and keratinocytes to protect the inside of the skin .

Healthy skin with a well-cycled turnover

Skin with irregular turnover cycles, uneven water content, and uneven cell size reflects less light that reaches the inside of the skin, and the uneven keratinocytes scatter the light to make the skin dull. You can see it at.

However, when the turnover cycle is normalized, the water content becomes uniform and the cells become uniform in size, aiming for transparent skin that reflects light . In addition, since the skin's moisture is retained, the skin's barrier function works to protect the skin from external stimuli such as ultraviolet rays .

Expected effects of chemical peels

  • Acne improvement
  • Improves dullness and reduces dark spots
  • Improvement of fine wrinkles
  • Improvement of unevenness of the skin

Removing dead skin cells improves the clogging of pores that cause acne and promotes the elimination of accumulated melanin pigment that causes age spots. In addition, by promoting the production of hyaluronic acid, collagen, and elastin, it can be expected to improve fine wrinkles and uneven skin .

Chemical peels eliminate the causes and exacerbations of acne

Acne develops when sebum and old keratin accumulate at the entrance of the pores and become keratin plugs, which clog the pores . In addition, when P. acnes, which feeds on sebum, grows, it becomes inflamed and causes pain and pus. Since chemical peeling removes old keratin, it can be expected to improve early acne by removing keratin plugs that clog pores . In addition, the peeling agent has the effect of reducing acne bacteria, so it can be said that it is also effective for inflamed acne . In addition, normalizing the turnover cycle prevents the pores from becoming clogged , leading to a skin condition that is less prone to acne .

It has been reported that when chemical peeling was performed on acne that does not respond to general treatment, it was effective in about 84%.

Since 2000, we have been actively performing chemical peels for acne that does not respond to general treatment. Of the 231 patients who underwent chemical peeling, 184 patients had acne, who underwent chemical peeling with glycolic acid and salicylic acid. Of these, 57 of the 165 patients who underwent continuous treatment were judged to be highly effective, and 81 were judged to be effective, with a total of approximately 84% showing efficacy.

Source: Examination of 165 clinical experiences of chemical peeling for acne performed at our hospital / Journal of Japanese Society of Clinical Dermatologists / Vol. 34 (2017) No. 3 /

Mechanism and process of acne formation

Acne is divided into stages according to the progress process, and is divided into "maintenance stage" white acne / black acne and "acute inflammatory stage" red acne / yellow acne. Proceed through.

White acne

White acne is also called "comedo" and is called "closed comedone" because sebum and keratin are accumulated at the entrance of the pores and the pores are closed .

Acne is hard to notice because it is not inflamed yet and has no symptoms such as pain or itching.

Black acne

Black acne is a condition in which pores are opened and the keratin plugs that are clogged in the pores are exposed to oxygen and oxidized to become black .

It is called "open comedone" because it has open pores. Like white acne, it is not inflamed, so there is no pain or itching.

Red acne

Red acne is a pimple that is accompanied by inflammation such as pain, itching, redness and swelling due to the growth of P. acnes that feeds on sebum.

It is said that red acne is prone to acne scars because it causes inflammation due to the growth of P. acnes and may damage the surrounding healthy skin tissue.

Yellow acne

Yellow acne is also known as pus acne, and as the name suggests, it refers to the condition in which pus accumulates in the pores and looks yellow .

When the number of acne bacteria increases too much, white blood cells that protect the body from foreign substances proliferate in order to repel the acne bacteria. When the dead white blood cells that fought against P. acnes accumulate, they become pus.

Acne with pus is a condition in which the dermis layer and subcutaneous tissue below the epidermis layer are damaged, so it tends to become acne scars (craters) that cause the skin to sink .

Characteristics of acne that differ by age

Acne is also called "adolescent acne" or "adult acne" depending on the age. In addition, chemical peeling can be expected to be effective for both "adolescent acne" that occurs during puberty when sebum secretion is active, and "adult acne" that occurs after 20s .

Characteristics of adolescent acne

Adolescent acne mainly refers to acne that occurs when you are in elementary school to high school.

Puberty is a period of elevated levels of adrenal androgens in women and hormones in adrenal androgens and gonadal testosterone in men. Elevated levels of these sex hormones have a significant effect on the development of the sebaceous glands that secrete sebum. Therefore, during puberty, excess sebum is secreted from the developed sebaceous glands , which accumulates in the pores and makes acne more likely to occur.

Adolescent acne tends to concentrate in areas where sebum is secreted, such as the forehead and the T-zone around the nose .

