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Chemexfoliation: Indications and cautions
Volume 18 Number 5, Part 1 May 1988
4. 5. 6. 7.
8. 9. 10. 11.
dermatitis herpetiformis. Br J Dermatol 1979;101:42933. Davies MG, Marks R, Nuki G. Dermatitis herpetiform i s - - a skin manifestation to a generalized disturbance in immunity. Q J Med 1978;186:221-48. Tedesco AS, Lynch PS. Association of dermatitis herpetifonnis and pernicious anemia. Arch Dermatol 1979; 119:115-7. Thomas JR, Su WFD. Concurrence of lupus erythematous and dermatitis herpetiformis. Arch Dermatol 1983; 119:740-5. Lodin AB, Stigell PO. Dermatitis herpetiformis: cases observed at the dermatologic clinic, Karolinska, Sjukhuset 1954-1963. Acta Derm Venereol Stockh 1965;45:35565. Alexander JOD. Dermatitis herpetiformis. Philadelphia: WB Saunders, 1975. Holt S, Blackwell JN. Dermatitis herpetiformis and diabetes mellitus. Postgrad Med J 1980;56:15-7. Reuna/a T, Solo OP, Tiilikainen A, Selroos O, Kuitunen P. Family studies in dermatitis herpetiformis. Ann Clin Res 1976;8:254-61. Walsh CH, Cooper BT, Wright AD, Malins JM, Cooke WT. Diabetes mellitus and cardiac disease: a clinical study. Q I Med 1978;185:89-100.
Chemexfoliation: Indications and cautions To the Editor: I would like to offer a few historical notes on the article by Lober (J AM ACAD DERMATOL 1987;17:109-12). In the first decades of this century chemical peeling was practiced by dermatologists in Europe. In general use were a resorcinol paste of Unna (zinc paste, 40 gm, resorcinol, 40 gm, ichthammol, 10 gm, petrolatum, 10 gm) and Lassar's prescription (13-naphthol, 10 gm, sulfur, 40 gin, sapo viridis [tincture of soap], 25 gm, petrolatum, 25 gm). Resorcinol is a less irritating hydrocarbon than phenol. The indications were "rejuvenation" of a wrinkled skin with irregular pigmentation and actinic keratoses. Unna's paste was applied for 3 to 4 days. When the skin became brown and shriveled, a mask of zinc gelatin (Unna's boot) was applied. After an overnight stay, the mask, with the adherent dead skin, was removed and a soothing application was given. When I became an associate in the practice of my father Dr. M. E. Polano in 1935, he still occasionally used chemical peeling but gradually we thought that the results did not outweigh the cumbersomeness of this treatment and we abandoned it. Stein, ~ in his contribution to the monumental "Handbuch" of Jadassohn,
Correspondence
1149
stated that chemical peeling was being gradually abandoned. Apparently lay institutes were of a different opinion. In recent decades, probably stimulated by the overwhelming interest of the public in cosmetic treatments, dermatologists became interested again. The methods in use at present for chemical peeling are excellently described in Lober's article and in the contributions of Stagnone 2 and Baker and Gordon. 3
M. K. Polano, M.D. Zwaluwenweg 25 1261 GH Blaricum, The Netherlands
REFERENCES 1. Stein RO. Jadassohn's Handbuch der Haut und Geschlechtskrankheiten. Berlin: Julius Springer, 1930;13: 69-92. 2. Stagnone JJ. Chemical peeling and chemabrasion. In: Epstein J, Epstein J Jr. Skin surgery. 7th ed. Philadelphia: WB Saunders, 1987:412-22. 3. Baker TJ, Gordon HL. Chemical peeling with phenol. In: Epstein J, Epstein J Jr. Skin surgery. 7th ed. Philadelphia: WB Saunders, 1987:423-38.
Reply To the Editor: I reviewed with great interest Dr. Polano's historical submission detailing methods of chemical peeling used earlier in this century. It is not surprising that resorcinol, a more soluble and less irritating compound than phenol, was effective. Walker t reported in 1922 on using "peeling the skin with resorcin" as a treatment for ache. "Equal parts of resorcin and Unna's zinc paste, thickly spread, are applied continuously to the skin for three or four days. At the end of this period some soothing ointment is applied, and in a day or two more the skin peels off in large flakes, bringing with it the hyperkeratotic horny layer and a large number of comedones." It is pleasing to see historical vignettes available in the JOURNAL. Although we have much to learn from clinical and basic science research, one can only hope that we will never lose track of where we have been.
REFERENCE 1. Walker, N. An introduction to dermatology. 7th ed. New York: William Wood, 1922:202.
