International report — Today’s aesthetic peels can treat much more than just wrinkles and fine lines, such as actinic keratoses and seborrheic keratoses.

According to Stephan C. Truedsson, M.D., the state-of-the-art Enerpeel technology from General Topics can exact a better homogeneous peel in the skin, achieving superior cosmetic results.

The Enerpeel technology optimizes the interaction between skin physiology and peeling acids, such as trichloracetic acid, which result in visibly superior cosmetic results.

"Other standard peels are only able to remove the water-soluble components of the skin. The unique technology of the Enerpeel allows more of a uniform absorption of the peel and diffuses the acid, not only through hydrophilic structures, but also through lipids and lipophilic structures in the skin, promoting a more efficient chemical peel of the lesion," says Dr. Truedsson, an aesthetic physician at Privatklinikken, Oslo, Norway.

The penetration of a TCA peel depends on the concentration of the TCA, as well as the preparation of the skin. The 25 percent Enerpeel TCA is a superficial peel that transcends the full thickness of the epidermis, whereas the 40 percent Enerpeel TCA is a medium-depth peel that reaches the papillary dermis.

Dr. Truedsson says that caution is warranted with peels above 35 percent TCA, as unpredictable outcomes can result, such as scarring. However, with the proper experience, cosmetic outcomes are good.

According to Dr. Truedsson, the Enerpeel 25 percent is very effective in treating actinic keratoses, thin seborrheic keratoses, epidermal melasma and hyperpigmentations (including post-inflammatory hyperpigmentation, ephelides and lentigines), acne and mild acne scarring, as well as mild to moderate photoaging.

The Enerpeel 40 percent is more suited for deeper targets, such as deeper acne scarring, but can also be effective in melasma, hyperpigmentation and thicker seborrheic keratoses.

"It is important that, at least six weeks prior to starting with the peel treatment, patients do not receive any therapy with tretinoin or glycolic acid and hydroquinone.

"This is crucial in helping to avoid post-peel complications such as post-inflammatory hyperpigmentation," Dr. Truedsson says.

When performing the Enerpeel procedure, Dr. Truedsson starts by defatting the skin with acetone or alcohol in order to achieve an even penetration of the peel. He then applies the peel with a brush, starting at the forehead, temples and cheeks, finishing up around the lips and around the eyelids.

Dr. Truedsson says that frosting indicates the endpoint of the reaction.

A level 1 frosting seen with less than 30 percent TCA is characterized by erythema with blotchy or wispy area of white frosting.

A level 2 frosting seen with more than 30 percent TCA is characterized by white frosting with areas of erythema showing through.

Once the desired frosting is achieved, the skin is cooled down with a neutralizer or water compress, giving the patient almost immediate relief from any discomfort.

"Patients will show a mild to moderate erythema and edema after the peel, but this typically lasts about 48 hours. The third day post-peel is accompanied by desquamation and serous exudation and re-epithelialization is complete by the seventh to tenth day post-peel.

"Patients should try to keep out of the sun and will need to apply sunscreen SPF 50 for four to six months," Dr. Truedsson says.

According to Dr. Truedsson, pre-peel preparation can sometimes be just as important as the actual peel itself. Prior to performing a peel, Dr. Truedsson speaks in depth with patients in order to establish realistic expectations and goals.

Also, the patient’s skin type, degree of sebaceous activity, as well as skin thickness, should be properly assessed before each peel. Photo-documentation should be made, and a careful medical history should also be taken to rule out viral and bacterial infections and other inflammatory dermatoses, as well as establish contraindications including recent plastic surgery, isotretinoin therapy within the previous six to eight months, phototype IV to VI and pregnancy.

"The Enerpeel system is the most sophisticated and complex peeling approach on the market and in my opinion, it is a quantum leap ahead of other traditional TCA peels we used to have.

"The peel demonstrates its superiority over other peels witnessed in the remarkable results in cosmetic patients. There is a shorter downtime with the Enerpeel system, and the cosmetic effect is more profound and visible as compared to older formulations of TCA preparations," Dr. Truedsson says. DT

Disclosures: Dr. Truedsson is a speaker for General Topics and holds stock in the Norwegian division of the company.