Characteristics of adult acne

Adult acne refers to acne that occurs after the age of 20. Unlike adolescent acne, it is caused by hormonal imbalances due to lifestyle-related habits such as lack of sleep and an unbalanced diet, and by incorrect skin care, which disrupts the skin turnover cycle .

In addition, stress can also reduce your immune system, making it easier for you to get acne.

Adult acne tends to form on areas with few sebaceous glands, such as the face line and neck .

Difference between types of chemical peels and peels that you can do yourself

Types of chemical peels

Salicylic acid

Salicylic acid is used by dissolving it in macrogol or ethanol, and is called "macrogol salicylate" or "ethanol salicylate", respectively.

However, salicylate macrogol is commonly used because ethanol salicylate can lead to salicylate poisoning if it penetrates deep into the skin and is absorbed by the blood .

Salicylic acid has a stratum corneum removing effect and an anti-inflammatory effect, and by dissolving it in macrogol, it can be expected to be effective in treating acne by removing the stratum corneum while preventing penetration into the deep skin.

If salicylic acid is neutralized and adjusted, it is difficult to recrystallize and formulate it. Therefore, when used in medical institutions, the concentration is 30% and the pH value is 1.7 .

pH is a value that indicates the degree of acidity and alkalinity. A pH value of "7" is neutral, a pH value of "7" is neutral, a pH value of "7" is acidic, a large pH value is alkaline, and the stronger the alkalinity, the milder the peeling effect.

0.2% salicylic acid in commercial cosmetics

The higher the concentration of the peeling agent, the greater the burden on the skin, and it may cause inflammation such as sore skin . Therefore, commercially available peeling agents that can be used at home are sold at a lower concentration than those used in medical institutions so that they can be used safely.

According to the cosmetics standards set by the Ministry of Health, Labor and Welfare , salicylic acid can be used at a concentration of 30% in medical institutions, but the upper limit that can be blended in commercial cosmetics is set at 0.2% of the formulation . [* 3]

[* 3] From the cosmetics standard "Ingredients with restrictions on formulation in all cosmetics": Ministry of Health and Welfare Notification No. 331

Glycolic acid

Glycolic acid is one of the "a-hydroxy acids (AHA)", also known as fruit acids, which have the effect of softening and peeling off keratin. The old stratum corneum is removed and the stratum corneum becomes thinner, which can be expected to improve the water retention capacity of the epidermis layer .

Glycolic acid is used by adjusting the concentration and pH value according to the condition of the skin. In addition, if it is applied to the skin for a longer period of time to allow glycolic acid to penetrate, it acts under the stratum corneum, so it can be expected to have the effect of peeling off deeper than salicylic acid macrogol.

However, if the acidity is strong, the peeling effect will be strong, and if you apply it to the skin in a strongly acidic state with a concentration of 30% or more and a pH value of 2 or less, the skin may become sore or scabbed, so be careful. It will not be.

Improves wrinkles and crater skin

Chemical peeling with glycolic acid can also be expected to improve wrinkles.

The cause of wrinkles is a decrease in hyaluronic acid, collagen, and elastin, which is the elastic fiber that binds collagen .

When glycolic acid is applied to the skin, it reacts with keratinocytes and secretes the protein "cytokine" that transmits information between cells. This stimulates the fibroblasts that produce hyaluronic acid and collagen, which promotes the production of hyaluronic acid and collagen.

When a large amount of hyaluronic acid and collagen are produced, elastin also increases, which can be expected to improve wrinkles and lead to elastic skin quality.

In addition, when glycolic acid is applied to crater skin that has been damaged to the dermis layer due to acne inflammation , hyaluronic acid, collagen, and elastin increase, which improves dents and makes the unevenness of the skin less noticeable .

Commercially available peeling agents containing glycolic acid have a low concentration

In order to market a glycolic acid peeling agent with a concentration higher than 3.6% in Japan, it is designated as a "deleterious substance" under the Poisonous and Deleterious Substances Control Law, so it is stipulated by law such as pharmacists and those who have completed the department related to applied science. It is necessary to have the qualification of "Person in charge of handling deleterious substances" that can be obtained only by those who have . Therefore, it is difficult to obtain products with a concentration higher than 3.6%.

However, there are more than 3.6% of peeling agents for overseas products that can be obtained by personal import from overseas, and although transfer or sale to others is prohibited by law, it can be used by the person who purchased it. I will. However, you should be careful when using it as it may cause skin irritation and strong redness .

