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Peel hรณa chแบฅt แปŸ vรนng da ngoร i mแบทt: Cฦก chแบฟ, chฤƒm sรณc sau peel, lฦฐu รฝ

5/5 - (1 bรฌnh chแปn)
5/5 - (1 bรฌnh chแปn)

Bร i viแบฟt Peel hรณa chแบฅt แปŸ vรนng da ngoร i mแบทt: Cฦก chแบฟ, chฤƒm sรณc sau peel, lฦฐu รฝ ฤ‘ฦฐแปฃc biรชn dแป‹ch bแปŸi Bs Phแบกm Tฤƒng Tรนng tแปซ Sรกch โ€œPEEL Hร“A CHแบคT Vร€ CรC THแปฆ THUแบฌT TRONG THแบจM Mแปธ DA” cแปงa tรกc giแบฃ Maria Claudia Almeida Issa vร  Bhertha Tamura.

1. Tร“M TแบฎT

Peel da mแบทt ฤ‘ฦฐแปฃc sแปญ dแปฅng rแป™ng rรฃi trong thแปฑc hร nh da liแป…u khรดng chแป‰ cho mแปฅc ฤ‘รญch thแบฉm mแปน mร  cรฒn cho mแปฅc ฤ‘รญch ฤ‘iแปu trแป‹ bแป‡nh. Kฤฉ thuแบญt peel da vรนng thรขn (peel body) dแปฑa trรชn cฦก sแปŸ kiแบฟn thแปฉc cแปงa peel da vรนng mแบทt vร  รกp dแปฅng lรชn cรกc vรนng da khรกc cแปงa cฦก thแปƒ trong khi vแบซn tรดn trแปng nhแปฏng ฤ‘แบทc tรญnh khรกc biแป‡t giแปฏa cแปงa vรนng da khรกc trรชn cฦก thแปƒ vแป›i vรนng da mแบทt.

Sแปญ dแปฅng ฤ‘รบng hรณa chแบฅt vร  kฤฉ thuแบญt lร  yแบฟu tแป‘ tiรชn quyแบฟt giรบp mang lแบกi hiแป‡u quแบฃ vร  tรญnh an toร n trong peel da hรณa chแบฅt แปŸ vรนng thรขn mรฌnh. ฤแปƒ ฤ‘แบกt ฤ‘ฦฐแปฃc kแบฟt quแบฃ ฤ‘iแปu trแป‹ tแป‘t nhแบฅt, ngฦฐแปi ta thฦฐแปng chแป‰ dรนng loแบกi peel nรดng vร  peel rแบฅt nรดng lแป›p sแปซng ฤ‘แปƒ ฤ‘iแปu trแป‹ แปŸ vรนng da แปŸ thรขn mรฌnh. Khi peel nรชn tiแบฟn hร nh peel nhiแปu liแป‡u trรฌnh vร  peel dแบงn dแบงn theo ฤ‘รบng chแป‰ ฤ‘แป‹nh.

Nhแปฏng nguyรชn tแบฏc nร y sแบฝ giรบp trรกnh xuแบฅt hiแป‡n ฤ‘แป da kรฉo dร i, tฤƒng sแบฏc tแป‘ sau viรชm, chแบญm lร nh vแบฟt thฦฐฦกng vร  thแบญm chรญ lร  hoแบกi tแปญ da (hoแบกi tแปญ da sแบฝ ฤ‘แปƒ lแบกi sแบนo xแบฅu).

2. Nแป˜I DUNG

Giแป›i thiแป‡u

  • Tรญnh chแบฅt riรชng biแป‡t cแปงa nhแปฏng vรนng da ngoร i da mแบทt
  • Chฤƒm sรณc ban ฤ‘แบงu trฦฐแป›c khi peel da แปŸ vรนng thรขn mรฌnh.

Cรกc hรณa chแบฅt peel chรญnh vร  chแป‰ ฤ‘แป‹nh

  • Salicylic acid
  • Dung dแป‹ch Jessner
  • Resorcin
  • Tretinoin
  • 5-Fluorouracil
  • Glycolic acid
  • Trichloroacetic acid
  • Thioglycolic acid

Chฤƒm sรณc ฤ‘แบทt biแป‡t sau thแปง thuแบญt Biแบฟn chแปฉng

Kแบฟt luแบญn Ghi nhแป› Tham khแบฃo

ย 3. GIแปšI THIแป†U

Mแบทc dรน nhu cแบงu sแปญ dแปฅng cรกc cรดng nghแป‡ mแป›i ngร y cร ng tฤƒng, viแป‡c sแปญ dแปฅng cรกc hรณa chแบฅt ฤ‘แปƒ peel da mแบทt vร  cฦก thแปƒ vแบซn ฤ‘รณng mแป™t vai trรฒ quan trแปng trong ngร nh da liแป…u do tรญnh hiแป‡u quแบฃ, an toร n, tรญnh thแปฑc tiแป…n vร  giรก thร nh thแบฅp cแปงa phฦฐฦกng phรกp nร y. Tuy nhiรชn, hแบงu hแบฟt nhแปฏng tร i liแป‡u khoa hแปc chแปง yแบฟu nhแบฅn mแบกnh vร o phฦฐฦกng phรกp peel da แปŸ vรนng da mแบทt vร  peel hรณa chแบฅt ฤ‘แป‘i vแป›i cรกc vรนng da ngoร i da mแบทt chแป‰ ฤ‘ฦฐแปฃc khuyแบฟn cรกo sแปญ dแปฅng trong mแป™t sแป‘ bแป‡nh lรญ cแปฅ thแปƒ cลฉng nhฦฐ ฤ‘แปƒ hแป— trแปฃ cรกc phฦฐฦกng phรกp ฤ‘iแปu trแป‹ khรกc.

Chฦฐฦกng nร y sแบฝ hแป‡ thแป‘ng nhแปฏng thรดng tin hiแป‡n cรณ vแป kฤฉ thuแบญt, chฤƒm sรณc vร  hฦฐแป›ng dแบซn cho phฦฐฦกng phรกp peel da vรนng ngoร i mแบทt nร y.

4. Tรญnh chแบฅt riรชng biแป‡t cแปงa nhแปฏng vรนng da ngoร i da mแบทt

Vรนng da ngoร i mแบทt cรณ mแป™t vร i ฤ‘แบทc tรญnh cแบงn lฦฐu รฝ nhฦฐ sau.

  1. Diแป‡n tรญch bแป mแบทt da rแป™ng: ฤ‘รขy lร  yแบฟu tแป‘ chรญnh ฤ‘รณng vai trรฒ trong viแป‡c ngแป™ ฤ‘แป™c hแป‡ thแป‘ng do hแบฅp thแปฅ hรณa chแบฅt qua da. Do ฤ‘รณ khuyแบฟn cรกo trฦฐแป›c khi ฤ‘iแปu trแป‹ phแบฃi phรขn chia thร nh tแปซng mแบฃng nhแป theo ฤ‘แป™ dร i, vร  tรญnh an toร n cแปงa hรณa chแบฅt Mแป™t vร i hรณa chแบฅt mร  tรกc dแปฅng cแปงa nรณ phแปฅ thuแป™c vร o thแปi gian tiแบฟp xรบc vร  cแบงn phแบฃi trung hรฒa. Do ฤ‘รณ khi peel แปŸ vรนng da lแป›n cแบงn phแบฃi chuแบฉn bแป‹ bแป mแบทt ฤ‘iแปu trแป‹ ฤ‘แปƒ khรดng แบฃnh hฦฐแปŸng ฤ‘แบฟn quรก trรฌnh trung hรฒa.
  2. Mแปฉc ฤ‘แป™ bong da vร  hรฌnh thร nh mร i nhแป: vร i ngร y sau khi peel da vรนng thรขn, chรบng ta cรณ thแปƒ thแบฅy hiแป‡n tฦฐแปŸng bong vแบฃy แปŸ nhiแปu mแปฉc ฤ‘แป™ khรกc nhau tรนy thuแป™c ฤ‘แป™ sรขu cแปงa ฤ‘iแปu trแป‹. Quรก trรฌnh bong vร y nร y kรฉo dร i hฦกn so vแป›i peel แปŸ da mแบทt. ฤแบทc ฤ‘iแปƒm nร y ฤ‘แบทc biแบฟt cรณ giรก trแป‹ ฤ‘แป‘i vแป›i peel nรดng da vรนng thรขn khi toร n bแป™ thฦฐแปฃng bแป‹ ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹.
  3. Thแปi gian hแป“i phแปฅc: thแปi gian hแป“i phแปฅc dร i hฦกn khi peel trรชn da vรนng thรขn do cรกc ฤ‘แบทc ฤ‘iแปƒm sau:
    • Sแป‘ lฦฐแปฃng ฤ‘ฦกn vแป‹ nang lรดng tuyแบฟn bรฃ: quรก trรฌnh lร nh vแบฟt thฦฐฦกng sau peel hรณa chแบฅt diแป…n ra thรดng qua sแปฑ tฤƒng sinh thฦฐแปฃng bแป‹ lรขn cแบญn vร  sแปฑ di cฦฐ cแปงa cรกc tแบฟ bร o gแป‘c hiแป‡n diแป‡n trong cรกc ฤ‘ฦกn vแป‹ nang lรดng tuyแบฟn bรฃ. Vรฌ vรนng da ngoร i mแบทt cรณ รญt cรกc thร nh phแบงn phแปฅ (bao gแป“m ฤ‘ฦกn vแป‹ nang lรดng tuyแบฟn bรฃ) hฦกn so vแป›i da mแบทt (รญt hฦกn thแบญm chรญ ฤ‘แบฟn 30 lแบงn แปŸ vรนng cแป•, vร  40 lแบงn แปŸ mแบทt lฦฐng bร n tay vร  cรกnh tay), do ฤ‘รณ cแบงn phแบฃi lฦฐu รฝ ฤ‘แบฟn ฤ‘แป™ sรขu cแปงa peel ฤ‘แปƒ trรกnh hoแบกi tแปญ sรขu vร o da (Kede 2009).
    • ฤแป™ dร y lแป›p thฦฐแปฃng bรฌ: da cร ng mแปng, thรฌ hรณa chแบฅt peel thแบฅm vร o cร ng ฤแปu nร y ฤ‘แบทc biแป‡t ฤ‘รบng vแป›i ฤ‘แป‘i tฦฐแปฃng bแป‡nh nhรขn lร  ngฦฐแปi lแป›n tuแป•i vรฌ da sแบฝ mแปng dแบงn theo ฤ‘แป™ tuแป•i. Cแบงn phแบฃi lฦฐu รฝ lร  luรดn chแปn ฤ‘รบng loแบกi hรณa chแบฅt peel ฤ‘แปƒ sแปญ dแปฅng.
    • Cung cแบฅp mรกu: lฦฐแปฃng mรกu cung cแบฅp giแบฃm nhฦฐ แปŸ vรนng chi dฦฐแป›i sแบฝ dแป… ฤ‘ฦฐa ฤ‘แบฟn biแบฟn chแปฉng chแบญm lร nh vแบฟt thฦฐฦกng. Khi ฤ‘iแปu trแป‹ แปŸ nhแปฏng vรนng nร y nรชn chแป‰ ฤ‘แป‹nh peel nรดng hoแบทc peel rแบฅt nรดng ฤ‘แปƒ giแบฃm tแป‘i ฤ‘a khแบฃ nฤƒng xแบฃy ra biแบฟn chแปฉng.

Lแปฑa chแปn ฤ‘รบng loแบกi hรณa chแบฅt peel vร  รกp dแปฅng ฤ‘รบng kฤฉ thuแบญt lร  cรกc yแบฟu tแป‘ quyแบฟt ฤ‘แป‹nh ฤ‘แบฟn sแปฑ an toร n vร  hiแป‡u quแบฃ khi peel da แปŸ cรกc vรนng khรกc cแปงa cฦก thแปƒ. ฤแปƒ thu ฤ‘ฦฐแปฃc hiแป‡u quแบฃ ฤ‘iแปu trแป‹ tแป‘t nhแบฅt ฤ‘แป‘i vแป›i nhแปฏng vรนng da ngoร i mแบทt, thรฌ peel rแบฅt nรดng แปŸ lแป›p sแปซng thฦฐแปฃng bแป‹ vร  peel nรดng แปŸ lแป›p thฦฐแปฃng bรฌ lร  nhแปฏng lแปฑa chแปn phรน hแปฃp nhแบฅt. Peel body nรชn thแปฑc hiแป‡n theo nhiแปu liแป‡u trรฌnh vร  tiแบฟn hร nh dแบงn dแบงn theo ฤ‘รบng chแป‰ ฤ‘แป‹nh (Landau 2008).

Nhแปฏng nguyรชn tแบฏc nร y sแบฝ giรบp trรกnh xuแบฅt hiแป‡n ฤ‘แป da kรฉo dร i, tฤƒng sแบฏc tแป‘ sau viรชm, chแบญm lร nh vแบฟt thฦฐฦกng vร  thแบญm chรญ lร  hoแบกi tแปญ da (hoแบกi tแปญ da sแบฝ ฤ‘แปƒ lแบกi sแบนo xแบฅu).

