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Aesthetic Dermatology
unpredictable results and are associated with a number of potential take care of a strict post-peel management protocol. Daily skincare
adverse effects.
5,6
without perfume and preservatives as well as sufficient sunscreen
is very important.
Our approach is to use topically acting agents. Bleaching agents can
be used in combination with superficially peeling agents to accelerate Results
the keratinocyte turn-over. Traditional depigmenting agents, such as The DFP is effective, painless, causes only short down-time and can be
hydroquinone, that are highly effective raise several safety concerns an appropriate tool in the management of chloasma. All patients
(for example ochronosis, atrophy, contact dermatitis, carcinogenesis responded well to the therapy, and there was never any darkening of the
and other local or systemic side effects). Therefore, one must avoid pigmentation. The result was not satisfactory in five patients. One
long-term and uncontrolled exposure, especially when using high suffered from chloasma for more than 10–15 years and had tried
concentrations. However, HQ is one of the best depigmenting and multiple therapies such as laser, kryotherapy, dermabrasion and multiple
very well known agents
4
(see Table 1). Furthermore, there are many topically depigmenting ointments. The others suffered from severe acne
other effective drugs to treat pigmentation disorders (e.g. kojic acid with remarkable post-inflammatory hyperpigmentation or exposed
and tretinoin). Finally, the combination of these bleaching agents with themselves to UV radiation without any control over or respect for the
superficial peeling agents can be a very appropriate and effective way condition of their skin (see Figures 2–4).
of managing chloasma.
This sort of peel never causes side effects such as scarring or
The efficacy of a medical antichloasma peel depends on many worsening of the chloasma. Bacterial superficial infections are
factors: the percentage and the method of combining depigmenting treatable with antibiotic ointments, and if a herpes labialis occurs the
agents, the consistency and composition of the treating agent or patient must take oral medication to prevent an eczema herpeticatum.
vehicle, the method of application, the peeling intensity and, last but
not least, the experience of the doctor. Conclusion
It is important to emphasise that the use of certain depigmenting
DepiFastPeel
®
(DFP
®
) agents such as HQ, kojic acid and tretinoin is much more effective
We established a new dermatological medical peel to treat chloasma. when these elements are combined.
7–9
Monotherapy is seldom
Our experience is based on a 4.5-year monitoring study that included effective. The depigmenting agents should act effectively in the
over 300 patients. The DepiFastPeel
®
(DFP
®
) is a superficial to lowest possible concentrations and the post-operative phase should
medium-depth chemical peel. The working agents are HQ, be as short as possible.
trans-retinoic-acid, kojic acid and, as peeling agents, salicylic acid,
alpha-hydroxy-acid and ascorbic acid. These agents have to be A deep but superficial peeling of the skin is essential for a good
delivered to and into the skin in the most effective way. Our method clinical outcome. The application of the agents in the form of a
of delivering potential agents is a mask. Application of medical specially designed peeling mask is safe and easy to perform.
ingredients via a mask provides a prolonged application time and a A home-care programme after the treatment is indispensable.
way to regulate delivery of the working agents. Galenics of the mask
is indispensable for the clinical result in terms of delivery The DPF can be a very effective and safe way to treat and manage
of ingredients and reciprocal stabilisation of the working agents. The melasma. We conclude that a patient suffering from melasma needs
dosage of depigmenting agents should be as low and as short as a life-long individually shaped regimen of skin treatment and care. ■
possible for a good clinical result (see Figure 1).
Sabine Zenker runs a private dermatology and aesthetic
The mask stays on the skin for several hours. The duration of this
dermatology clinic as well as a specialised institute for
therapy is reliant on factors including skin type, the severity of the cosmedic medicine and spa, Dr Zenker Cosmetics. She
chloasma and the skin condition. There are also the expectations of
gives lectures and medical training courses nationally
and internationally in the field of aesthetic dermatology.
the patient and the doctor to consider in terms of efficacy of
As her goal is to implement new technologies and
the treatment and acceptance of down-time. After four to five treatments in her daily practice, as well as to invent
days the superficial layer of the skin peels off gently. As melasma
new therapeutic strategies, she has already established
some of the most advanced techniques in Germany.
develops gradually, the resolution of melasma is gradual. At that
She is the consultant dermatologist for L’Oréal Paris in Germany and Switzerland,
point in the procedure, the chloasma still has not disappeared; the writes articles for press and gives interviews for television. She received her medical
patient still has to undergo a post-peel treatment at home with a
training at the Ludwig-Maximilians University Faculty of Medicine, University College
London, Pitié-Salpétrière Paris and the Memorial Sloan Kettering Cancer Center in New
specially designed post-peel cream for approximately three
York, and her dermatology and aesthetic dermatology training at Ludwig-Maximilians
months. This cream consists of the same working agents as in the University Faculty of Medicine and Dr Luitgard Wiest.
mask but in very low concentrations. In addition, the doctor has to
1. Barclay L, Primary Care Management of Skin Pigmentation 5. Pérez-Bernal A, Munoz-Perez MA, Canacho F, patients with moderate to severe melasma, Br J Dermatol,
Disorders, Medscape Medical News, 2009. Management of facial hyperpigmentation, Am J Clin 2008;159(3):697–703.
2. James W, Berger T, Elston D, Andrews’ Diseases of the Skin: Dermatol, 2000;1(5):261–8. 8. Gupta AK, Gover MD, Nouri K, Taylor S, The treatment of
Clinical Dermatology, 10th edition, Saunders, 2005. 6. Prignano F, Ortonne JP, Buggiani G, et al.,Therapeutical melasma: A review of clinical trials, J Am Acad Dermatol,
3. Bolanca I, Bolanca Z, Kuna K, et al., Chloasma—the mask approaches in melasma, Dermatol Clin, 2007;25(3):337–42. 2006;55:1048–65.
of pregnancy, Coll Antropol, 2008;(Suppl. 2):139–41. 7. Chan R, Park KC, Lee MH, et al., A randomized controlled 9. Rendon M, Cardona LM, Bussear EW, et al., Successful
4. Prignano F, Ortonne JP, Buggiani G, et al., Therapeutical trial of the efficacy and safety of a fixed triple combination treatment of moderate to severe melasma with triple-
approaches in melasma, Dermatol Clin, 2007;25(3): (fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin combination cream and glycolic acid peels: a pilot study,
337–42. 0.05%) compared with hydroquinone 4% cream in Asian Cutis, 2008;82(5):372–8.
48 EUROPEAN DERMATOLOGY
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