Even in overseas products that can be imported individually from overseas, there are almost no peeling agents that contain 30% glycolic acid, which is used in medical institutions.

Chemical peeling is highly effective in exfoliating

Skin structure
Peeling that can be done at home is similar to chemical peeling performed at medical institutions, and there is also a type that applies a drug to the skin and wipes it off, but in most cases, skin care products that contain the drug are used to promote the effect. Also, due to the low concentration of the peeling agent, the action is limited to the stratum corneum at the top of the epidermis.

Chemical peels performed at medical institutions depend not only on the stratum corneum at the top of the epidermis, but also on the stratum granulosum, stratum spinosum, and basal underneath, depending on the type of peeling agent and the time it takes to apply and wipe off the peeling agent. It can be peeled off to the layer.

Types of peeling you can do yourself

Soap peeling

Peeling with soap is one of the easy peeling methods at home, and in most cases it can be used not only on the face but also on the whole body. The main ingredients in soap peels are fruit acid and salicylic acid.

It is a simple and easy peeling method that can be used every day as a soap for washing your face.

Peeling gel

Peeling gel is a liquid and when rubbed on the skin, it becomes a white mass, and at the same time, it entangles old keratin and dirt. The main components are a "gelling agent" that hardens when rubbed and a "cationic surfactant" that has bactericidal and sterilizing effects.

Water peeling

Water peeling is a method of removing old keratin and keratin plugs with water and vibration using a dedicated machine without using chemicals.

Downtime and Risks of Acne Treatment with Chemical Peeling

Downtime for acne treatment with chemical peels

Immediately after chemical peeling, the treated area may become irritated and reddish, but it tends to subside within 2 to 3 days.

However, if the pain is so severe that the redness does not go away, the peeling agent can be neutralized with alkali to suppress irritation, so please consult a medical institution .

Risks and side effects of acne treatment with chemical peels

Chemical peeling as a treatment for acne may cause redness, peeling, swelling and worsening of the inflamed area of acne, and acne may increase, but it is a temporary deterioration that appears during the treatment process. is.

In most cases, it will improve in 3 to 4 days, but if the swelling or redness does not disappear, see a medical institution .

What you need to know before getting a chemical peeling acne treatment

Those who need consultation with a doctor before the procedure

Pregnant / lactating

If you are pregnant, please tell the doctor that you are pregnant before the procedure because the condition of your skin is likely to change due to changes in hormone balance and your skin is likely to become rough.

Those who are undergoing herpes treatment

If you are undergoing herpes treatment, please consult your doctor in advance as herpes bacteria may spread to the entire face when applying the peeling agent.

Those with keloid constitution

If the peeling agent penetrates deep into the skin, it can cause scars and keloids, so if you have had keloids before, please tell the doctor before the procedure.

Those who have undergone surgery or radiation therapy within 2 months

Facial surgery and radiation therapy reduce or eliminate the stratum corneum, leaving the skin dry.

When a peeling agent is applied to dry skin, the keratin thinned by radiation therapy becomes even thinner, and the peeling agent may penetrate deep into the skin, leaving scars .

Frequency and frequency of chemical peeling

Chemical peeling may improve acne with a single treatment, but it can be expected to be more effective if it is taken multiple times .

Glycolic acid Salicylic acid
Number of treatments 3 to 10 times 3 to 6 times
Treatment interval 2 weeks to 1 month 1 month

Price of acne treatment by chemical peeling

Chemical peels are not covered by insurance because they are free medical treatment . Therefore, the fee varies from 4,000 yen to 15,000 yen depending on the medical institution.

In addition, depending on the medical institution, the set fee of chemical peeling and other treatments may be displayed as a treatment for acne instead of the cost of chemical peeling alone.

Things to avoid before the procedure and why

Anyone can receive chemical peels regardless of gender. However, please note the following before the procedure.

Shaving, hair removal, scrub face washing

If the stratum corneum is damaged by shaving, hair removal, scrubbing, etc. before chemical peeling, the peeling agent can easily penetrate deep into the skin, which may cause swelling and redness . Therefore, please refrain from shaving, hair removal, scrubbing, etc. the day before.

Chemical peeling / laser treatment

If you have been doing chemical peeling or laser treatment one month before the treatment, you may not be able to do chemical peeling depending on the condition of your skin, so please consult with your doctor before the treatment.