5. Chฤƒm sรณc ban ฤ‘แบงu trฦฐแป›c khi peel da แปŸ vรนng thรขn mรฌnh

Nhแปฏng bแป‡nh nhรขn cรณ tiแปn sแปญ bแป‡nh khรดng tแป‘t, ฤ‘แบทc biแป‡t liรชn quan ฤ‘แบฟn cรกc phแบฃn แปฉng khรดng mong muแป‘n trong nhแปฏng lแบงn ฤ‘iแปu trแป‹ trฦฐแป›c nhฦฐ dแป‹ แปฉng, sแบนo lแป“i, bแป‡nh da mแบกn tรญnh (viรชm da dแบงu vร  viรชm da cฦก ฤ‘แป‹a), sแปญ dแปฅng thuแป‘c uแป‘ng nhฦฐ isotretinoin thรฌ cแบงn phแบฃi ฤ‘ฦฐแปฃc chรบ รฝ. Ngoร i ra cลฉng cแบงn phแบฃi hแบฟt sแปฉc cแบฉn thแบญn vแป›i nhแปฏng bแป‡nh nhรขn cรณ tiแปn sแปญ tฤƒng sแบฏc tแป‘ sau viรชm, ฤ‘แบทc biแป‡t lร  nhแปฏng ngฦฐแปi cรณ phรขn loแบกi da Fitzpatrick tแปซ IV, V, VI.

Thแปง thuแบญt nร y cรณ chแป‘ng chแป‰ ฤ‘แป‹nh tฦฐฦกng ฤ‘แป‘i แปŸ nhแปฏng ngฦฐแปi cรณ ฤ‘iแปu trแป‹ liแป‡u phรกp phรณng xแบก trรชn vรนng da cแปงa cฦก thแปƒ, do khแบฃ nฤƒng cรกc cแบฅu trรบc phแปฅ cแปงa da ฤ‘รฃ bแป‹ phรก hแปงy dแบซn tแป›i lร m ฤ‘รฌnh trแป‡ quรก trรฌnh tรกi tแบกo thฦฐแปฃng bรฌ. Trong nhแปฏng trฦฐแปng hแปฃp nร y, cแบงn phแบฃi kiแปƒm tra sแปฑ tแป“n tแบกi cแปงa nhแปฏng sแปฃi lรดng mแบฃnh ฤ‘แปƒ ฤ‘แบฃm bแบฃo cรกc thร nh phแบงn phแปฅ cแปงa da vแบซn toร n vแบนn. Nแบฟu tiแบฟn hร nh peel แปŸ bแป‡nh nhรขn cรณ dรนng isotretinoin trong vรฒng 6 thรกng trแปŸ lแบกi, thรฌ thแปi gian lร nh vแบฟt thฦฐฦกng sแบฝ dร i hฦกn vร  cรณ thแปƒ ฤ‘แปƒ lแบกi sแบนo.

Nรชn trรกnh tiแบฟp xรบc nhiแปu vแป›i รกnh sรกng mแบทt trแปi trong nhแปฏng ngร y sau khi lร m thแปง thuแบญt ฤ‘แปƒ hแบกn chแบฟ nguy cฦก kรญch hoแบกt cรกc tแบฟ bร o melanocyte, trรกnh tรฌnh trแบกng tฤƒng sแบฏc tแป‘ sau viรชm.

Chuแบฉn bแป‹ da trฦฐแป›c thแปง thuแบญt khรดng thแปฑc sแปฑ cแบงn thiแบฟt trong cรกc peel rแบฅt nรดng, nhฦฐng cรณ thแปƒ thแปฑc hiแป‡n vแป›i mแปฅc ฤ‘รญch ngฤƒn ngแปซa rแป‘i loแบกn sแบฏc tแป‘. Viแป‡c chuแบฉn bแป‹ da nรชn bแบฏt ฤ‘แบงu trฦฐแป›c khi lร m thแปง thuแบญt รญt nhแบฅt 14 ngร y. Nรชn sแปญ dแปฅng cรกc chแบฅt khแปญ sแบฏc tแป‘ nhฦฐ hy- droquinone vร  kojic acid phแป‘i hแปฃp vแป›i retinoids hoแบทc alpha hydroxyl Nhแปฏng chแบฅt nร y sแบฝ giรบp lร m vแบฟt thฦฐฦกng nhanh lร nh, hแบกn chแบฟ tฤƒng sแบฏc tแป‘, ฤ‘แบทc biแป‡t lร  nhแปฏng ngฦฐแปi cรณ phรขn loแบกi da theo Fitzpatrick IV, V, vร  VI. Nhแปฏng loแบกi thuแป‘c kแปƒ trรชn nรชn ngฦฐng tแปซ 3-5 ngร y trฦฐแป›c thแปง thuแบญt ฤ‘แปƒ hแบกn chแบฟ แบฃnh hฦฐแปŸng ฤ‘แบฟn chแบฅt peel trรกnh hรณa chแบฅt peel xรขm nhแบญp xรขu hฦกn ngoร i sแปฑ mong ฤ‘แปฃi vร o da.

ฤแปƒ ฤ‘iแปu trแป‹ nhแปฏng tแป•n thฦฐฦกng thฦฐแปฃng bรฌ cรณ mแปฉc ฤ‘แป™ dร y sแปซng cao hฦกn nhฦฐ dร y sแปซng tuyแบฟn bรฃ hoแบทc dร y sแปซng รกnh sรกng, nรชn sแปญ dแปฅng ฤ‘แป‘t ฤ‘iแป‡n vร  รกp lแบกnh nitrogen lแปng nhฦฐ lร  nhแปฏng ฤ‘iแปu trแป‹ hแป— trแปฃ trฦฐแป›c thแปง thuแบญt ฤ‘แปƒ mang lแบกi kแบฟt qua lรขm sร ng tแป‘ hฦกn.

Cuแป‘i cรนng lร  khรดng nรชn cแบกo lรดng แปŸ nhแปฏng vรนng da ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹ รญt nhแบฅt 5 ngร y sau thแปง thuแบญt ฤ‘แปƒ trรกnh gรขy tแป•n thฦฐฦกng thฦฐแปฃng bรฌ, viรชm da tiแบฟp xรบc dแป‹ แปฉng hoแบทc viรชm da kรญch แปฉng nguyรชn phรกt. Nhแปฏng vแบฅn ฤ‘แป nร y sแบฝ ฤ‘ฦฐa ฤ‘แบฟn mแบฅt sแปฑ toร n vแบนn cแปงa

Tแบกi thแปi ฤ‘iแปƒm tiแบฟn hร nh thแปง thuแบญt: ฤiแปu quan trแปng cแบงn lฦฐu รฝ lร  lแปฑa chแปn ฤ‘รบng loแบกi chแบฅt rแปญa mแบทt: lotion rแปญa mแบทt nhแบน, alcohol-ether hoแบทc ace- tone tinh khiแบฟt. Sแปฑ lแปฑa chแปn nร y quแบฟt ฤ‘แป‹nh ฤ‘แบฟn khแบฃ nฤƒng xรขm nhแบญp nhiแปu hฦกn hay รญt hฦกn cแปงa hรณa chแบฅt peel, ฤ‘แบทc biแป‡t ฤ‘แป‘i vแป›i nhแปฏng chแบฅt cรณ khแบฃ nฤƒng thแบฅm vร o thฦฐแปฃng bรฌ cao hฦกn nhฦฐ

6. CรC Hร“A CHแบคT PEEL CHรNH Vร€ CHแปˆ ฤแปŠNH

6.1. Salicylic acid

Salicylic acid lร  mแป™t loแบกi beta hydroxy acid ฤ‘ฦฐแปฃc sแปญ dแปฅng แปŸ nแป“ng ฤ‘แป™ 20% vร  30% trong dung mรดi ethanol nhฦฐ lร  mแป™t hรณa chแบฅt peel nรดng. Acid nร y cรณ tรกc dแปฅng tiรชu cรฒi mแปฅn, li sแปซng, vร  khรกng viรชm vร  ฤ‘ฦฐแปฃc sแปญ dแปฅng trong ฤ‘iแปu trแป‹ mแปฅn trแปฉng cรก, dร y sแปซng nang lรดng, vร  tฤƒng sแบฏc tแป‘ sau viรชm. Ngoร i ra hiแป‡u quแบฃ ฤ‘iแปu trแป‹ cแปงa nรณ cรฒn ฤ‘ฦฐแปฃc thแบฅy trong ฤ‘iแปu trแป‹ lรฃo hรณa da รกnh sรกng nhแบน, cแบฅu trรบc da khรดng ฤ‘แปu, vร  nhแปฏng nแบฟp nhฤƒn nhแป (Peterson vร  Goldman 2011). Phรกc ฤ‘แป“ ฤ‘iแปu trแป‹ cรณ thแปƒ tแปซ ba ฤ‘แบฟn sรกu liแป‡u trรฌnh vแป›i khoแบฃng cรกch thแปi gian tแปซ 15-30 ngร y tรนy thuแป™c vร o chแป‰ ฤ‘แป‹nh lรขm sร ng vร  mแปฉc ฤ‘แป™ tแป•n thฦฐฦกng. Thฦฐแปng thรฌ sau khi bรดi sal- icylic acid 1-3 phรบt sแบฝ xuแบฅt hiแป‡n lแป›p tinh thแปƒ trแบฏng, ฤ‘รขy lร  dแบฅu hiแป‡u ฤ‘แปƒ ฤ‘รกnh giรก sแปฑ ฤ‘แป“ng nhแบฅt khi bรดi (hรฌnh 1a, b).

Hรฌnh 1: (a, b) Peel salicylic acid 30% trong dung mรดi ethanol trong ฤ‘iแปu trแป‹ mแปฅn trแปฉng cรก viรชm. Hรฌnh (b) cho thแบฅy lแป›p kแบฟt tแปงa trแบฏng cแปงa acid salicylic.
Hรฌnh 1: (a, b) Peel salicylic acid 30% trong dung mรดi ethanol trong ฤ‘iแปu trแป‹ mแปฅn trแปฉng cรก viรชm. Hรฌnh (b) cho thแบฅy lแป›p kแบฟt tแปงa trแบฏng cแปงa acid salicylic.

Sau ฤ‘รณ bแป‡nh nhรขn sแบฝ cรณ cแบฃm giรกc bแปng rรกt trong vร i phรบt vร  thแบฅy tรช nhแบน แปŸ vรนng ฤ‘iแปu trแป‹. Cรณ thแปƒ thแบฅy cรกc ฤ‘iแปƒm frosting (level 1) แปŸ nhแปฏng sang thฦฐฦกng mแปฅn viรชm. Acid nร y khรดng cแบงn phแบฃi tiแบฟn hร nh trung hรฒa. Lแป›p kแบฟt tแปงa trแบฏng quรก mแปฉc ฤ‘ฦฐแปฃc loแบกi bแป sau 5-10 phรบt vแป›i nฦฐแป›c vร  lotion rแปญa mแบทt. Trong 3-5 ngร y sau ฤ‘รณ cรณ thแปƒ xuแบฅt hiแป‡n vแบฃy trแบฏng rแบฅt mแปng.

Cรกc triแป‡u chแปฉng ngแป™ ฤ‘แป™c salicyl- ic mแบทc dรน hiแบฟm cรณ nhฦฐng cรณ thแปƒ xแบฃy ra tแปซ nhแบน (thแปŸ nhanh, รน tai, khรดng nghe ฤ‘ฦฐแปฃc, chรณng mแบทt, buแป“n nรดn, nรดn vร  ฤ‘au bแปฅng) cho ฤ‘แบฟn nแบทng (nhแปฏng thay ฤ‘แป•i แปŸ hแป‡ thแบงn kinh trung ฦฐฦกng nhฦฐ trong ngแป™ ฤ‘แป™c rฦฐแปฃu). Do ฤ‘รณ, chแป‰ nรชn dรนng salicylic trรชn mแป™t vรนng bแป mแบทt nhแป nhฦฐ cแป• vร  vรนng trฦฐแป›c xฦฐฦกng แปฉc (Brubacher vร  Hoffmann 1996). Gแบงm ฤ‘รขy cรณ xuแบฅt hiแป‡n mแป™t cรดng thแปฉc mแป›i chแปฉa salicylic acid 30% trong dung mรดi polyethylene glycol (PEG), dung dแป‹ch nร y ฤ‘รฃ ฤ‘ฦฐแปฃc sแปญ dแปฅng vร  mang lแบกi hiแป‡u quแบฃ lรขm sร ng tแป‘t แปŸ nhแปฏng tรฌnh nguyแป‡n viรชn cรณ tรฌnh trแบกng da bแป‹ giร  hรณa, kแบฟt quแบฃ cho thแบฅy cรณ sแปฑ cแบฃi thiแป‡n cแบฅu trรบc da, lร m biแบฟn mแบฅt nhรขn mแปฅn vร  mแปฅn viรชm แปŸ nhแปฏng bแป‡nh nhรขn cรณ mแปฅn trแปฉng cรก. Nhแป ฤ‘แบทc tรญnh รญt bay hฦกi, PEG cรณ รกi lแปฑc cao hฦกn vแป›i salicylic acid vร  do ฤ‘รณ chแป‰ nhแบฃ salicylic acid ra theo lฦฐแปฃng nhแป แปŸ lแป›p bแป mแบทt cแปงa thฦฐแปฃng bรฌ. รi lแปฑc cao nร y giรบp acid รญt bแป‹ hแบฅp thu hฦกn vร  do ฤ‘รณ รญt gรขy ngแป™ ฤ‘แป™c hแป‡ thแป‘ng cลฉng nhฦฐ giแบฃm cแบฃm giรกc bแปng rรกt khi bรดi (Dainichi 2008). Mแบทt khรกc, cรดng thแปฉc salicylic acid trong dung mรดi phenol cรณ tรญnh ฦฐa lipid cao hฦกn nรชn cรณ รกi lแปฑc cao vแป›i cรกc ฤ‘ฦกn vแป‹ nang lรดng tuyแบฟn bรฃ hฦกn nรชn sแบฝ lร m khรด da tแป‘t hฦกn cho nhแปฏng bแป‡nh nhรขn bแป‹ mแปฅn trแปฉng cรก trรชn vรนng thรขn (Peterson vร  Goldman 2011).

