Aprile Vol.2 N° 1 - 2006 - Salute per tutti

More documents

Recommendations

Info

18 C. Cotellessa, L. De Angelis, T. Micantonio, K. Peris However, in the execution of the chemical peeling, the strength of pyruvic acid can be modulated varying both its concentration and the composition of the solution. A well-equilibrated proportion of water and ethanol in the vehicle is able to balance the strength of the acid. The presence of more water in the vehicle has a sort of soothing effect because it induces the transformation of a part of pyruvic acid into lactic acid. The use of pyruvic acid as a chemical peeling offers the possibility to vary the potency of cutaneous effects, both modifying employed concentrations and water/ethanol proportions in solution (6). Concentrated pyruvic acid (100%) is liquid at room temperature and causes epidermolysis within 30-60 seconds after application to facial skin. In general, the response occurs faster in women and on younger skin (7). The clinical sign of epidermolysis following application of pyruvic acid is blanching, similar to the effect seen with high concentrations of glycolic acid. Lower concentrations of pyruvic acid, ranging between 40% and 60% in a well-balanced proportion between water and ethanol are currently used to obtain a superficial-medium peeling. At concentrations currently used for chemical peeling, pyruvic acid induces keratinocyte detachment with thinning of the upper layers of the epidermis. Pyruvic acid penetrates down to the upper papillary dermis and causes dermoepidermal separation and stimulates an increased production of collagen, elastic fibres and glycoproteins (8, 9). This action is more evident using high concentrations. In addition to its keratolytic and dermoplastic properties, for the presence of a ketonic group, pyruvic acid is less hydrophilic as compared to alpha hydroxyl acid, but it presents a more evident lipophily: this characteristic consents a good penetration into sebaceous glands, where pyruvic acid has been showed a sebostatic and antimicrobial activity (1). Based on its peculiarity, recently pyruvic acid has been successfully employed in the treatment of several dermatologic diseases, such as inflammatory acne, moderate acne scars, wrinkles and actinically damaged skin, seborrhoeic dermatitis, striae cutis distensae (10). The Authors describe their experience with pyruvic acid at different concentration and with various times of application in the treatment of several dermatological affections. Journal of Plastic Dermatology 2006; 2, 1 eeling procedure P The effects of pyruvic acid on the skin depend mainly on the used concentration and on the time of application before neutralization. In our clinical experience we used concentrations of 40%, 50% and 60%, depending on the pathology to treat, the characteristics of patient’s skin, the expecting results. 40% pyruvic acid is available in two different solutions: 40% strong and 40% mild, that differ for the percentage of water and ethanol in the solution. Before chemical peeling, the skin is generally cleansed with cotton gauze soaked with 70% ethanol. This procedure is particularly important in patients with oily and thick skin. Then, skin must be accurately dry, because the presence of water could induce a greater transformation of pyruvic acid in the corresponding lactic acid. A solution of 40%-60% pyruvic acid is then applied on the skin. Modality of application differs according to the procedure preferred by the physician, but it is generally effected using a gauze pad or a brush. Many physicians prefer to carry out the application on successive regions, beginning from the forehead and the central area of the face and successively treating the two sides. Times of application are extremely variable and depend on patient’s reactivity and on the desired deep of peeling. Topical application of an alcoholic solution of pyruvic acid is associated with the rapid onset of a burning sensation and of an intense erythema, that slowly increases until neutralization. Pyruvic acid must be inactivated by the application of a solution of 10% sodium bicarbonate in water. Application of sodium bicarbonate solution quickly removes the burning sensation, although erythema generally persists for a few hours after peeling. Most subjects experienced no discomfort immediately after the peel. Chemical peeling with pyruvic acid is generally perfectly well-tolerated by patients, and no immediate or late side effects are observed. Application of pyruvic acid is followed by a very mild desquamation, persisting for 3-5 days after peeling, which does not appear to interfere with the patient’s social life. Postpeel care is similar to that of other superficial peeling agents: patients must be instructed to avoid sun exposure and to apply facial moisturizer for a few days after treatment. Complete re-epithelialization occurs in 5-7 days. Treatments can be repeated every 2-4 weeks.