What to avoid after treatment and why

Skin that has undergone a chemical peel is temporarily dry and delicate. Therefore, for about one week after the treatment, it is expected that the skin quality improved by chemical peeling will be maintained by not irritating the skin.

Stimulation from ultraviolet rays

After chemical peeling, old keratin is removed and the skin absorbs UV rays more easily, so it is recommended to take proper measures against UV rays.

Akasuri / Hair Removal / Pack

Since the stratum corneum is thin after chemical peeling, avoid rubbing the treatment area strongly or excessively moisturizing. It may cause scars or keloids due to strong irritating hair removal.

In addition, excessive moisturizing with a facial mask may cause more sebum to accumulate in the pores than necessary . Then, P. acnes and staphylococci that feed on sebum proliferate, making it easier for acne to occur.

Hair perm / dyeing

If the chemicals used for perming or hair dyeing adhere to the skin, it may become rough or reddish, so please refrain from perming or hair dyeing for about a week after chemical peeling.

Pool

Please refrain from pooling for about 1 week after chemical peeling because the chlorine agent contained in the pool irritates the skin .

Treatments that are effective against acne other than chemical peels

In addition to chemical peels, acne treatment includes topical and internal medicines, and acne treatment may be performed independently, but synergistic effects can be expected when used in combination with chemical peels.

External medicine

Diferingel (adapalene) Promotes skin turnover and prevents pore clogging
Bepiogel (benzoyl peroxide: BPO) Removes dead skin cells and improves pore clogging. Suppresses the growth of P. acnes and Staphylococcus aureus
Epiduo gel While the combination of Diferin gel and Vepio gel is highly effective, it has side effects such as redness and peeling.
Clindamycin Antibiotics that have antibacterial action to prevent the growth of P. acnes and Staphylococcus aureus and suppress inflammation, and can be expected to be effective with inflammation.
Duac combination gel Contains bepiogel and clindamycin Antibacterial and suppresses inflammation
Zebiax Lotion Aquatim Cream

Although the main components are different, they all suppress the growth of antibiotics Acne and Staphylococcus aureus, which have antibacterial and anti-inflammatory effects, and suppress inflammation such as swelling and pain.

The external medicines introduced above are covered by insurance.

Oral medicine

Lower cutane Suppresses excessive sebum secretion, suppresses the growth of P. acnes and Staphylococcus aureus Effective against red and yellow acne with advanced inflammation, so be sure to consult with a doctor and strictly adhere to the dosage regimen. Taking
Vibramycin Antibiotics that kill acne and Staphylococcus aureus and suppress inflammation Effective against red and yellow acne
Minocycline Effective against red and yellow acne because it suppresses the growth of P. acnes and Staphylococcus aureus and also has a bactericidal action / td>

Roacutane is an FDA-approved oral drug for the treatment of severe acne, but it is not covered by insurance because it is not approved in Japan, but the other two are covered by insurance.

Iontophoresis

Iontophoresis, also known as iontophoresis, is a treatment that allows the active ingredient to penetrate the skin while passing a weak electric current through the skin .

Effective improvement of acne can be expected by iontophoresis of "vitamin C" that removes dead skin cells by chemical peeling and conditions the skin and "tranexamic acid" that prevents rough skin and dryness.

Hormone therapy

By taking a low-dose pill, which is a type of hormone therapy, and controlling the balance of female hormones to suppress excessive sebum secretion, it can be expected to have the effect of leading to skin quality that is less likely to cause acne .

However, you should continue to drink at the same time each day for a long period of time.

Acne improves with cosmetic dermatology before it becomes acne scars

Since acne is a familiar skin problem that can occur regardless of age, not many people go to a medical institution. However, it is a type of skin disease that tends to become chronic once it is done.

It may heal spontaneously, but self-styled skin care can exacerbate acne and cause acne scars.

Acne scars rarely heal spontaneously, and the treatment period for improvement tends to be longer.

Even in the early stages without inflammation, you can prevent the aggravation and chronicity of acne by visiting a medical institution and providing appropriate treatment.

Differences in acne treatment between dermatologists and cosmetic dermatologists

In both general dermatology and cosmetic dermatology, acne treatment by chemical peeling can be performed.

In general dermatology acne treatment, the types of treatments for acne are limited compared to cosmetic medicine, so the same treatment may be applied to all acne regardless of the progress of acne such as inflammation.

On the other hand, in cosmetic medicine, there are a wide variety of treatments, machines, and drugs, so you can receive treatments as the acne progresses, and you can aim for effective improvement of acne .

(Updated January 2021)

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