Clifford W. Lober, M.D., F.A.C.P. 800 N. Central Ave., Kissimmee, FL 32741
4. 5. 6. 7.
8. 9. 10. 11.
dermatitis herpetiformis. Br J Dermatol 1979;101:42933. Davies MG, Marks R, Nuki G. Dermatitis herpetiform i s - - a skin manifestation to a generalized disturbance in immunity. Q J Med 1978;186:221-48. Tedesco AS, Lynch PS. Association of dermatitis herpetifonnis and pernicious anemia. Arch Dermatol 1979; 119:115-7. Thomas JR, Su WFD. Concurrence of lupus erythematous and dermatitis herpetiformis. Arch Dermatol 1983; 119:740-5. Lodin AB, Stigell PO. Dermatitis herpetiformis: cases observed at the dermatologic clinic, Karolinska, Sjukhuset 1954-1963. Acta Derm Venereol Stockh 1965;45:35565. Alexander JOD. Dermatitis herpetiformis. Philadelphia: WB Saunders, 1975. Holt S, Blackwell JN. Dermatitis herpetiformis and diabetes mellitus. Postgrad Med J 1980;56:15-7. Reuna/a T, Solo OP, Tiilikainen A, Selroos O, Kuitunen P. Family studies in dermatitis herpetiformis. Ann Clin Res 1976;8:254-61. Walsh CH, Cooper BT, Wright AD, Malins JM, Cooke WT. Diabetes mellitus and cardiac disease: a clinical study. Q I Med 1978;185:89-100.
Chemexfoliation: Indications and cautions To the Editor: I would like to offer a few historical notes on the article by Lober (J AM ACAD DERMATOL 1987;17:109-12). In the first decades of this century chemical peeling was practiced by dermatologists in Europe. In general use were a resorcinol paste of Unna (zinc paste, 40 gm, resorcinol, 40 gm, ichthammol, 10 gm, petrolatum, 10 gm) and Lassar's prescription (13-naphthol, 10 gm, sulfur, 40 gin, sapo viridis [tincture of soap], 25 gm, petrolatum, 25 gm). Resorcinol is a less irritating hydrocarbon than phenol. The indications were "rejuvenation" of a wrinkled skin with irregular pigmentation and actinic keratoses. Unna's paste was applied for 3 to 4 days. When the skin became brown and shriveled, a mask of zinc gelatin (Unna's boot) was applied. After an overnight stay, the mask, with the adherent dead skin, was removed and a soothing application was given. When I became an associate in the practice of my father Dr. M. E. Polano in 1935, he still occasionally used chemical peeling but gradually we thought that the results did not outweigh the cumbersomeness of this treatment and we abandoned it. Stein, ~ in his contribution to the monumental "Handbuch" of Jadassohn,
Correspondence
1149
stated that chemical peeling was being gradually abandoned. Apparently lay institutes were of a different opinion. In recent decades, probably stimulated by the overwhelming interest of the public in cosmetic treatments, dermatologists became interested again. The methods in use at present for chemical peeling are excellently described in Lober's article and in the contributions of Stagnone 2 and Baker and Gordon. 3
M. K. Polano, M.D. Zwaluwenweg 25 1261 GH Blaricum, The Netherlands
REFERENCES 1. Stein RO. Jadassohn's Handbuch der Haut und Geschlechtskrankheiten. Berlin: Julius Springer, 1930;13: 69-92. 2. Stagnone JJ. Chemical peeling and chemabrasion. In: Epstein J, Epstein J Jr. Skin surgery. 7th ed. Philadelphia: WB Saunders, 1987:412-22. 3. Baker TJ, Gordon HL. Chemical peeling with phenol. In: Epstein J, Epstein J Jr. Skin surgery. 7th ed. Philadelphia: WB Saunders, 1987:423-38.
Reply To the Editor: I reviewed with great interest Dr. Polano's historical submission detailing methods of chemical peeling used earlier in this century. It is not surprising that resorcinol, a more soluble and less irritating compound than phenol, was effective. Walker t reported in 1922 on using "peeling the skin with resorcin" as a treatment for ache. "Equal parts of resorcin and Unna's zinc paste, thickly spread, are applied continuously to the skin for three or four days. At the end of this period some soothing ointment is applied, and in a day or two more the skin peels off in large flakes, bringing with it the hyperkeratotic horny layer and a large number of comedones." It is pleasing to see historical vignettes available in the JOURNAL. Although we have much to learn from clinical and basic science research, one can only hope that we will never lose track of where we have been.
REFERENCE 1. Walker, N. An introduction to dermatology. 7th ed. New York: William Wood, 1922:202.
Clifford W. Lober, M.D., F.A.C.P. 800 N. Central Ave., Kissimmee, FL 32741