Clive Anderson - AT THE DERMATOLOGIST READERS' FEEDBACK
Hi Doc,
I read your article in The Gleaner and found it interesting. I would like to get some more information on the Dermabrasion and Chemical Peel procedures. I have tiny indentations on my face and is interested in finding out which of the two is best for me. I would also like to know the price range of doing such a procedure.
Kindly reply and update me. Incidentally, can any of these procedures be carried out on the back of the hands? I have terrible (dry and cracky) hands and would do anything to get them corrected.
DERMATOLOGIST'S RESPONSE
The reader indicates that he/she has fine indentations on the face. These sound like acne scars. Any acne bump can leave a scar in the skin on healing. These scars are of three main types:
Ice pick scars sharp edged,
deep, rounded
Atrophic scars wider,
shallow scars
Keloid scars thickened,
raised
Some persons have a preponderance of one type of scar or another. The treatment for these scars has to be individualised. Very often several treatments have to be combined to achieve good results.
The best treatment for acne scarring is prevention. This means aggressive treatment of existing acne so as to prevent scaring. Once the scarring has occurred it may improve, that is, become less obvious with time but it does not go away without treatment.
The treatment depends on the type of scar.
Microdermabrasion and chemical peels are useful only for the shallow scars. These modalities do not work as well for the indentations (ice pick scars) that this reader asks about.
Laser resurfacing is also better for the management of the shallow imperfections.
Punch technique may be used to remove the ice-pick scars
Subscision is a surgical technique used to cut the fibres holding down the skin below the scars, may be used for all scars.
The reader asks about Dermabrasion which is a procedure using a rough- surfaced instrument to physically rub off the outer layers of the skin. The effect is like what happens when we fall and get a so-called graze to the skin. The skin eventually heals with the defect gone. Black skin however, is a challenge in that on healing hyperpigmentation or darkening of the skin is common. For this reason most Dermatologists do not do Dermabrasion but do instead Microdermabrasion, which is a more superficial process. Chemical peels and Microdermabrasion are part of what may be termed non-ablative rejuvenation programmes.
Both procedures serve to exfoliate the outer layers of the skin thus stimulating epidermal growth. These procedures remove damaged layers of skin replacing it with more normalised tissue and induce the production of collagen and ground substance (the support structures) in the dermis of the skin. The degree and depth of exfoliation is dependent on the chemical used for peeling, the preparation of the skin and the time of contact in the case of a chemical peel.
For Microdermabrasion, the number of passes and the power setting used, control the depth of exfoliation achieved. Chemical peels use a chemical agent to exfoliate the top layer of the skin. Peels are classified according to the level of skin affected. In Microdermabrasion fine crystals are thrown at the skin under pressure and suctioned away in a closed system. This is a type of sandblasting of the skin and results in the removal of the outer layers. Both of these procedures are useful in treating the following:
Photaging - sallow
complexion, rough skin
Pigmentary changes dark
spots on the skin
Stretch marks
Acne bumps improve the
appearance of acne scars
No good, controlled studies exist as to the frequency of treatment with these modalities but generally a series of three to six is required with a maintenance programme at three to six month intervals. In darker skin the pre- and post-procedure treatment of the skin is important to prevent complications and increase efficacy.
The cost of Microdermabrasion is greater than that of a chemical peel. The price range depends on the depth of the procedures and varies from $4,000 $10,000.
To answer the reader's second question: Yes, Glycolic peels are often used to treat dry, cracked skin on the hands and legs.
Dr. Clive Anderson is a Dermatologist and Venerologist.