6.2. Dung dแป‹ch Jessner

Dung dแป‹ch Jessner chแปฉa 14% salicylic acid, 14% lactic acid, vร  14% resorcin trong ethanol. Dung dแป‹ch cรณ hoแบกt tรญnh li sแปซng, khรกng viรชm, vร  lร m sรกng da. Tรนy thuแป™c vร o sแป‘ lแป›p dung dแป‹ch ฤ‘ฦฐแปฃc bรดi lรชn bแป‡nh mแบทt vร  thแปƒ tรญch ฤ‘ฦฐแปฃc sแปญ dแปฅng, peel da bแบฑng dung dแป‹ch Jessner cรณ thแปƒ ฤ‘ฦฐแปฃc phรขn loแบกi tแปซ peel rแบฅt nรดng ฤ‘แบฟn peel trung bรฌnh. Khแบฃ nฤƒng thแบฅm vร o da cแปงa dung dแป‹ch ฤ‘ฦฐแปฃc quyแบฟt ฤ‘แป‹nh mแป™t phแบงn nhแป hoแบกt tรญnh li thฦฐแปฃng bรฌ cแปงa lactic acid (mแบทc dรน แปŸ nแป“ng ฤ‘แป™ thแบฅp) vร  phแปฅ thuแป™c vร o nแป“ng ฤ‘แป™ pH cแปงa dung dแป‹ch.

Dung dแป‹ch nร y ฤ‘ฦฐแปฃc sแปญ dแปฅng ฤ‘แปƒ ฤ‘iแปu trแป‹ hแป— trแปฃ ฤ‘แป‘i vแป›i tรฌnh trแบกng mแปฅn trแปฉng cรก viรชm แปŸ vรนng tฤƒng sแบฏc tแป‘ trรชn thรขn (trฦฐแป›c vร  sau), ฤ‘แบทc biแป‡t แปŸ ngฦฐแปi cรณ phรขn loแบกi da tแป‘i mร u. Trong nhแปฏng trฦฐแปng hแปฃp nร y, thฦฐแปng nรชn sแปญ dแปฅng gแบกc ฤ‘แปƒ bรดi vร  tแบกo mแป™t รกp lแปฑc lรชn da ฤ‘แบทc biแป‡t lร  vรนng da cรณ lแป›p sแปซng dร y vร  cรณ nhiแปu cแบฅu trรบc tuyแบฟn bรฃ nhแปn. Peel dung dแป‹ch Jessner cรฒn ฤ‘ฦฐแปฃc chแป‰ ฤ‘แป‹nh ฤ‘แปƒ ฤ‘iแปu trแป‹ trแบป hรณa da vรนng cแป•, nhฦฐng vแป›i sแป‘ lแป›p bรดi รญt hฦกn (Peterson vร  Goldman 2011; Brody 1997; hรฌnh 2a- c).

Hรฌnh 2: (a-c) Peel dung dแป‹ch Jessner (3 lแป›p) trong ฤ‘iแปu trแป‹ lรฃo hรณa รกnh sรกng mแปฉc ฤ‘แป™ vแปซa. (a) trฦฐแป›c khi lร m thแปง thuแบญt, (b) sau liแป‡u trรฌnh ฤ‘แบงu tiรชn (ngร y thแปฉ 14), vร  (c) sau 2 liแป‡u trรฌnh (ngร y thแปฉ 400.
Hรฌnh 2: (a-c) Peel dung dแป‹ch Jessner (3 lแป›p) trong ฤ‘iแปu trแป‹ lรฃo hรณa รกnh sรกng mแปฉc ฤ‘แป™ vแปซa.
(a) trฦฐแป›c khi lร m thแปง thuแบญt, (b) sau liแป‡u trรฌnh ฤ‘แบงu tiรชn (ngร y thแปฉ 14), vร  (c) sau 2 liแป‡u trรฌnh (ngร y thแปฉ 400.

Peel dung dแป‹ch Jessner แปŸ bแป‡nh nhรขn thฦฐแปng ฤ‘ฦฐแปฃc dung nแบกp tแป‘t, chแป‰ gรขy cแบฃm giรกc chรขm chรญnh nhแบน ฤ‘แบฟn vแปซa vร  kรฉo dร i trong khoแบฃng tแปซ 3 dแบฟn 10 phรบt. Sau khi bรดi sแบฝ xuแบฅt hiแป‡n mแป™t lแป›p trแบฏng nhแบน trรชn da do sแปฑ kแบฟt tแปงa cแปงa salicylic acid, sau ฤ‘รณ da sแบฝ trแปŸ nรชn ฤ‘แป vแป›i nhiแปu mแปฉc ฤ‘แป™ khรกc nhau vร  xuแบฅt hiแป‡n vรนng frosting nhแบน (level 0-1). Khuyแบฟn cรกo nรชn ฤ‘แปฃi 3-4 phรบt rแป“i mแป›i bรดi lแป›p dung dแป‹ch mแป›i ฤ‘แปƒ cรณ thแปƒ ฤ‘รกnh giรก ฤ‘ฦฐแปฃc mแปฉc ฤ‘แป™ peel ฤ‘รฃ ฤ‘ฦฐแปฃc tiแบฟn hร nh. Phฦฐฦกng phรกp peel nร y khรดng cแบงn phแบฃi trung hรฒa acid. Salicylic acid lแบฏng ฤ‘แปng cรณ thแปƒ rแปญa bแบฑng nฦฐแป›c hoแบทc lotion rแปญa mแบทt. Sau ฤ‘รณ xuแบฅt hiแป‡n sแปฑ bong trรณc cรกc mแบฃng trแบฏng ฤ‘แบฟn nรขu tแปซ 3-5 ngร y. Nรชn sแปญ dแปฅng dung dแป‹ch Jess- ner tแปซ 3 ฤ‘แบฟn 6 liแป‡u trรฌnh, vแป›i khoแบฃng cรกch thแปi gian giแปฏa cรกc liแป‡u trรฌnh lร  2 tuแบงn hoแบทc 1 thรกng.

Peel Jessner ฤ‘ฦฐแปฃc ฤ‘รกnh giรก lร  rแบฅt an toร n: phแบฃn แปฉng dแป‹ แปฉng (ฤ‘ฦฐแปฃc quyแบฟt ฤ‘แป‹nh bแปŸi mแปฉc ฤ‘แป™ nhแบกy cแบฃm vแป›i thร nh phแบงn resorcin) cรณ tแป‰ lแป‡ thแบฅp vร  รญt gรขy ngแป™ ฤ‘แป™c do nแป“ng ฤ‘แป™ thแบฅp cแปงa resorcin vร  salicylic acid trong cรดng thแปฉc. ฤแปƒ tฤƒng thรชm tรญnh an toร n, nรชn tiแบฟn hร nh peel luรขn phiรชn giแปฏa cรกc vรนng ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹ vร  giแปฏa cรกc thแปง thuแบญt. Cรกch nร y cลฉng cรณ thแปƒ รกp dแปฅng cho tแบฅt cแบฃ cรกc loแบกi peel mร  hรณa chแบฅt peel cรณ thแปƒ hแบฅp thu vร o hแป‡ thแป‘ng mแบกch mรกu (bแบฃng 1).

6.3. Resorcin

Resorcin lร  mแป™t chแบฅt an mรฒn thuแป™c nhรณm phenol, tan cแบฃ trong nฦฐแป›c vร  alcohol, ฤ‘ฦฐแปฃc sแปญ dแปฅng trong dung dแป‹ch tแบฉy rแปญa hoแบทc hแป“ dรกn แปŸ nแป“ng ฤ‘แป™ tแปซ 10% ฤ‘แบฟn 50%. Trong peel nรดng body ฤ‘แบทc biแป‡t lร  peel trแป‹ mแปฅn แปŸ vรนng lฦฐng trฦฐแป›c vร  sau, thรฌ sแปญ dแปฅng resorcin แปŸ nแป“ng ฤ‘แป™ thแบฅp hฦกn tแปซ 20% ฤ‘แบฟn 30% sแบฝ hแปฃp lรญ hฦกn. Nรณ cรณ thแปƒ sแปญ dแปฅng phแป‘i hแปฃp vแป›i sulfur, cแบฃ 2 chแบฅt ฤ‘แปu แปŸ nแป“ng ฤ‘แป™ 24% trong dung dแป‹ch nฦฐแป›c cแบฅt (Kede 2009). Peel loแบกi nร y cลฉng ฤ‘ฦฐแปฃc chแป‰ ฤ‘แป‹nh ฤ‘iแปu trแป‹ rแป‘i loแบกn sแบฏc tแป‘, nแบฟp nhฤƒn nhแป, vร  tฤƒng sแบฏc tแป‘ sau viรชm. Cรขn nhแบฏc viแป‡c bรดi thแปญ trฦฐแป›c khi peel vรฌ nรณ cรณ thแปƒ gรขy viรชm da tiแบฟp xรบc (Kede 2009). ฤแป‘i vแป›i peel resorcin แปŸ nแป“ng ฤ‘แป™ cao hฦกn vร  trรชn vรนng cรณ diแป‡n tรญch lแป›n cแบงn phแบฃi chฤƒm sรณc ฤ‘แบทc biแป‡t.

Bแบฃng 1: ฤiแปu trแป‹ luรขn phiรชn trong peel body

ฤiแปu trแป‹ luรขn phiรชn- peel body
Khoแบฃng thแปi gianVรนng ฤ‘iแปu trแป‹Loแบกi peelKhoแบฃng thแปi gian/ sแป‘ liแป‡u trรฌnh
Tuแบงn ฤ‘แบงuNgแปฑc vร  cแป•Dung dแป‹ch Jessner, glycolic acidHร ng thรกng hoแบทc mแป—i 2 thรกng/ 3-6
Tuแบงn thแปฉ 2Vรนng lฦฐng bร n tay vร  cแบณng tayTCA, dung dแป‹ch Jessner
Tuแบงn thแปฉ 3Vai vร  cรกnh taySalicylic acid
Tuแบงn thแปฉ 4ฤรนi vร  cแบณng chรขnThioglycolic acid

 

6.4. Tretinoin

Tretinoin cรฒn ฤ‘ฦฐแปฃc gแปi lร  reti- noic acid lร  mแป™t loแบกi thuแป‘c thuแป™c nhรณm retinoids ฤ‘ฦฐแปฃc sแปญ dแปฅng ฤ‘แปƒ peel nรดng bแป mแบทt. Cรดng thแปฉc peel nร y ฤ‘ฦฐแปฃc pha chแบฟ trong mแป™t dung dแป‹ch mร u vร ng cรณ tรชn lร  propylene glycol; acid ฤ‘ฦฐแปฃc sแปญ dแปฅng แปŸ nแป“ng ฤ‘แป™ tแปซ 5% ฤ‘แบฟn 12%. ฤแปƒ tฤƒng hiแป‡u quแบฃ thแบฉm mแปน cรณ thแปƒ thรชm thuแป‘c nhuแป™m vร o trong cรดng thแปฉc. Loแบกi peel nร y ฤ‘ฦฐแปฃc sแปญ dแปฅng rแป™ng rรฃi trong thแบฉm mแปน da nhแป cรณ nhiแปu tรกc dแปฅng phแป‘i hแปฃp nhฦฐ: khแบฃ nฤƒng lร m mแปng vร  sฤƒn chแบฏc lแป›p sแปซng thฦฐแปฃng bรฌ, khรดi phแปฅc nhแปฏng tแบฟ bร o khรดng ฤ‘iแปƒn hรฌnh cแปงa thฦฐแปฃng bรฌ, kรญch thรญch tรขn sinh collagen แปŸ lแป›p bรฌ, tฤƒng lแบฏng ฤ‘แปng glycosaminoglycan, kรญch thรญch tรกi tแป• chแปฉc cรกc sแปฃi collagen ฤ‘รฃ bแป‹ tแป•n thฦฐฦกng do tiแบฟp xรบc vแป›i รกnh sรกng mแบทt trแปi, vร  loแบกi bแป vร  phรขn tรกn nhแปฏng tรบi chแปฉa melanin trong cรกc tแบฟ bร o sแปซng (keratinocyte) (Kede 2009). Tretinoin ฤ‘ฦฐแปฃc sแปญ dแปฅng chแปง yแบฟu ฤ‘แปƒ ฤ‘iแปu trแป‹ lรฃo hรณa da vร  nhแปฏng thay ฤ‘แป•i da do รกnh sรกng mแบทt trแปi (vรญ dแปฅ: ฤ‘แป‘m da Civatte) (Landau 2008), trong ฤ‘iแปu trแป‹ cรกc tรฌnh trแบกng nhฦฐ viรชm nang lรดng sau cแบกo rรขu, mแปฅn, vแบฟt cรดn trรนng cแบฏn, vร  nรกm mรก khรดng แปŸ vรนng mแบทt, vร  tแป•n thฦฐฦกng do chแบฅn thฦฐฦกng ฤ‘แบทc biแป‡t lร  แปŸ vรนng thรขn vร  chi. Trong ฤ‘iแปu trแป‹ mแปฅn, cรณ thแปƒ phแป‘i hแปฃp thรชm vแป›i viแป‡c sแปญ dแปฅng loแบกi retinoin dรนng แปŸ nhร  ฤ‘แปƒ lร m tฤƒng viแป‡c loแบกi bแป mแปฅn cลฉng nhฦฐ ngฤƒn hรฌnh thร nh dร y sแปซng nang lรดng.

