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Peel preparation varies with the condition being treated. Regimens differ for photodamage, hyperpigmentation (melasma and post-inflammatory hyperpigmentation) and acne vulgaris.
In addition there are special issues to be considered when treating darker racial-ethnic groups (see darker skin section). A detailed history and cutaneous examination is performed in all patients prior to chemical peeling. Standardized
photographs are taken of the areas to be peeled including full-face frontal and lateral views.
   Use of topical retinoids (tretinoin, tazarotene, retinol formulations) for 2–6 weeks prior to peeling thin the stratum corneum and enhance epidermal turnover. Such agents also reduce the content of epidermal melanin and expedite epidermal healing. Retinoids also enhance the penetration of the peeling agent.
   They should be discontinued several days prior to the peeling procedure. Retinoids can be resumed post-operatively after all evidence of peeling and irritation subsides. In contrast to photodamage, when treating conditions such
as melasma, post-inflammatory hyperpigmentation, and acne as well as darker skin types, retinoids should be discontinued 1 or 2 weeks before peeling or even eliminated from the prep to avoid post-peel complications such as excessive erythema, desquamation,and post-inflammatory hyperpigmentation.
   Topical alpha hydroxy acid or polyhydroxy acid formulations can also be used to prep the skin. In general, they are less aggressive agents in impacting peel outcomes. The skin is usually prepped for 2–4 weeks with a formulation of
hydroquinone 4% or higher compounded formulations (5–10%) to reduce epidermal melanin.
   This is extremely important when treating hyperpigmentation. Although less effective, other topical bleaching agents include azelaic acid,kojic acid, arbutin, and licorice (see photoaging section). Patients can also resume use of topical bleaching agents post-operatively after peeling and irritation subsides.
   When treating acne vulgaris, topical and systemic therapies (if indicated) are initiated 2 to 4 weeks prior to peeling. Topical antibiotics and benzoyl peroxide based products can be used daily and discontinued 1 or 2 days prior to peeling. However, unless a deeper peel is desired, retinoids should be discontinued

7–10 days prior to salicylic acid peeling. Broad-spectrum sunscreens (UVA and UVB) should be worn daily (see Photodamage, Sunscreen section).

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