“There are no direct studies comparing peeling to lasers,” said Harold Brody, MD, FAAD, who is a clinical professor of dermatology at Emory University School of Medicine in Atlanta, Georgia, and former president of the International Peeling Society- USA (IPL), based in Rolling Meadows, Illinois, during a presentation at the 2022 annual meeting of the American Academy of Dermatology.1 He also noted that the procedures vary from one dermatologist to another. “However, trichloroacetic acid (TCA) chemical skin scar reconstruction (CROSS) is superior to any laser treatment for pitted scars because it penetrates deeper,” Brody said. Dermatology Times®.
“Many dermatologists who practice medical dermatology are unaware of the advances in peeling over the past 15 years, and some patients and dermatologists may be ‘brainwashed’ by industry laser advertising,” Brody said. Dermatology Times® in a follow-up interview. In his presentation, he noted that peeling is more cost-effective than laser treatment and results can be “competitively comparable” if performed by physicians familiar with the modality being used. He also noted that radio frequency (RF) microneedling was not considered in his speech due to its focus, but its effectiveness is changing.
Brody backed up this overview with a detailed breakdown of lasers and peels to treat four different issues.
Brody said scar treatment requires the use of a physical modality with peeling: dry ice followed by TCA or a Jessner (JS) peel followed by TCA with sandpaper or the CROSS technique for pitted scars. . “The goal is to convert stiff scars into distensible scars and then elevate them with long-lasting fillers,” he added. Ablative fractional lasers, according to Brody, can provide variable improvement.
“Peels are underused for wrinkles but the phenol-croton oil formulas are ‘superb’. The new formulas require no hydration or ECG and IV analgesia in segmental peeling,” Brody said. Dermatology Times®. He noted that peeling can eliminate photoaging III and IV in 1 treatment using 1 of these new formulas. Lasers can achieve these results in one treatment for photoaging III, but photoaging IV is harder to remove in one treatment, he said. Fully ablative erbium lasers may come close to these results, but prolonged healing may hamper its viability.
Brody noted that both lasers and peels are helpful in treating melasma, but both can have varying success. He believes that both modalities can improve patients’ quality of life, although both may require multiple treatments. For post-inflammatory hyperpigmentation, Brody said Dermatology Times® that here, too, he sees a role for superficial peels and non-ablative fractional lasers to help whitening agents penetrate “faster and better.”
Actinic keratoses (AK)
AKs can be removed with a properly performed medium depth peel in 1 treatment, resulting in a 75% to 90% reduction (of lesions). The 927 fractional thulium laser can do the same but requires up to 4 treatments at 2-6 week intervals. Brody noted that peels are generally best for one-treatment improvement, while lasers work best over multiple treatments, but the benefit to the patient is that they may require less downtime. He added that both may require follow-ups for small recurrences.
Considerations for Patients of Color
“For patients of color, peels are great, but peels and lasers should be gentler,” Brody said. Dermatology time®. He added that dermatologists need to know when to tell patients of color to stop pre-regimes: several days before for people with darker Fitzpatrick skin types, but on the day of the procedure for those with darker skin types. clearer.
Brody listed the following relevant disclosures: Allergan, Inc., Galderma Laboratories and Merz Aesthetics
Brody H and Ibrahimi O. Do lasers have better results than chemical peels? Presented at the 2022 Annual Meeting of the American Academy of Dermatology; March 25-29, 2022; Boston, Massachusetts.