Peel retinoin thฦฐแปng ฤ‘ฦฐแปฃc sแปญ dแปฅng sau thแปง thuแบญt vi mร i da (micro- dermabrasion) vแป›i tinh thแปƒ aluminum oxide (trong thแปง thuแบญt nร y lแป›p thฦฐแปฃng bแป‹ ฤ‘ฦฐแปฃc loแบกi bแป theo cฦก chแบฟ vแบญt lรฝ). Phฦฐฦกng phรกp phแป‘i hแปฃp nร y lร m tฤƒng hiแป‡u quแบฃ ฤ‘iแปu trแป‹ do tฤƒng khแบฃ nฤƒng thแบฅm vร o sรขu hฦกn cแปงa acid (Hexsel 2005). Chแป‰ ฤ‘แป‹nh ฤ‘iแปu trแป‹ vแป›i peel nร y cรณ thแปƒ ฤ‘ฦฐแปฃc mแปŸ rแป™ng ฤ‘แปƒ ฤ‘iแปu trแป‹ nhแปฏng vแบฟt rแบกn da cลฉ (cรณ mร u trแบฏng ngแปc trai) cลฉng nhฦฐ nhแปฏng vแบฟt rแบกn mแป›i (cรณ mร u hแป“ng). Vแป›i chแป‰ ฤ‘แป‹nh nร y thรฌ nแป“ng ฤ‘แป™ retinoic acid nรชn dรนng lร  10% bรดi vร  giแปฏ trong khoแบฃng thแปi gian tแปซ 4-6 h, sau ฤ‘รณ rแปญa vแป›i nฦฐแป›c (Kede 2009). Peel nร y ฤ‘ฦฐแปฃc khuyแบฟn khรญch sแปญ dแปฅng sau nhแปฏng thแปง thuแบญt nhฦฐ ฤ‘รดng ฤ‘iแป‡n hoแบทc cryotherapy (รกp lแบกnh bแบฑng nitro- gen lแปng) trong ฤ‘iแปu trแป‹ cรกc bแป‡nh tฤƒng sinh thฦฐแปฃng bรฌ nhฦฐ dร y sแปซng tuyแบฟn bรฃ, dร y sแปซng รกnh sรกng, mแปฅn thแป‹t, tฤƒng sแบฃn tuyแบฟn bรฃ, vร  bแป‡nh sแบฉn ฤ‘en (papulosis nigricans). Cรกc nghiรชn cแปฉu cho thแบฅy rแบฑng sแปฑ phแป‘i hแปฃp nร y giรบp vแบฟt thฦฐฦกng nhanh lร nh hฦกn (Hung 1989), lร m ฤ‘แป“ng nhแบฅt hรณa tone mร u cแปงa da vร  cแบฃi thiแป‡n chแบฅt lฦฐแปฃng cแปงa da sau ฤ‘รณ.

Peel tretinoin thฦฐแปng khรดng ฤ‘au vร  dแป… thแปฑc hiแป‡n. Acid ฤ‘ฦฐแปฃc bรดi bแบฑng tay ฤ‘eo gang. Thแปi gian trung bรฌnh lร  khoแบฃng 3-4 ngร y da sแบฝ bong vแบฃy khรด vร  tรนy thuแป™c vร o nแป“ng ฤ‘แป™ vร  thแปi gian tiแบฟp xรบc vแป›i acid. Khoแบฃng cรกch giแปฏa cรกc liแป‡u trรฌnh cรณ thแปƒ lร  mแป—i hai tuแบงn hoแบทc mแป—i thรกng. ฤรขy lร  thแปง thuแบญt hoร n toร n khรดng ฤ‘au vรฌ tretinoin khรดng cรณ pH acid ฤ‘แปง ฤ‘แปƒ gรขy ฤ‘รดng vรณn protein แปŸ da. Vรฌ retinoic acid nhแบกy cแบฃm รกnh sรกng do ฤ‘รณ nรชn bรดi vร o buแป•i chiแปu tแป‘i trong ngร y vร  giแปฏ acid trรชn mแบทt trong รญt nhแบฅt 4-6 tiแบฟng (Landau 2008).

ฤแปƒ ฤ‘แบกt kแบฟt quแบฃ ฤ‘iแปu trแป‹ tแป‘t nhแบฅt, cรณ thแปƒ tฤƒng dแบงn thแปi gian tiแบฟp xรบc vแป›i acid trong mแป—i liแป‡u trรฌnh tแปซ 4-12h (tแป‘i ฤ‘a). Khรดng khuyแบฟn cรกo sแปญ dแปฅng loแบกi peel nร y แปŸ phแปฅ nแปฏ ฤ‘ang cรณ thai vร  ฤ‘ang trong thแปi gian cho con bรบ (hรฌnh 3a-c).

Hรฌnh 3: (a-c) Peel tretinoin 5% trong dung mรดi propylene glycol trong ฤ‘iแปu trแป‹ tฤƒng sแบฏc tแป‘ sau viรชm do chแบฅn thฦฐฦกng. (a) Trฦฐแป›c thแปง thuแบญt, (b) ngay sau khi lร m thแปง thuแบญt, vร  (c) sau liแป‡u trรฌnh ฤ‘แบงu tiรชn (ngร y thแปฉ 14).
Hรฌnh 3: (a-c) Peel tretinoin 5% trong dung mรดi propylene glycol trong ฤ‘iแปu trแป‹ tฤƒng sแบฏc tแป‘ sau viรชm do chแบฅn thฦฐฦกng. (a) Trฦฐแป›c thแปง thuแบญt, (b) ngay sau khi lร m thแปง thuแบญt, vร  (c) sau liแป‡u trรฌnh ฤ‘แบงu tiรชn (ngร y thแปฉ 14).

6.5. Fluorouracil

5 fluorouracil (5-FU) lแบง mแป™t base pyrimidine ฤ‘ฦฐแปฃc florite hรณa thuแป™c nhรณm khรกng chuyแปƒn hรณa hoแบกt ฤ‘แป™ng nhฦฐ mแป™t chแบฅt แป•n ฤ‘แป‹nh tแบฟ bร o trong ฤ‘iแปu trแป‹ nhแปฏng bแป‡nh ung thฦฐ vร  tiแปn ung thฦฐ da.

Phฦฐฦกng phรกp peel vแป›i chแบฅt nร y cรฒn ฤ‘ฦฐแปฃc gแปi lร  fluorouracil-pulsed peel vร  lร  sแปฑ phแป‘i hแปฃp cแปงa 2 loแบกi chแบฅt peel khรกc nhau, thฦฐแปng lร  phแป‘i hแปฃp thรชm vแป›i dung dแป‹ch Jessner hoแบทc gly- colic acid. Bฦฐแป›c ฤ‘แบงu tiรชn lร  bแบฏt ฤ‘แบงu peel vแป›i dung dแป‹ch Jessner hoแบทc gly- colic acid 70% แปŸ dแบกng gel lแปng. Nแบฟu bแบฏt ฤ‘แบงu vแป›i dung dแป‹ch Jesner thรฌ nรชn bรดi mแป™t hoแบทc hai lแป›p ฤ‘แบฟn khi ฤ‘แบกt ฤ‘ฦฐแปฃc ฤ‘แป da bฦฐแป›c ฤ‘แบงu (level 0) hoแบทc cรณ sแปฑ kแปƒ tแปงa cแปงa salicylic, sau ฤ‘รณ khรดng cแบงn phแบฃi trung hรฒa. Nแบฟu lร  sแปญ dแปฅng glycolic acid thรฌ phแบฃi trung hรฒa vแป›i nฦฐแป›c hoแบทc sodium bicarbonate. Bฦฐแป›c tiแบฟp theo bรดi dung dแป‹ch 5-FU 5% trong propyl- ene glycol hoแบทc dแบกng kem lรชn bแป mแบทt da (khรดng quรก 500 cm2, khoแบฃng 23 x 23 cm) vร  lฦฐu lแบกi trรชn da tแปซ 6-12h.

Thแปง thuแบญt nร y ฤ‘ฦฐแปฃc thแปฑc hiแป‡n hร ng tuแบงn hoแบทc mแป—i 2 tuแบงn, vแป›i tแป•ng 8 liแป‡u trรฌnh nแบฟu ฤ‘iแปu trแป‹ dร y sแปซng รกnh sรกng ฤ‘a ฤ‘iแปƒm. Trong mแป™t nghiรชn cแปฉu ฤ‘ฦฐแปฃc thแปฑc hiแป‡n bแปŸi Katz (1995), phแป‘i hแปฃp 5-fluorouracil vแป›i peel dung dแป‹ch Jessner giรบp lร m giแบฃm 86% tแป•n thฦฐฦกng ฤ‘ฦฐแปฃc nghiรชn cแปฉu; trong mแป™t nghiรชn cแปฉu khรกc , Marrero (1998) ฤ‘รฃ thu ฤ‘ฦฐแปฃc kแบฟt quแบฃ tแป‘t nhแบฅt lร  giแบฃm ฤ‘ฦฐแปฃc 92% tแป•n thฦฐฦกng khi phแป‘i hแปฃp vแป›i gly- colic acid 70%.

6.6. Glycolic acid

Glycolic acid (GA) cรณ nguแป“n gแป‘c tแปฑ nhiรชn trong mรญa, ฤ‘ฦฐแปฃc chiแบฟt xuแบฅt trong phรฒng nghiรชn cแปฉu ฤ‘แปƒ sแปญ dแปฅng nhฦฐ lร  hรณa chแบฅt peel. ฤรขy lร  loแบกi acid cรณ kรญch thฦฐแป›c phรขn tแปญ nhแป nhแบฅt trong cรกc acid thuแป™c nhรณm alpha hydroxy acid. Do ฤ‘รณ, so vแป›i nhแปฏng loแบกi acid cรนng nhรณm khรกc, glycolic acid cรณ khแบฃ nฤƒng xรขm nhแบญp vร o da dแป… dร ng hฦกn. GA cรณ thแปƒ ฤ‘ฦฐแปฃc sแปญ dแปฅng ฤ‘แปƒ peel nรดng hoแบทc peel rแบฅt nรดng tรนy thuแป™c vร o nแป“ng ฤ‘แป™ ฤ‘ฦฐแปฃc sแปญ dแปฅng, ฤ‘แป™ pH cแปงa cรดng thแปฉc vร  thแปi gian tiแบฟp xรบc vแป›i bแป mแบทt da (Clark vร  Scerri 2008; Fischer 2010). แปž nแป“ng ฤ‘แป™ 70%, pH thแบฅp hฦกn 1.0 GA cรณ thแปƒ cรณ hoแบกt tรญnh peel trung bรฌnh tรนy thuแป™c vร o thแปi gian tiแบฟp xรบc vแป›i bแป mแบทt da. Nแป“ng ฤ‘แป™ GA cร ng cao, pH cร ng thแบฅp, vร  thแปi gian tiแบฟp xรบc vแป›i da cร ng lรขu thรฌ peel sแบฝ cร ng sรขu. ฤแปu nร y cรณ ฤ‘ฦฐแปฃc do ฤ‘แบทc tรญnh sinh khแบฃ dแปฅng cao hฦกn cแปงa hรณa chแบฅt trong nhแปฏng ฤ‘iแปu kiแป‡n trรชn (Kede 2009).

Peel nร y ฤ‘ฦฐแปฃc chแป‰ ฤ‘แป‹nh nhฦฐ lร  ฤ‘iแปu trแป‹ hแป— trแปฃ ฤ‘แป‘i vแป›i tรฌnh trแบกng lรฃo hรณa รกnh sรกng แปŸ vรนng ngoร i mแบทt, mแปฅn viรชm, sแบนo mแปฅn teo, vร  trong nhแปฏng rแป‘i loแบกn sแบฏc tแป‘ nhฦฐ melasma vร  tฤƒng sแบฏc tแป‘ sau viรชm (Clark vร  Scerri 2008; Take- naka 2012; Callender 2011). Ngoร i ra cลฉng cรณ thแปƒ ฤ‘แบกt ฤ‘ฦฐแปฃc kแบฟt quแบฃ lรขm sร ng tแป‘t khi ฤ‘iแปu trแป‹ viรชm nang lรดng vร  viรชm giแบฃ nang lรดng แปŸ vรนng bแบนn vร  mรดng. Tรกc dแปฅng cแปงa GA cรณ ฤ‘ฦฐแปฃc lร  do nรณ cรณ hoแบกt tรญnh lร m sฤƒn chแบฏc lแป›p sแปซng, lร m dร y thฦฐแปฃng bรฌ, vร  tฤƒng lแบฏng ฤ‘แปng collagen vร  mucin แปŸ lแป›p bรฌ.

