Has anyone performed a  lactic peel on a rosacea client?   I read online that rosacea clients can achieve great results from this.  I have always avoided peels on rosacea. 

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Gina,

I have had great success with the Sensi Peel from PCA Skin. I also suggest that they begin to use a very powerful antioxidant supplement with grapeseed extract because a naturopath that I bring in from Scottsdale once a month said this will help strengthen capillary walls. Most in the market place are not powerful enough. I recommend Arbonne Essentials juice form or microtech 95% grapeseed pill form. The microtech website is a distributor's website so those are retail prices, if you want the name of the company directly I can send you their number. 

The arbonne baby lotion is the one miracle cream I have seen for eczema and rosacea. I could not believe it, and I could not believe when a dermatologist told me about it. It completely cured my eczema on the elbows. And I didn't even finish the bottle.

I have done lactic peel before my wedding to have some good looks and it gave me good results after that i continued with my rosacea skin care cream.

I am definitely not very good with lactic peels, but the peel I have had amazing results with on a rosacea skin is the Active Peel from Yonka. Excellent! Never ever in the 8 years that I have been using it, has gave me any problems on any skin types or conditions. It leaves the skin glowing.

Gina

I have not really seen a topical acid do what some claim online but with that said, I also look at what a chemical acid is doing to the skin. If you look at the cause of rosacea, how is a chemical peel helping counter that cause?  Some say massaging the skin can help and that would imply a circulatory issue but increasing cell movement, I am not so sure.

Rosacea has many forms and some are so mild as to be only a flushing of the skin to some types that are very sad.  Maybe you have seen such cases. I have always felt that sometimes it is best to NOT handle a client and refer to an MD for topical or internal medications that we as skin care pros cannot prescribe. Sometimes success as a skin care professional comes from the clients we decide not to take then the ones we do.

Rosacea / Acne... such a bummer for those who have to go through it. Best of luck with your client.

Marty

SkinCareScience.com

Yes, it can be very helpful, but you definitely want to start small - low %'s, higher pH's, and short applications.  Neutralize well.  

They help for several reasons...  1) by stimulating turnover and production of healthy cells, lactic peels plump up the skin and create a cushion of healthy cells between the epidermis and the capillaries under the skin, reducing the level of sensitivity and appearance of those capillaries; 2) because lactic is a humectant, it binds moisture into the epidermis, helping to prevent trans-epidermal water loss; 3) lactic is also a brightener, and those genetic rosacea types usually need some gentle brightening, too. 

I like to follow my LA peels for rosacea with Hydropeptide's Instant Miracle Mask, which has a cooling sensation and reduces redness by introducing a healthy concentration of peptides to the skin.

Christine

I almost did not respond.  Only because there are so many ideas and opinions within the skin care industry but...  {  I do not want to offend you or anybody else :)   }

"Rosacea is not curable. Nonetheless it is a treatable condition which can be moderated by the informed physician. Caring for the rosacea patients requires a dedication on the part of the clinician and the patient. Naturally treatment schedules are determined by the stage and severity of the disease."

"Rosacea patients have skin which is unusually vulnerable to chemical and physical insults. All sources of local irritation such as soaps, alcoholic cleansers, tinctures and astringents, abrasives and peeling agents must be avoided. Only very mild soaps or properly diluted detergents are advised..."

Acne and Rosacea      Pleig - Kligman     (page 439 - First and Second paragraph)

Nothing I say is my own. Everything I say must be either backed by many many years of medical findings inside and outside of the US. FDA, Health Canada or the EU. There are and have been medical strides made with regards to some skin conditions but the lion share of the ones that licensed skin care professionals see are still the same and treated the same.

But what you said from my understanding has not been proven yet and some parts are suspect.  Sorry for the confrontational post.  It is not what I mean to do...

Marty

SkinCareScience.com

you first plan shoukd be to control the inflammation before considering peels.  ive had great success with circadias rosecea line.  once the inflammation subsides, and is in check, ive started with true enzymes, oxygen treatments, then peels after prepping skin over time.  while lactic can decrease senstivity, rosecea is inflammatory.  creating a controlled wound on inflammed skin increases risk of cell damage.  you need to study and understand the benefit and harm involved with inflamnation... also wound healing

Thanks Marty, I don't find your response to be confrontational at all.  You are correct that there are many opinions and approaches within the community.  I do stand by my protocols as they reflect both my training and the years of good results that I have seen.  I also think it's worth mentioning that when my rosacea clients need adjunct dermatological care, they tend to do better on rx finacea (azelaic acid) than metrogel (antifungal).  I would also note that most of the rosacea clients that I see are HIGHLY underexfoliated, with lots of sebaceous activity - this is probably a geographical phenomenon, as I'm in the hot humid dirty South, and dry skin is a rarity here.  When I do see a rosacea client with sensitized skin, I focus on restoring the barrier before adding exfoliation.  Finally, I failed to mention that I ALWAYS use light therapy (either LED or LHE) after performing a mild peel on a rosacea client, and I believe the combination is extremely efficacious.  

The bottom line with rosacea is that it is not understood yet.  When Kligman was practicing and researching, the milder acids were not yet in common use in the field.  I have not looked into whether he did any research with lactic and rosacea, but given his vintage (those were the days of phenol and carbolic acid peels, remember), it may not have been something readily available that he would have studied.  Additionally, he did all his research in the Northeast, where the colder, dry climate would have led to much more highly reactive rosacea presentations.