Figure 1a. Patient with mild papulopustular acne before treatment. Figure 1b. The same patient showed a complete remission of cutaneous lesions after treatment with pyruvic acid. Although pyruvic acid vapours are non-toxic, they are pungent and can irritate the lining of the upper respiratory tract and ocular mucosae. To avoid irritation, the chemical peeling procedure should be performed in a well-ventilated area, and patients must be instructed to keep eyes closed during the whole procedure. atients and Methods P Papulo-pustular acne Peeling with pyruvic acid is very effective in the treatment of patients with mild to moderate papulo-pustular acne (Figure 1), used either alone or in association with traditional therapies. The efficacy of pyruvic acid is essentially due to its keratolytic effects, associated with a high capacity to penetrate into sebaceous glands, with a sebostatic and antimicrobic action. In a recent study, we demonstrated a good improvement in cutaneous lesions of patients with papulo-pustular acne treated with pyruvic acid. In addition, in these patients we observed an important decrease of seborrhoea after peeling treatment, without a simultaneous reduction of cutaneous hydration (1). The reduction of seborrhoea is important in the treatment of acneic patients, because it results in evident improvement in the oily skin that is characteristic of these patients. The simultaneous lack of reduction in cutaneous hydration differentiates pyruvic acid from other peeling 1a. 1b. The use of chemical peeling with pyruvic acid in the treatment of different dermatological diseases agents, such as salicylic acid, that cause dryness and desquamation of the treated areas (10). Patients with acne are generally treated with medium concentrations of pyruvic acid: 40% strong or 50%, based on skin reactivity, with medium times of application (2-4 minutes). During peeling, in sites of acneic lesions it can be observed the quick onset of white frost, that indicates dermo-epidermal separation. This event should be considered perfectly normal and favours a rapid improvement of cutaneous lesions. Treatments can be repeated every two weeks and during the intervals patients can use specific local therapies. Acne scars Acne scars and other kind of superficial skin scars can be treated with pyruvic acid. In these patients the aim of peeling is to obtain a keratolityc effect, associated with a stimulation of an increased production of collagen, elastic fibres and glycoproteins. For this reason, acne scars are generally treated with medium-high concentrations of pyruvic acid (50-60%) and longer times of application (4-5 minutes). In fact, dermoplastic properties of pyruvic acid are more evident using higher concentrations. Based on the high concentrations employed, generally peeling are repeated every 3-4 weeks. Seborrhoeic dermatitis Recently, the use of pyruvic acid has been proposed also in patients with mild to moderate seborrhoeic Journal of Plastic Dermatology 2006; 2, 1 19
Page 1 and 2: Periodico quadrimestrale - Spedizio
Page 3 and 4: Journal of Plastic Dermatology Edit
Page 5 and 6: 6 U. Bauer mento dello spazio orbit
Page 7 and 8: 8 U. Bauer dolenti, e talora si è
Page 9 and 10: 10 U. Bauer 8. Cattelan AM, Bauer U
Page 11 and 12: 14 F. Bruno Da quando Frumes e Lewi
Page 13: Claudia Cotellessa 1 Linda De Angel
Page 17 and 18: Figure 4a. Patient with striae cuti
Page 19 and 20: 24 A. Sparavigna, M. Setaro, A. Di
Page 25 and 26: Adele Sparavigna 1 Michele Setaro 1
Page 27 and 28: hardens and strengthens the nail (6
Page 29 and 30: Figure 3. Rate of subjects with nai
Page 31 and 32: Figure 6. Rate of subjects with mod
Page 33 and 34: 1° Corso ISPLAD, Milano 2005 Clini
Page 35 and 36: Figura 3. Figura 4. Esame endoscopi
Page 37 and 38: Figura 11. Figura 12. ET-WASH in si
Page 39 and 40: La diagnosi endoscopica nella patol
Page 41 and 42: 50 P. D. Pigatto Staphylococcus aur
Page 43 and 44: 52 P. D. Pigatto 16. Waersted A, Hj
Page 45 and 46: 56 L. Brambilla, V. Boneschi, A. Am
Page 55 and 56: 68 L. Brambilla, A. Amoroso lite an
Page 57 and 58: 70 L. Brambilla, A. Amoroso ne infi
Page 59 and 60: 1° Corso ISPLAD, Milano 2005 Istit
Page 61 and 62: tite allergica da contatto di tipo
Page 63 and 64: 5. Rudner E.J., Clendenning W.E., E
Page 65 and 66:
80 L. Brambilla, A. Amoroso loro fu
Page 67 and 68:
82 L. Brambilla, A. Amoroso diclofe
Page 69:
84 L. Brambilla, A. Amoroso I chelo
show all

Aprile Vol.2 N° 1 - 2006 - Salute per tutti

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?