GA ฤ‘ฦฐแปฃc bรกn trรชn thแป‹ trฦฐแปng แปŸ dแบกng acid tแปฑ do, trung hรฒa mแป™t phแบงn. Cรกc sแบฃn phแบฉm cแปงa cรกc cรดng ty khรกc nhau sแบฝ cรณ pH khรกc nhau trong khoแบฃng tแปซ 1.0 ฤ‘แบฟn 3.0. Mแป™t vร i cรดng thแปฉc cรณ ฤ‘แป™ pH thแบฅp hฦกn trong khoแบฃng 0.6. ฤแป™ pH cร ng thแบฅp thรฌ lฦฐแปฃng acid tแปฑ do cร ng nhiแปu, cho phรฉp acid xรขm nhแบญp vร o da cร ng sรขu vร  quรก trรฌnh hรฌnh thร nh frosting (lแป›p phแปง trแบฏng nhฦฐ tuyแบฟt) cร ng nhanh vร  rแป™ng. Lแป›p frosting nร y cho thแบฅy ฤ‘ฦฐแปฃc vรนng da cรณ sแปฑ li giแบฃi cรกc tแบฟ bร o thฦฐแปฃng bรฌ, cรณ mร u sแบฏc tแปซ trแบฏng cho ฤ‘แบฟn trแบฏng xรกm tรนy thuแป™c vร o khแบฃ nฤƒng xรขm nhแบญp vร o da cแปงa GA (Clark vร  Scerri 2008). แปž vรนng da cรณ lแป›p sแปซng dร y, cรณ thแปƒ lแปฑa chแปn cรดng thแปฉc cรณ ฤ‘แป™ pH thแบฅp hฦกn (0.6-1.0) ฤ‘แปƒ lร m tฤƒng khแบฃ nฤƒng xรขm nhแบญp cแปงa acid mร  khรดng แบฃnh hฦฐแปŸng ฤ‘แบฟn tรญnh an toร n cแปงa thแปง thuแบญt. Tแบฅt cแบฃ cรกc loแบกi peel vแป›i alpha hydroxyl acid ฤ‘รฒi hแปi phแบฃi trung hรฒa khi ฤ‘รฃ ฤ‘แบกt ฤ‘ฦฐแปฃc ฤ‘แป™ sรขu mong muแป‘n. Cรณ thแปƒ trung hรฒa bแบฑng cรกch sแปญ dแปฅng cรกc dung dแป‹ch kiแปm hoแบทc nฦฐแป›c. Nรชn sแปญ dแปฅng dung dแป‹ch sodium bicarbonate 10% แปŸ dแบกng gel lแปng ฤ‘แปƒ trung hรฒa vรฌ vแป›i ฤ‘แบทc tรญnh cแปงa mแป™t dung dแป‹ch kiแปm nรณ sแบฝ gรขy sแปงi bแปt tแบกi vแป‹ trรญ ฤ‘ฦฐแปฃc trung hรฒa khi tiแบฟp xรบc vแป›i pH acid cแปงa dung dแป‹ch peel, ฤ‘แปu nร y giรบp kiแปƒm soรกt peel tแป‘t hฦกn ฤ‘แปƒ ฤ‘แบกt ฤ‘ฦฐแปฃc ฤ‘แป™ sรขu nhฦฐ chรบng ta mong muแป‘n.

Nแบฟu peel sau khi lร m sแบกch da hoร n toร n thรฌ nรชn bรดi mแป™t lแป›p mแปng GA. Sau ฤ‘รณ nรชn trung hรฒa ngay vแป›i sodium bicarbonate khi vรนng da peel bแบฏt ฤ‘แบงu xuแบฅt hiแป‡n frosting. Nรชn sแปญ dแปฅng bรดng tฤƒm ฤ‘แปƒ bรดi nhแบฑm trรกnh dung dแป‹ch acid xรขm nhแบญp quรก sรขu vร o da. Sau ฤ‘รณ khi thแบฅy cรณ sแปฑ xuแบฅt hiแป‡n ฤ‘แป da rรต vร  ฤ‘แป“ng nhแบฅt (level 0 -1) thรฌ tiแบฟn hร nh trung hรฒa toร n bแป™ vรนng da ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹. ฤแป da xuแบฅt hiแป‡n cho thแบฅy acid ฤ‘รฃ xรขm nhแบญp qua lแป›p sแปซng vร  bแบฏt ฤ‘แบงu xรขm nhแบญp vร o lแป›p hแบกt (Clark vร  Scerri 2008; Fischer 2010). Nรชn bแบฏt ฤ‘แบงu liแป‡u trรฌnh peel vแป›i GA 50% vร  sau ฤ‘รณ tฤƒng lรชn 70% cho liแป‡u trรฌnh tiแบฟp theo. Khแบฃ nฤƒng dung nแบกp cแปงa bแป‡nh nhรขn lร  rแบฅt tแป‘t khi peel GA แปŸ nแป“ng ฤ‘แป™ cao, bแป‡nh nhรขn ฤ‘แบงu tiรชn sแบฝ cแบฃm thแบฅy แบฅm vร  sau ฤ‘รณ hฦกi chรขm chรญch vร  cuแป‘i cรนng lร  rรกt nhแบน (hรฌnh 4a-d).

Hรฌnh 4: (a-e) Peel glycolic acid 70% (pH = 0.6) แปŸ dแบกng gel ฤ‘แปƒ ฤ‘iแปu trแป‹ tฤƒng sแบฏc tแป‘ sau viรชm. (a) trฦฐแป›c khi bรดi; (b) ngay sau khi bรดi gel trong suแป‘t; (c) xuแบฅt hiแป‡n sแปงi bแปt sau khi gel ฤ‘ฦฐแปฃc trung hรฒa bแบฑng sodium bicarbonate; (d) ngay sau khi bรดi; (e) sau liแป‡u trรฌnh thแปฉ 2 (ngร y thแปฉ 60)
Hรฌnh 4: (a-e) Peel glycolic acid 70% (pH = 0.6) แปŸ dแบกng gel ฤ‘แปƒ ฤ‘iแปu trแป‹ tฤƒng sแบฏc tแป‘ sau viรชm. (a) trฦฐแป›c khi bรดi; (b) ngay sau khi bรดi gel trong suแป‘t; (c) xuแบฅt hiแป‡n sแปงi bแปt sau khi gel ฤ‘ฦฐแปฃc trung hรฒa bแบฑng sodium bicarbonate; (d) ngay sau khi bรดi; (e) sau liแป‡u trรฌnh thแปฉ 2 (ngร y thแปฉ 60)

Mแบทc dรน phแปฅ thuแป™c vร o thแปi gian, nhฦฐng sแบฝ rแบฅt khรดng khรดn ngoan nแบฟu ฤ‘แปƒ ฤ‘iแปu nร y xแบฃy ra, thay vร o ฤ‘รณ cแบงn phแบฃi ฤ‘แบกt ฤ‘ฦฐแปฃc ฤ‘แป da cร ng ฤ‘แป“ng nhแบฅt cร ng tแป‘t khi peel. ฤแบทt biแป‡t phแบฃi hแบฟt sแปฉc lฦฐu รฝ khi peel แปŸ vรนng cแป• do lแป›p sแปซng thฦฐแปฃng bรฌ vรนng nร y mแปng hฦกn do ฤ‘รณ acid sแบฝ xรขm nhแบญp vร o da mแป™t cรกch nhanh chรณng. แปž nhแปฏng vรนng nร y, frosting vร  sแปฑ li giแบฃi thฦฐแปฃng bรฌ thฦฐแปng xแบฃy ra ฤแบทt biแป‡t phแบฃi hแบฟt sแปฉc lฦฐu รฝ khi peel แปŸ vรนng cแป• do lแป›p sแปซng thฦฐแปฃng bรฌ vรนng nร y mแปng hฦกn do ฤ‘รณ acid sแบฝ xรขm nhแบญp vร o da mแป™t cรกch nhanh chรณng. แปž nhแปฏng vรนng nร y, frosting vร  sแปฑ li giแบฃi thฦฐแปฃng bรฌ thฦฐแปng xแบฃy ra nhanh vร  nhiแปu hฦกn, do ฤ‘รณ phแบฃi giแปฏ sแบตn dung dแป‹ch trung hรฒa trรชn tay ฤ‘แปƒ nhanh chรณng trung hรฒa acid. ฤแบทc biแป‡t phแบฃi lฦฐu tรขm ฤ‘แบฟn nhแปฏng vรนng nแบฟp nhฤƒn do nhแปฏng vรนng nร y ฤ‘ฦฐแปฃc bรดi lฦฐแปฃng acid lแป›n hฦกn vร  thฦฐแปng gรขy ra nhแปฏng vแบฟt hoแบกi tแปญ nhแป. Kแบฟ hoแบกch ฤ‘iแปu trแป‹ vแป›i mแปฅc ฤ‘รญch nร y thฦฐแปng phแบฃi lร m trรชn 6 liแป‡u trรฌnh vแป›i khoแบฃng cรกch giแปฏa cรกc liแป‡u trแป‹ lร  2 tuแบงn hoแบทc 4 tuแบงn (Clark vร  Scerri 2008). GA lร  mแป™t loแบกi peel khรดng ฤ‘แป™c, do ฤ‘รณ khรดng gรขy ngแป™ ฤ‘แป™c hแป‡ thแป‘ng.

Tuy nhiรชn, nรชn sแปญ dแปฅng cรกc sแบฃn phแบฉm cแปงa cรนng mแป™t nhร  sแบฃn xuแบฅt ฤ‘แปƒ trรกnh sแปฑ khรกc biแป‡t vแป dung mรดi vร  ฤ‘แป™ pH.

6.7. Trichloroacetic acid

Trichloroacetic acid (TCA) lร  mแป™t chแบฅt แป•n ฤ‘แป‹nh, khรดng ฤ‘แบฏt vร  khรดng cแบงn phแบฃi trung hรฒa cลฉng nhฦฐ khรดng cรณ ฤ‘แป™c tรญnh hแป‡ thแป‘ng. Phฦฐฦกng phรกp peel nร y cรณ thแปƒ dแป… dร ng ฤ‘ฦฐแปฃc kiแปƒm soรกt vรฌ ฤ‘แป™ sรขu khi peel ฤ‘ฦฐแปฃc quyแบฟt ฤ‘แป‹nh bแปŸi cรกc thรดng sแป‘ lรขm sร ng liรชn quan tแป›i mแปฉc ฤ‘แป™ ฤ‘แป da, khu vแปฑc xuแบฅt hiแป‡n frost- ing vร  sแปฑ biแบฟn ฤ‘แป•i sแปฉc cฤƒng da nhฦฐ ฤ‘รฃ ฤ‘ฦฐแปฃc ฤ‘แป cแบญp trong mแป™t chฦฐฦกng trฦฐแป›c ฤ‘รณ. Lแป›p frosting hay lแป›p mร u trแบฏng ฤ‘ฦฐแปฃc tแบกo ra do khแบฃ nฤƒng tแบฅn cรดng cแปงa TCA, dแบซn ฤ‘แบฟn lร m biแบฟn tรญnh protein vร  hoแบกi tแปญ cรกc tแบฟ bร o da. TCA lร  mแป™t loแบกi peel linh ฤ‘แป™ng cรณ hiแป‡u quแบฃ trong trแบป hรณa da vรนng cฦก thแปƒ vร  tฤƒng sแบฏc tแป‘ thฦฐแปฃng bรฌ. TCA cรณ thแปƒ cรณ nhiแปu dแบกng ฤ‘iแปu chแบฟ nhฦฐ ฤ‘ฦฐแปฃc mรด tแบฃ bรชn dฦฐแป›i:

  • Trong dung mรดi nฦฐแป›c cแบฅt

TCA trong dung mรดi nฦฐแป›c cแบฅt ฤ‘ฦฐแปฃc sแปญ dแปฅng แปŸ nแป“ng ฤ‘แป™ 10-15% khi peel rแบฅt nรดng cรกc vรนng da body; 20-25 % ฤ‘แปƒ peel nรดng vร  trรชn 30% ฤ‘แปƒ peel trung bรฌnh, แปŸ nแป“ng ฤ‘แป™ 45% hoแบทc 50% acid nร y cรณ thแปƒ xรขm nhแบญp ฤ‘แบฟn lแป›p bรฌ lฦฐแป›i trรชn. แปž nแป“ng ฤ‘แป™ cao nhฦฐ thแบฟ nร y kแบฟt quแบฃ sแบฝ khรณ dแปฑ ฤ‘oรกn hฦกn vร  nguy cฦก biแบฟn chแปฉng cao khi peel แปŸ cแบฃ vรนng da mแบทt vร  vรนng da ngoร i mแบทt (Landau 2008).

Xuแบฅt phรกt tแปซ mแป‘i lo ngแบกi vแป sแปฑ xรขm nhแบญp quรก mแปฉc cแบงn thiแบฟt cแปงa peel, ngฦฐแปi ta ฤ‘รฃ phรกt triแปƒn phฦฐฦกng phรกp peel phแป‘i hแปฃp trong ฤ‘รณ sแปญ dแปฅng hai hoแบทc nhiแปu loแบกi hรณa chแบฅt peel trong cรนng mแป™t liแป‡u trรฌnh. Hiแป‡u quแบฃ cแปงa mแป—i hรณa chแบฅt sแบฝ phแป‘i hแปฃp vแป›i nhau. Trong phฦฐฦกng phรกp nร y thรฌ hรณa chแบฅt peel ฤ‘แบงu tiรชn ฤ‘ฦฐแปฃc sแปญ dแปฅng thฦฐแปng lร  mแป™t chแบฅt ly sแปซng nhฦฐ dung dแป‹ch Jessner hoแบทc glycolic acid 70%, sau ฤ‘รณ tiแบฟn hร nh bรดi ngay dung dแป‹ch TCA 35% pha trong nฦฐแป›c cแบฅt. phฦฐฦกng phรกp phแป‘i hแปฃp peel trung bรฌnh nร y ฤ‘รฃ trแปŸ nรชn rแบฅt phแป• biแบฟn ฤ‘แบทc biแป‡t ฤ‘แป‘i vแป›i nhแปฏng ฤ‘iแปu trแป‹ แปŸ vรนng mแบทt do phฦฐฦกng phรกp nร y dแป… thแปฑc hiแป‡n hฦกn, kiแปƒm soรกt tแป‘t hฦกn mแปฉc ฤ‘แป™ xรขm nhแบญp cแปงa hรณa chแบฅt vร o da, vร  ฤ‘แบกt ฤ‘ฦฐแปฃc mแปฉc ฤ‘แป™ frosting ฤ‘แป“ng nhแบฅt hฦกn so vแป›i chแป‰ sแปญ dแปฅng TCA ฤ‘ฦกn thuแบงn แปŸ nแป“ng ฤ‘แป™ cao (Monheit 1995; Coleman vร  Fu- trell 1994). Mแป™t vร i chuyรชn gia ฤ‘รฃ รกp dแปฅng phฦฐฦกng phรกp phแป‘i hแปฃp peel nร y vร o trong ฤ‘iแปu trแป‹ แปŸ cรกc vรนng da body vแป›i kแบฟt quแบฃ ฤ‘แบกt ฤ‘ฦฐแปฃc khรก tแป‘t ฤ‘แบทc biแป‡t lร  nhแปฏng tแป•n thฦฐฦกng lรฃo hรณa da mแปฉc ฤ‘แป™ trung bรฌnh. Tuy nhiรชn, ฤ‘แปƒ trรกnh tรกc dแปฅng khรดng mong muแป‘n, nhแปฏng bรกc sฤฉ chฦฐa cรณ kinh nghiแป‡m khรดng nรชn thแปฑc hiแป‡n loแบกi peel nร y.