Christine

The results are in the eye of the client so what is one to say, results are the results. But your second post definitely speaks of a deep personal / professional experience in much more detail then your first, and I am sure any skin care professional will find it very informative, as did I.

Allow me to offer this:

1975 and 1993 where the years this particular book were published.  Second edition was 1993. But..

I would like to mention that the use of AHAs was known very early on:

“Van Scott a dermatologist and skin biologist, Yu a dermatopharmacologist and skin chemist—submitted the landmark publication in October 1974”

I have the unique position of being the past CEO / Managing Director of a skin care line that originated in 1995 and used extensive glycolic acids within its formulas. Maybe you will remember these two dr.s (Van Scott & Yu) and their company (TriStrata) filing legal action on every single company who used AHA in their formulas.  Google (TriStrata Technology, Inc. v. Mary Kay Inc.) it and it will come up.  Even my old company will come up in the mix. Tristrata won, I think close to 100 million in damages and those big skin care companies paid. They had to.

The legal council for Tri-Strata is actually a friend of mine.  Well friend might stretch the truth but I could call him tomorrow and he would take my call and talk about life and family. :) Any way, its worth a read if your interested in the foundation of the skin care industry.

And don’t forget the ‘Mother of Skin Care’, Cleopatra…and how long ago that was.

Regarding Phenol… (Landmark case of a single women, her picture made it to all the Derm conferences regarding topical procedures and its potential)

Phenol was used on an older lady with remarkably cobble-stoned skin (Maybe you have seen the picture?).  She was very fair Fitz II or even Fitz I and here skin was deeply wrinkled.  It was bad.  After a full face phenol the results were beyond words and at that time with plastic surgery in its infancy or I should say, break out period, these topical results were un-heard of.  That case brought on what we have today and as of 1990 – 1995, the AHA craze within the medical field brought out the top skin care lines you see today. The explosion of skin care lines actually happened 1996 – 1999.

Regarding Azelaic acid…

Azelaic acid is an FDA ingredient. Meaning you cannot use it at certain percentages without a prescription or being over-the-counter. At the percentages that I wanted to use, (I wanted a cream with 20% - that is where the research for results starts) the FDA had too much to say to me so it was not worth continuing the formula.  Its like today’s SPF products, if you are not compliant with FDA, your products are off the market and quickly. 

A point on Humidity…

Humidity increases TEWL in most cases at a specific level then when humidity rises past that point TEWL stops, so the processes of exfoliation are normally brought to a halt as a result of this back and forth. They say, according to my research, that a loss of water within the skin of 10% stops the enzyme process, which the skin uses to break down the structure holding cells together. That might explain the sebaceous activity and large number of acne clients in your area? I cannot really say about the ‘dry skin’ being a rarity in your area, I am on the west coast.

I can say this, though, with west coast clients and acne / Sensitive Skin, I advise them to NOT take long hot steamy showers.  It does make a difference.  But that is just me giving some advice on just one more thing a person can do to ‘see’ if it helps.

Your second posts gave me food for thought and that is why I like these boards and the interaction.

 

Marty

SkinCareScience.com

Great info Marty.  There really is so much more for me to read and learn.

I do think that your experience with azelaic acid is a great reminder that so much does depend on the original hypotheses that researchers use to set up clinical trials.  For example, you mentioned that you wanted at least a 20% azelaic formulation since that's where the research started at that time, however now we know that azelaic at 15% (finacea) helps immensely for rosacea (where 20%, azelex, is more effective for acne).  Add to this the fact that I hope we all realize that there will be some rosacea sufferers who gain relief from 20%, and some acne sufferers for whom 15% is sufficient.  I find the same principle to be true with other acids, specifically lactic as we had originally discussed.  Just because Kligman and Pleweg observed negative outcomes with the peels available at that time, which as you point out were still primarily phenolic peels, does not mean that no acid is ever beneficial in rosacea care...  if anything, the positive outcomes with azelaic acid strongly reinforce to me that other keratolytic acids, particularly lactic which has secondary beneficial effects, are indeed effective when, as I and other posters who use it have pointed out, the concentrations are low, the pH not too low, and the application times very short initially until skin's resilience is restored.

Since I have only ever practiced esthetics in New Orleans, and only ever lived in Southern cities, my observations regarding the humidity and TEWL are just that, however my observations are reinforced by the traditional practice of having clients use more humectant-based mositurizers in the summer, and more emollient-rich blends in the winter.

Christine,

On the lac acid point with regards to a more humid environment, one of my educators in a colder climate (Canada) cringes with the use of acid peels on rosacea clients. She is overly protective and not too adventurous but that is her opinion and the way of it as she sees it.

I would be willing to give it a go but I would want to know exactly what treatment or medical treatment she received in the past and if at any time oral meds have been taken. The only formula I have is 40% 3.5pH so in this post Gina does not specifiy percentage or pH. But at 3.5pH that makes it a pretty week acid in addition to its original state.

Gina, I cannot help but think you received a lot of information.  Got a little off topic on my part but I learned a few things as well.

Marty

SkinCareScience.com

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