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Salicylic acid peels

 Despite some general predictable outcomes, even superficial chemical peeling procedures can cause hyperpigmentation and undesired results. Popular standard salicylic acid peeling techniques involve the  use of 20 and 30% salicylic acid in an ethanol formulation. Salicylic acid peels are performed at 2- to 4-week intervals.
   Maximal results are achieved with a series of three to six peels. Always performs the initial peel with a 20% concentration to assess the patients’
sensitivity and reactivity. Before treatment, the face is thoroughly cleansed with alcohol and/or acetone to remove oils. The peel is then applied with 2×2 wedge sponges, 2×2 gauze sponges, or cotton-tipped applicators. Cotton-tipped
swabs can also be used to apply the peeling agent to periorbital areas.

   A total of two to three coats of salicylic acid is usually applied. The acid is first applied to the medial cheeks working laterally, followed by application to the perioral area, chin, and forehead. The peel is left on for 3–5 min. Most patients experience some mild burning and stinging during the procedure.After 1–3 min, some patients experience mild peel-related anesthesia of the face. Portable handheld fans substantially mitigate the sensation of burning and stinging.
   A white precipitate, representing crystallization of the salicylic acid, begins to form at 30 s to 1 min following peel application
   This should not be confused with frosting or whitening of the skin,which represents protein agglutination. Frosting usually indicates that the patient will observe some crusting and peeling following the procedure

   This may be appropriate when treating photodamage. However, the author prefers to have minimal to no frosting when treating other conditions.
After 3–5 min the face is thoroughly rinsed with tap water, and a bland cleanser such as Cetaphil is used to remove any residual salicylic acid precipitate. A bland moisturizer is applied after rinsing. My favorites are Cetaphil, Purpose, Theraplex, and SBR Lipocrea (C)Pearl E.Grimes

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