Trong peel nรดng phแป‘i hแปฃp, ngฦฐแปi ta sแปญ dแปฅng TCA cรณ nแป“ng ฤ‘แป™ thแบฅp hฦกn tแปซ 15% ฤ‘แบฟn 25% ฤ‘ฦฐแปฃc pha trong nฦฐแป›c cแบฅt ฤ‘แปƒ peel sau khi bรดi dung dแป‹ch Jessner tแปซ mแป™t ฤ‘แบฟn hai lแป›p trฦฐแป›c ฤ‘รณ. Phฦฐฦกng phรกp nร y cho kแบฟt quแบฃ ฤ‘iแปu trแป‹ tแป‘t ฤ‘แป‘i vแป›i cรกc tรฌnh trแบกng tแป•n thฦฐฦกng da do รกnh sรกng mแปฉc ฤ‘แป™ nhแบน, rแป‘i loแบกn sแบฏc tแป‘, vร  cรกc ฤ‘แป‘m nรขu trong bแป‡nh poi- kiloderma of Civatte (Tung and Rubin 2011). Acid TCA trong peel nรดng cรณ thแปƒ xรขm nhแบญp ฤ‘แบฟn lแป›p thฦฐแปฃng bรฌ da vร  ฤ‘แบกt ฤ‘ฦฐแปฃc mแปฉc ฤ‘แป™ 1 cแปงa hiแป‡n tฦฐแปฃng frosting (ฤ‘แป da kรจm cรกc dแบฃi nhแป mร u trแบฏng) ). ฤแป‘i vแป›i cรกc rแป‘i loแบกn sแบฏc tแป‘ nแบฑm sรขu vร  ฤ‘แป‘m nรขu kรฉo dร i, sau khi peel nรดng phแป‘i hแปฃp cรณ thแปƒ peel bแบฑng acid TCA nแป“ng ฤ‘แป™ cao hฦกn tแปซ 35% ฤ‘แบฟn 50% tรนy khu vแปฑc cแปงa cฦก thแปƒ. Chแป‰ nรชn peel tiรชu ฤ‘iแปƒm vร  khu trรบ ฤ‘แปƒ ฤ‘iแปu trแป‹ riรชng biแป‡t cรกc tแป•n thฦฐฦกng vแป›i nhau.

Cook vร  Cook (200) ฤ‘รฃ mรด tแบฃ phฦฐฦกng phรกp phแป‘i hแปฃp peel trung bรฌnh khรดng dรนng cho da vรนng da mแบทt, trong ฤ‘รณ peel glycolic acid ฤ‘ฦฐแปฃc sแปญ dแปฅng ฤ‘แบงu tiรชn แปŸ dแบกng gel 70%, sau ฤ‘รณ bรดi TCA 40% pha trong nฦฐแป›c cแบฅt. Dung mรดi gel ฤ‘แป‘i vแป›i glycolic acid lร  cแบงn thiแบฟt bแปŸi vรฌ nรณ hoแบกt ฤ‘แป™ng nhฦฐ lร  mแป™t rร o cแบฃn ฤ‘แปƒ lร m tฤƒng khแบฃ nฤƒng xรขm nhแบญp cแปงa TCA. Sau khi ฤ‘แบกt ฤ‘ฦฐแปฃc mแปฉc ฤ‘แป™ frosting nhฦฐ mong muแป‘n, thรฌ tiแบฟn hร nh trung hรฒa vแป›i dung dแป‹ch sodium bicarbonate 10% ฤ‘แปƒ kแบฟt thรบc quรก trรฌnh peel.

  • แปž dแบกng hแป“ bแป™t

TCA cลฉng cรณ thแปƒ ฤ‘ฦฐแปฃc sแปญ dแปฅng แปŸ dแบกng hแป“ bแป™t vแป›i nแป“ng ฤ‘แป™ tแปซ 10-20%. Hแป“ bแป™t ฤ‘ฦฐแปฃc bรดi bแบฑng cรกch sแปญ dแปฅng que ฤ‘รจ lฦฐแปกi. Sau khi bรดi xong, cแบงn loแบกi bแป bแป›t mแป™t phแบงn hแป“ bแป™t tแบกo mแป™t โ€œcแปญa sแป•โ€ ฤ‘แปƒ cรณ thแปƒ quan sรกt ฤ‘รกnh giรก mแปฉc ฤ‘แป™ xรขm nhแบญp cแปงa acid do dแบกng hแป“ bแป™t ฤ‘แปฅc khรดng thแปƒ ฤ‘รกnh giรก ฤ‘ฦฐแปฃc. Mแบทc dรน โ€œcแปญa sแป•โ€ nร y khรดng thแปƒ ฤ‘แบกi diแป‡n cho toร n bแป™ vรนng da ฤ‘ฦฐแปฃc peel nhฦฐng lร  mแป™t cรกch chรญnh xรกc ฤ‘แปƒ ฤ‘รกnh giรก ฤ‘iแปƒm cuแป‘i lรขm sร ng vร  giรบp trung hรฒa acid ฤ‘รบng lรบc. Quรก trรฌnh trung hรฒa ฤ‘ฦฐแปฃc tiแบฟn hร nh bแบฑng cรกch sแปญ dแปฅng dung dแป‹ch alcohol ฤ‘แปƒ loแบกi bแป lแป›p hแป“ bแป™t TCA. ฤรขy lร  lแปฑa chแปn an toร n vร  hiแป‡u quแบฃ ฤ‘แปƒ tiแบฟn hร nh ฤ‘iแปu trแป‹ แปŸ vรนng bร n tay vร  cแบฃng tay.

  • แปž dแบกng gel

ฤรขy lร  dแบกng cรณ nแป“ng ฤ‘แป™ acid phรน hแปฃp nhแบฅt khi peel แปŸ vรนng body. Peel nร y sแปญ dแปฅng TCA แปŸ dแบกng gel trong suแป‘t, ฤ‘แป™ ฤ‘ร n hแป“i cao, dแป… sแปญ dแปฅng, รญt gรขy tai nแบกn lรบc peel, vร  cho phรฉp quan sรกt cรกc hiแป‡n tฦฐแปฃng da chuyแปƒn sang mร u trแบฏng vร  phรน nแป cแปงa toร n bแป™ vรนng da ฤ‘ฦฐแปฃc peel (ฤ‘รขy lร  nhแปฏng yแบฟu tแป‘ cแบงn thiแบฟt ฤ‘แปƒ ฤ‘รกnh giรก mแปฉc ฤ‘แป™ xรขm nhแบญp cแปงa acid). แปž dแบกng gel nร y thรฌ TCA sแบฝ ฤ‘ฦฐแปฃc bรดi ฤ‘แป“ng nhแบฅt hฦกn.

Quy trรฌnh chuแบฉn bแป‹ da trฦฐแป›c peel giแป‘ng vแป›i hฦฐแป›ng dแบซn trong bร i peel TCA, lฦฐu รฝ lร  phแบฃi ngฦฐng nhแปฏng chแบฅt cรณ hoแบกt tรญnh ly sแปซng trฦฐแป›c khi tiแบฟn hร nh thแปง thuแบญt. Acid TCA แปŸ loแบกi peel nร y ฤ‘ฦฐแปฃc sแปญ dแปฅng แปŸ nแป“ng ฤ‘แป™ thแบฅp hฦกn tแปซ 10% ฤ‘แบฟn 20%, phแปฅ thuแป™c vร o ฤ‘แป™ dร y lแป›p thฦฐแปฃng bรฌ cรนng vรนng cฦก thแปƒ ฤ‘ฦฐแปฃc peel vร  mแปฉc ฤ‘แป™ xรขm nhแบญp cแปงa hรณa chแบฅt peel muแป‘n ฤ‘แบกt ฤ‘ฦฐแปฃc. Phฦฐฦกng phรกp peel nร y ฤ‘ฦฐแปฃc chแป‰ ฤ‘แป‹nh ฤ‘แปƒ ฤ‘iแปu trแป‹ lรฃo hรณa da mแปฉc ฤ‘แป™ nhแบน vร  trung bรฌnh phรขn bแป‘ chแปง yแบฟu แปŸ vรนng trฦฐแป›c xฦฐฦกng แปฉc, cแป•, cแบณng tay, vร  mu bร n tay.

Peel ฤ‘ฦฐแปฃc tiแบฟn hร nh bแบฑng cรกch sแปญ dแปฅng tay mang gฤƒng ฤ‘แปƒ bรดi mแป™t lแป›p gel mแปng duy nhแบฅt (ฤ‘แป™ dร y tแปซ 0.1-0.2 mm) lรชn vรนng ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹ (Zanini 2007). Nhแป khแบฃ nฤƒng gรขy bรญt tแบฏt cแปงa dแบกng gel, acid xรขm nhแบญp nhanh hฦกn vร  ฤ‘แป“ng nhแบฅt hฦกn mร  khรดng cแบงn phแบฃi bรดi nhiแปu lแป›p nhฦฐ khi peel acid pha vแป›i nฦฐแป›c cแบฅt (Zanini 2007).

ฤแป™ sรขu peel thu ฤ‘ฦฐแปฃc khi peel TCA แปŸ dแบกng gel cรณ thแปƒ tแปซ level 0 (ฤ‘แป da ฤ‘แป“ng nhแบฅt) khi peel rแบฅt nรดng lแป›p thฦฐแปฃng bรฌ (loแบกi bแป toร n bแป™ lแป›p sแปซng thฦฐแปฃng bรฌ) ฤ‘แบฟn level 1 (xuแบฅt hiแป‡n frost- ing tแปซng dแบฃi vร  lแป‘m ฤ‘แป‘m trรชn nแปn ฤ‘แป da) khi peel แปŸ mแปฉc ฤ‘แป™ sรขu hฦกn nhแบฑm phรก hแปงy mแป™t phแบงn lแป›p thฦฐแปฃng bรฌ hoแบทc sรขu hฦกn . Khi peel แปŸ da trรชn vรนng cฦก thแปƒ, nรชn xem sแปฑ xuแบฅt hiแป‡n cแปงa cรกc dแบฃi frosting lร  thรดng sแป‘ ฤ‘รกnh giรก tแป‘i ฤ‘a mแปฉc ฤ‘แป™ xรขm nhแบญp cแปงa acid. Khรกc vแป›i peel TCA แปŸ dแบกng pha vแป›i nฦฐแป›c cแบฅt, chรบng ta sแบฝ phแบฃi loแบกi bแป ngay cร ng sแป›m cร ng tแป‘t acid khi ฤ‘แบกt ฤ‘ฦฐแปฃc ฤ‘iแปƒm cuแป‘i lรขm sร ng cแบงn thiแบฟt. Quรก trรฌnh loแบกi bแป acid cรณ thแปƒ ฤ‘ฦฐแปฃc thแปฑc hiแป‡n bแบฑng cรกch sแปญ dแปฅng gแบกc แบฉm cรณ thแบฅm cแป“n hoแบทc ฤ‘ฦกn giแบฃn hฦกn lร  sแปญ dแปฅng nฦฐแป›c ฤ‘แปƒ trรกnh acid xรขm nhแบญp sรขu quรก mแปฉc vร o da (hรฌnh 5a-d).

Hรฌnh 5: (a-d) Peel trichloroacetic acid 20% trong ฤ‘iแปu trแป‹ lรฃo hรณa da do รกnh sรกng. (a) trฦฐแป›c thแปง thuแบญt, (b) trong quรก trรฌnh lร m thแปง thuแบญt (frosting level 1), (c) vแบฃy vร  mร i nรขu (ngร y thแปฉ 6), vร  (d) sau liแป‡u trรฌnh thแปฉ nhแบฅt (ngร y thแปฉ 40).
Hรฌnh 5: (a-d) Peel trichloroacetic acid 20% trong ฤ‘iแปu trแป‹ lรฃo hรณa da do รกnh sรกng. (a) trฦฐแป›c thแปง thuแบญt, (b) trong quรก trรฌnh lร m thแปง thuแบญt (frosting level 1), (c) vแบฃy vร  mร i nรขu (ngร y thแปฉ 6), vร  (d) sau liแป‡u trรฌnh thแปฉ nhแบฅt (ngร y thแปฉ 40).

ฤiแปu trแป‹ theo phฦฐฦกng phรกp nร y cรณ thแปƒ hoร n tแบฅt vแป›i 2 ฤ‘แบฟn 3 liแป‡u trรฌnh peel, khoแบฃng cรกch giแปฏa cรกc lแบงn peel lร  45-60 ngร y. Peel nแป“ng ฤ‘แป™ thแบฅp nhiแปu ฤ‘แปฃt liรชn tiแบฟp giรบp ฤ‘แบกt ฤ‘ฦฐแปฃc kแบฟt quแบฃ ฤ‘iแปu trแป‹ tแป‘t, แป•n ฤ‘แป‹nh vร  cรณ thแปƒ dแปฑ ฤ‘oรกn ฤ‘ฦฐแปฃc trong khi khi vแบซn ฤ‘แบฃm bแบฃo tรญnh an toร n vแป›i nguy cฦก bแป‹ rแป‘i loแบกn sแบฏc tแป‘ vร  hรฌnh thร nh sแบนo thแบฅp hฦกn. Thแปi gian phแปฅc hแป“i sau thแปง thuแบญt tฦฐฦกng tแปฑ nhฦฐ khi peel TCA pha trong dung dแป‹ch nฦฐแป›c cแบฅt hoแบทc แปŸ dแบกng hแป“ bแป™t, trong thแปi gian nร y da bong vแบฃy mแปng mร u nรขu. Cแบงn lฦฐu รฝ lร  sแปฑ xuแบฅt hiแป‡n giรฃn mแบกch gรขy ra bแปŸi TCA trรชn vรนng cรณ diแป‡n tรญch lแป›n cแปงa cฦก thแปƒ cรณ thแปƒ gรขy hแบก huyแบฟt รกp, nhแป‹p nhanh vร  ngแบฅt.

6.8. Thioglycolic acid

Thioglycolic acid lร  mแป™t ฤ‘แบกi diแป‡n cแปงa nhรณm thioglycolate, ฤ‘รขy lร  nhแปฏng hแปฃp chแบฅt ฤ‘รฃ ฤ‘ฦฐแปฃc sแปญ dแปฅng tแปซ lรขu trong ngร nh cรดng nghiแป‡p lร m ฤ‘แบนp ฤ‘แปƒ sแบฃn xuแบฅt thuแป‘c tแบฉy lรดng, duแป—i tรณc vร  nhuแป™m tรณc (Costa 2010). Acid nร y cรฒn ฤ‘ฦฐแปฃc gแปi lร  mercaptoacetic acid, trong thร nh phรขn cแปงa nรณ cรณ chแปฉa sulfur vร  cรณ khแบฃ nฤƒng tan nhiแปu trong nฦฐแป›c vร  alcohol, vร  lร  loแบกi acid dแป… bแป‹ oxi hรณa. Acid nร y cรณ mรนi rแบฅt mแบกnh vร  ฤ‘แบทc biแป‡t. รi tรญnh cแปงa acid nร y vแป›i sแบฏt thฦฐฦกng tแปฑ nhฦฐ รกi tรญnh cแปงa nรณ vแป›i apoferritin: nhรณm thiol trong thร nh phแบงn cแบฅu trรบc cแปงa nรณ cho phรฉp chelate hรณa sแบฏt trong phรขn tแปญ hemosiderin (Costa 2010). Phฦฐฦกng phรกp peel nร y ฤ‘ฦฐแปฃc sแปญ dแปฅng cho nhแปฏng bแป‡nh nhรขn cรณ phรขn loแบกi da tแปซ tรญp I ฤ‘แบฟn IV ฤ‘แปƒ ฤ‘iแปu trแป‹ cรกc rแป‘i loแบกn sแบฏc tแป‘ cรณ nguแป“n gแป‘c do melanin hoแบทc hemosiderin nhฦฐ tฤƒng sแบฏc tแป‘ vรนng quanh แป• mแบฏt (Costa 2010) vร  viรชm da ochre (Yokomizo 2013).

แปž dแบกng gel, acid cรณ nแป“ng ฤ‘แป™ tแปซ 5% ฤ‘แบฟn 12%. Khi peel body ฤ‘แปƒ ฤ‘iแปu trแป‹ viรชm da ochre แปŸ chi dฦฐแป›i chรบng tรดi khuyแบฟn cรกo sแปญ dแปฅng liแป‡u trรฌnh ฤ‘iแปu trแป‹ nhiแปu ฤ‘แปฃt, mแป—i ฤ‘แปฃt cรกch nhau 2 hoแบทc 4 tuแบงn, vแป›i nแป“ng ฤ‘แป™ acid tแปซ 10% ฤ‘แบฟn 12%. Sau khi lร m sแบกch vรนng da, tiแบฟn hร nh bรดi mแป™t lแป›p gel mแปng (0.1-0.2 mm) bแบฑng tay mang gฤƒng. Hiแป‡u quแบฃ cแปงa peel thioglycolic acid trแปฑc tiแบฟp phแปฅ thuแป™c vร o thแปi gian bรดi. Nรชn tiแบฟn hร nh rแปญa sแบกch vแป›i nฦฐแป›c ngay khi xuแบฅt hiแป‡n ฤ‘แป da hoแบทc frosting แปŸ level 0. Khi peel bแป‡nh nhรขn cรณ thแปƒ cแบฃm thแบฅy khรณ chแป‹u kรจm vแป›i xuแบฅt hiแป‡n ฤ‘แป da rแปi rแบกc tแบกi thแปi ฤ‘iแปƒm bรดi. Trong khoแบฃng 3 ngร y sau peel, cรณ thแปƒ sแบฝ xuแบฅt hiแป‡n tแปซ ฤ‘แป da nhแบน cho ฤ‘แบฟn bong vแบฃy mแปng mร u nรขu แปŸ mแป™t sแป‘ ฤ‘iแปƒm, tรนy thuแป™c vร o thแปi gian tiแบฟp xรบc vแป›i acid. Cแบงn phแบฃi ฤ‘แบทc biแป‡t lฦฐu รฝ nguy cฦก acid xรขm nhแบญp sรขu quรก mแปฉc khi peel แปŸ vรนng chi dฦฐแป›i vรฌ vรนng nร y da khรณ lร nh hฦกn vรนng khรกc.

7. CHฤ‚M Sร“C ฤแบถC BIแป†T SAU THแปฆ THUแบฌT

Chรบng tรดi chia quy trรฌnh chฤƒm sรณc ฤ‘แบทt biแป‡t sau thแปง thuแบญt thร nh 2 giai ฤ‘oแบกn: chฤƒm sรณc ngay khi kแบฟt thรบc thแปง thuแบญt vร  chฤƒm sรณc nhแปฏng ngร y sau thแปง thuแบญt.

7.1. Chฤƒm sรณc ngay kแบฟt thรบc thแปง thuแบญt

Peel rแบฅt nรดng vรนng body thฦฐแปng khรดng gรขy ฤ‘au, nhฦฐng cรณ thแปƒ cแบฃm thแบฅy ngแปฉa hoแบฏc hฦกi nรณng rรกt, nhแปฏng cแบฃm giรกc nร y sแบฝ biแบฟn mแบฅt trong vร i phรบt. Trong peel nรดng toร n bแป™ lแป›p thฦฐแปฃng bรฌ sแบฝ bแป‹ hoแบกi tแปญ, ฤ‘แบทc biแป‡t lร  khi peel bแบฑng TCA, ฤ‘แบงu tiรชn bแป‡nh nhรขn sแบฝ cแบฃm thแบฅy nรณng, sau ฤ‘รณ lร  cแบฃm giรกc rรกt bแปng vแปซa phแบฃi. Cรณ thแปƒ ฤ‘แบฏp gแบกc lแบกnh hoแบทc mรกy lร m mรกt ฤ‘แปƒ giแบฃm cแบฃm giรกc nร y cho bแป‡nh nhรขn.

7.2. Chฤƒm sรณc nhแปฏng ngร y sau thแปง thuแบญt

Cรกch lร m trong trฦฐแปng hแปฃp nร y rแบฅt giแป‘ng trong trฦฐแปng hแปฃp peel da แปŸ vรนng mแบทt. Nรชn giแปฏ sแบกch vรนng da ฤ‘รฃ ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹ vแป›i xร  phรฒng hoแบทc lotion rแปญa ฤ‘แป‘i vแป›i da nhแบกy cแบฃm vร  nรชn luรดn dฦฐแปกng แบฉm cho da trong 5-7 ngร y vแป›i cรกc sแบฃn phแบฉm dฦฐแปกng แบฉm ฤ‘แบทc hoแบทc lแปng nhฦฐ Vaselin, cรกc loแบกi gel hoแบทc kem dฦฐแปกng แบฉm ฤ‘แปƒ thay thแบฟ cho hร ng rร o da vแป‘n ฤ‘รฃ bแป‹ tแป•n thฦฐฦกng do peel hรณa chแบฅt. Quรก trรฌnh lร m แบฉm sแบฝ giรบp lร m dแป‹u cแบฃm giรกc ฤ‘au vร  bแปng rรกt sau thแปง thuแบญt. ฤแป‘i vแป›i nhแปฏng vรนng da tiแบฟt nhiแปu dแบงu, thรฌ nรชn sแปญ dแปฅng cรกc sแบฃn phแบฉm รญt chแปฉa dแบงu trong thร nh phแบงn. Quy trรฌnh chฤƒm sรณc nร y sแบฝ giรบp ngฤƒn ngแปซa bรนng phรกt tแป•n thฦฐฦกng dแบกng mแปฅn trแปฉng cรก sau thแปง thuแบญt.

Hai ngร y sau ฤ‘iแปu trแป‹ cรณ thแปƒ bแบฏt ฤ‘แบงu sแปญ dแปฅng chแป‘ng nแบฏng phแป• rแป™ng (chแป‘ng cแบฃ tia UVA vร  UVB), ฦฐu tiรชn sแปญ dแปฅng cรกc sแบฃn phแบฉm cรณ chแปฉa nhแปฏng thร nh phแบงn chแป‘ng nแบฏng vแบญt lรฝ trong thร nh phแบงn cแปงa nรณ. Viแป‡c sแปญ dแปฅng chแป‘ng nแบฏng ngay sau khi lร m thแปง thuแบญt cรณ thแปƒ gรขy cแบฃm giรกc bแปng rรกt; do ฤ‘รณ sแปญ dแปฅng chแป‘ng nแบฏng khรดng cรณ thร nh phแบงn hรณa hแปc nรชn ฤ‘ฦฐแปฃc chแป‰ ฤ‘แป‹nh ฤ‘แปƒ trรกnh gรขy kรญch แปฉng da. Nรชn trรกnh phฦกi nแบฏng trong nhแปฏng ngay sau khi lร m thแปง thuแบญt, dรน ฤ‘รฃ cรณ sแปญ dแปฅng chแป‘ng nแบฏng phรน hแปฃp thรฌ tแป‘t nhแบฅt vแบซn nรชn trรกnh รกnh nแบฏng. Nแบฟu peel แปŸ vรนng cแบณng tay vร  bร n tay, chรบng tรดi khuyแบฟn cรกo nรชn ngฦฐng nhแปฏng hรณa chแบฅt cรณ liรชn quan ฤ‘แบฟn nhแปฏng hoแบกt ฤ‘แป™ng nแป™i tแบกi nhฦฐ xร  phรฒng vร  chแบฅt tแบฉy rแปญa cรณ tรญnh chแบฅt mร i mรฒn da, cho tแป›i khi quรก trรฌnh tรกi tแบกo thฦฐแปฃng bรฌ hoร n tแบฅt.

Nhแปฏng sแบฃn phแบฉm ฤ‘iแปu trแป‹ thoa tแบกi chแป— แปŸ nhร  nรชn bแบฏtฤ‘แบงu sแปญ dแปฅng ngay khi quรก trรฌnh viรชm sau thแปง thuแบญt biแบฟn mแบฅt. Cแบงn lฦฐu รฝ lร  phแบฃi mแบทc quแบงn รกo rแป™ng rรฃi, thแปa mรกi ฤ‘แปƒ hแบกn chแบฟ ma sรกt vร o vรนng ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹.

8. BIแบพN CHแปจNG

Nhiแป…m khuแบฉn vร  nแบฅm hiแบฟm khi xแบฃy ra ฤ‘แป‘i vแป›i thแปง thuแบญt peel rแบฅt nรดng hoแบทc peel nรดng body bแปŸi vรฌ thแปง thuแบญt nร y chแป‰ phรก hแปงy lแป›p thฦฐแปฃng bรฌ mร  thรดi. Nแบฟu peel ฤ‘แปƒ lแบกi nhแปฏng tแป•n thฦฐฦกng sรขu khรดng mong muแป‘n thรฌ vรนng da ฤ‘รณ cแบงn phแบฃi ฤ‘ฦฐแปฃc rแปญa bแบฑng dung dแป‹ch acetic acid 0.25% tแปซ 2 ฤ‘แบฟn 4 lแบงn mแป—i ngร y,

sau ฤ‘รณ rแปญa lแบกi bแบฑng nฦฐแป›c sแบกch. Cรกch nร y giรบp vแบฟt thฦฐฦกng giแบฃm ฤ‘รณng mร i vร  giแบฃm nguy cฦก bแป‹ nhiแป…m trรนng. Tuy nhiรชn nแบฟu bแป‹ nhiแป…m trรนng, thรฌ ngay lแบญp tแปฉc sแปญ dแปฅng khรกng sinh vร  tiแบฟn hร nh lแบฅy bแป‡nh phแบฉm nuรดi cแบฅy lร m khรกng sinh ฤ‘แป“. Nแบฟu ฤ‘แปu trแป‹ kแป‹p thแปi cรณ thแปƒ sแบฝ lร m giแบฃm ฤ‘ฦฐแปฃc nhแปฏng biแบฟn chแปฉng cรณ thแปƒ xแบฃy ra sau nร y.

Nแบฟu bแป‡nh nhรขn cรณ tiแปn sแปญ tรกi nhiแป…m herpes แปŸ vรนng da ฤ‘ฦฐแปฃc ฤ‘iแปu trแป‹ hoแบทc vรนng lรขn cแบญn thรฌ nรชn tiแบฟn hร nh ฤ‘iแปu trแป‹ dแปฑ phรฒng herpes vแป›i acyclo- vir 200mg, 5 lแบงn mแป—i ngร y, hoแบทc vala- cyclovir 500mg, 2 lแบงn mแป—i ngร y. Liแป‡u trรฌnh ฤ‘iแปu trแป‹ bแบฏt ฤ‘แบงu 2 ngร y trฦฐแป›c thแปง thuแบญt vร  tiแบฟp tแปฅc thรชm 5 ngร y sau khi peel hoแบทc cรณ thแปƒ duy trรฌ cho ฤ‘แบฟn khi quรก trรฌnh tรกi tแบกo thฦฐแปฃng bรฌ diแป…n ra hoร n tแบฅt (Tung vร  Rubin 2011; Anitha 2010).

Nแบฟu cรณ vรนng da chแบญm lร nh vแบฟt thฦฐฦกng vแป›i biแปƒu hiแป‡n lรขm sร ng lร  ฤ‘แป da kรฉo dร i hoแบทc xuแบฅt hiแป‡n nhแปฏng vแบฟt loรฉt nhแป thรฌ nรชn sแปญ dแปฅng corticoste- roid bรดi vแปซa ฤ‘แบฟn mแบกnh, cรณ thแปƒ sแปญ dแปฅng thรชm khรกng sinh bรดi nแบฟu cแบงn thiแบฟt. Cรกch tiแบฟp cแบญn nร y giรบp giแบฃm thiแปƒu tแป‘i ฤ‘a nguy cฦก xuแบฅt hiแป‡n cรกc biแบฟn chแปฉng tฤƒng vร  giแบฃm sแบฏc tแป‘ hoแบทc hรฌnh thร nh sแบนo trong tฦฐฦกng lai.

9. KแบพT LUแบฌN

Khi mร  peel trung bรฌnh แปŸ vรนng mแบทt ฤ‘ฦฐแปฃc xem lร  mแป™t thแปง thuแบญt ฤ‘ฦกn giแบฃn thรฌ viแป‡c thแปฑc hiแป‡n thแปง thuแบญt nร y แปŸ vรนng da khรกc trรชn cฦก thแปƒ khรดng phแบฃi lร  mแป™t lร  lแปฑa chแปn tแป‘t do tแป‰ lแป‡ biแบฟn chแปฉng cao nhฦฐ chแบญm lร nh vแบฟt thฦฐฦกng vร  thแบญm chรญ lร  sแบนo xแบฅu. Do ฤ‘รณ khuyแบฟn cรกo chแป‰ nรชn peel nรดng แปŸ vรนng da ngoร i vรนng mแบทt vร  kแบฟt quแบฃ lรขm sร ng cรณ thแปƒ thแบฅy ฤ‘ฦฐแปฃc sau mแป™t vร i liแป‡u trรฌnh ฤ‘iแปu trแป‹

Bแบฃng 2: Hรณa chแบฅt peel body vร  chแป‰ ฤ‘แป‹nh chรญnh.

Hรณa chแบฅt peel body

Chแป‰ ฤ‘แป‹nh

Salicylic acidMแปฅn trแปฉng cรก, dร y sแปซng nang lรดng, nรกm mรก
Dung dแป‹ch JessnerTฤƒng sแบฏc tแป‘ sau viรชm, nรกm mรก, da bแป‹ tแป•n thฦฐฦกng do รกnh sรกng
ResorcinTฤƒng sแบฏc tแป‘ sau viรชm
TretinoinDa bแป‹ tแป•n thฦฐฦกng รกnh sรกng
5-FluouracilDร y sแปซng รกnh sรกng
Glycolic acidLรฃo hรณa da รกnh sรกng, mแปฅn viรชm, sแบนo mแปฅn, vร  rแป‘i loแบกn sแบฏc tแป‘
Trichoroacetic acidTแป•n thฦฐฦกng รกnh sรกng nhแบน, rแป‘i loแบกn sแบฏc tแป‘, poikiloder- ma of Civatte
Thioglycolic acidTฤƒng sแบฏc tแป‘ do hemosiderin, viรชm da ochre

 

Nรชn peel da body phแป‘i hแปฃp vแป›i chฤƒm sรณc tแบกi nhร  ฤ‘แปƒ cรณ thแปƒ ฤ‘แบกt ฤ‘ฦฐแปฃc kแบฟt quแบฃ ฤ‘iแปu trแป‹ tแป‘t nhแบฅt. ฤแปƒ hแบกn chแบฟ biแบฟn chแปฉng vร  rรบt ngแบฏn thแปi gian hแป“i phแปฅc cแปงa bแป‡nh nhรขn, cรณ thแปƒ phแป‘i hแปฃp peel hรณa chแบฅt vแป›i nhแปฏng cรดng nghแป‡ khรกc nhฦฐ ฤ‘รดng ฤ‘iแป‡n hoแบทc cryotherapy (รกp lแบกnh nitฦก lแปng) khi ฤ‘iแปu trแป‹ nhแปฏng tแป•n thฦฐฦกng dร y.

Trong nhแปฏng kฤฉ thuแบญt hiแป‡n cรณ, thรฌ peel hรณa chแบฅt body lร  mแป™t phฦฐฦกng phรกp ฤ‘iแปu trแป‹ hiแป‡u quแบฃ, chi phรญ thแบฅp vร  cho kแบฟt quแบฃ lรขm sร ng rรต rแป‡t. Do ฤ‘รณ vแป›i cรกc bรกc sฤฉ nhแปฏng ngฦฐแปi mร  chแป‰ รกp dแปฅng ฤ‘iแปu trแป‹ hแบกn chแบฟ cรกc cรดng nghแป‡ nhฦฐ laser vร  IPL thรฌ nรชn xem peel da nhฦฐ lร  mแป™t sแปฑ lแปฑa chแปn thay thแบฟ (bแบฃng 2).

10. GHI NHแปš

  • Peel hรณa chแบฅt cho vรนng da ngoร i mแบทt khรดng chแป‰ ฤ‘ฦฐแปฃc khuyแบฟn cรกo ฤ‘แป‘i vแป›i mแป™t sแป‘ bแป‡nh cแปฅ thแปƒ mร  cรฒn ฤ‘แปƒ hแป— trแปฃ cho cรกc ฤ‘iแปu trแป‹ khรกc.
  • Mแป™t vร i hรณa chแบฅt ฤ‘ฦฐแปฃc chแป‰ ฤ‘แป‹nh ฤ‘แปƒ peel body nhฦฐ salicylic acid, dung dแป‹ch Jessner, retinoic acid, gly- colic acid, TCA, vร  thioglyolic
  • Thแปi gian lร nh vแบฟt thฦฐฦกng khi peel body dร i hฦกn so vแป›i peel da แปŸ vรนng mแบทt.
  • Khi mร  peel trung bรฌnh แปŸ vรนng mแบทt ฤ‘ฦฐแปฃc xem lร  mแป™t thแปง thuแบญt ฤ‘ฦกn giแบฃn thรฌ viแป‡c thแปฑc hiแป‡n thแปง thuแบญt nร y แปŸ vรนng da khรกc trรชn cฦก thแปƒ khรดng phแบฃi lร  mแป™t lร  lแปฑa chแปn tแป‘t do tแป‰ lแป‡ biแบฟn chแปฉng cao nhฦฐ chแบญm lร nh vแบฟt thฦฐฦกng vร  thแบญm chรญ lร  sแบนo xแบฅu.
  • Khuyแบฟn cรกo chแป‰ nรชn peel nรดng แปŸ vรนng da ngoร i vรนng mแบทt vร  kแบฟt quแบฃ lรขm sร ng cรณ thแปƒ thแบฅy ฤ‘ฦฐแปฃc sau mแป™t vร i liแป‡u trรฌnh ฤ‘iแปu trแป‹.
  • Cรณ thแปƒ phแป‘i hแปฃp peel hรณa chแบฅt vแป›i nhแปฏng cรดng nghแป‡ khรกc nhฦฐ ฤ‘รดng ฤ‘iแป‡n hoแบทc cryotherapy (รกp lแบกnh nitฦก lแปng) khi ฤ‘iแปu trแป‹ nhแปฏng tแป•n thฦฐฦกng dร y.
  • Peel hรณa chแบฅt body lร  mแป™t phฦฐฦกng phรกp ฤ‘iแปu trแป‹ hiแป‡u quแบฃ, chi phรญ thแบฅp vร  cho kแบฟt quแบฃ lรขm sร ng rรต rแป‡t.
  • Nรชn trรกnh tiแบฟp xรบc nhiแปu vแป›i รกnh sรกng mแบทt trแปi trong nhแปฏng ngร y trฦฐแป›c vร  sau thแปง thuแบญt ฤ‘แปƒ hแบกn chแบฟ tแป‘i ฤ‘a nguy cฦก hoแบกt hรณa cรกc tแบฟ bร o sแบฏc tแป‘ vร  lร m tฤƒng sแบฏc tแป‘ sau thแปง thuแบญt.

11. THAM KHแบขO

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  2. Brody HJ. Super๏ฌcial peeeling. In: Brody HJ, editor. Chemical peel- ing and resurfacing. 2nd ed. St Louis: Mosby Year Book; 1997. p. 73โ€“108.
  3. Brubacher JR, Hoffmann RS. Salicylism from topical salicylates: re- view of the literature. J Clin Toxicol. 1996;34(4):431โ€“6.
  4. Callender VD, St Surin-Lord S, Davis EC, et al. Post- in๏ฌ‚ammatory hy- perpigmentation. Etiologic and thera- peutic considerations. Am J Clin Der- matol. 2011; 12(2):87โ€“99.
  5. Clark E, Scerri L. Super๏ฌcial and mรฉdium-depth chemical peels. Clin Dermatol. 2008;26:209โ€“18.
  6. Coleman WP, Futrell JM. The gly- colic acid tri- chloroacetic acid peel. J Dermatol Surg Oncol. 1994;20(1):76โ€“ 80.
  7. Cook K, Cook JR. Chemical peel of nonfacial skin using glycolic acid gel augmented with TCA and neutral- ized based on visual staging. Dermatol Surg. 2000;26:11.
  8. Costa IMC, Gomes CM. Peelings mรฉdios/Peles clara e negra/รreas extrafaciais. In: Mateus A, Palermo E, edi- tors. Cosmiatria e laser: prรกtica no consultรณrio mรฉdico. 1ath ed. Sรฃo Paulo: AC Farmacรชutica; 2012. p. 167โ€“ 74. Costa A, Basile AVD, Medeiros VLS, Moisรฉs TA, Ota FS, Palandi JAC. Peel- ing de gel de รกcido tioglicรณlico 10%: opรงรฃo segura e e๏ฌciente na pigmen- taรงรฃo infraorbicular constitucion- al. Surg Cosmet Dermatol. 2010; 2(1):29โ€“33.
  9. Dainichi T, Ueda S, Imayama S, Furue M. Excellent clin- ical results with a new preparation for chemical peeling in acne: 30% salicylic acid in polyethylene glycol vehi- cle. Derma- tol Surg. 2008;34:891โ€“9.
  10. Fischer TC, Perosino E, Poli F, Viera MS, et al. Chemical peels in aesthetic dermatology: an update 2009. J Eur Acad Dermatol Venereol. 2010;24:281โ€“92.
  11. Hexsel D, Mazzuco R, Dalโ€™forno T, Zechmeister.
  12. Microdermabrasion fol- lowed by a 5% retinoid acid chemical peel vs. a 5% retinoid acid chemical peel for the treatment of photoaging โ€“ a pilot study. J Cosmet Dermatol. 2005;4(2):111โ€“6.
  13. Hung VC, Lee JY, Zitelli JA, Heb- da PA. Topical tretinoin and epithe- lial wound healing. Arch Dermatol. 1989;1255:65โ€“9.
  14. Katzย ย  BE.ย ย  The ๏ฌ‚uor-hydroxy pulse peel: a pilot evaluation of a new super๏ฌcial chemical peel. Cosmet Der- matol. 1995;8:24โ€“30.
  15. Kede MPV. Dermatologia estรฉti- ca. Sรฃo Paulo: Ed Atheneu; 2009.
  16. Landau M.Chemical peels. Clin Dermatol. 2008;26:200โ€“ 8.
  17. Marrero GM, Katz BE. The new ๏ฌ‚uor-hydroxy pulse peel. A combina- tion of 5-๏ฌ‚uoruracil and glycolic acid. Dermatol Surg. 1998;24:973โ€“8.
  18. Monheit GD. The Jessnerโ€™s โ€“ tri- chloroacetic acid peel. An enhanced medium โ€“ depth chemical peel. Der- matol Clin. 1995;13:277โ€“83.
  19. Peterson JD, Goldman MP. Reju- venation of the aging chest. A review and our experience. Dermatol Surg. 2011;37:555โ€“71.
  20. Takenaka Y, Hayashi N, Takeda M, et al. Glycolic acid chemical peeling improves in๏ฌ‚ammatory acne erup- tions through its inhibitory and bac- tericidal effects on Propionibacterium acnes. J Dermatol. 2012;39:350โ€“4. Tung CR, Rubin MG. Procedures in cosmetic dermatology series: body peeling. In: Chemical peels, vol. 12. 2nded. Philadelphia: Elsevier; 2011. p. 117โ€“22.
  21. Yokomizo VMF, Benemond TMH, Chisaki C, Benemond PH. Peel- ings quรญmicos: revisรฃo e aplicaรงรฃo prรกtica. Surg Cosmet Dermatol. 2013;5(1):58โ€“68.
  22. Zanini M. Trichloroacetic acid โ€“ a new method for an old acid. Med Cut Iber Lat Am. 2007;35(1):14โ€“7.

Tham khแบฃo thรชm mแป™t sแป‘ bร i viแบฟt cรนng chแปง ฤ‘แป

 

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Ngร y viแบฟt:
Nฤƒm 2009: Tแป‘t nghiแป‡p Y ฤa Khoa tแบกi trฦฐแปng ฤ‘แบกi Hแปc Y Hร  Nแป™i Nฤƒm 2010: Bแบฏt ฤ‘แบงu lร m viแป‡c tแบกi Phรฒng khรกm Da liแป…u Hร  Nแป™i Nฤƒm 2016: Lร  bรกc sฤฉ tแบกi Khoa Phแบซu thuแบญt Laser- vแบญt lรฝ trแป‹ liแป‡u - chฤƒm sรณc da, Bแป‡nh viแป‡n Da Liแป…u Hร  Nแป™i

BรŒNH LUแบฌN