BOOK

REVIEWS

Textbook of chemical peels: Supercial, medium and deep peels in cosmetic practice Philippe Duprez, New York, 2007, Informa Healthcare. 400 pages. $329.95. ISBN-13: 978-184184495-4. This excellent treatise on chemical peeling features two standout attributes that make it a worthwhile manual for all those interested in this procedure and target its readership as both the beginning and more experienced physician employing these techniques. These are, rstly, the practical component of this book, and secondly, the global experience of this European author. This latter feature adds an international avor to this treatise, and introduces several products that may not be on the knowledge forefront of the American physician. This book features extensive basic science, including a discussion of chemical peeleinduced histologic changes, the mechanisms of action of the various chemical peeling agents, wound healing, and remodeling features, with an emphasis on newly recognized remodeling cytokines, such as heat shock proteins. Paradigm boxes are sprinkled throughout the chapters and include practical tips of care and various factors that might inuence the particular choice of chemical peels. The rst section focuses on classifying the various chemical peeling agents. What is different from other books on this subject is that the author actually goes into the specic time and number of layers of application for each chemical peeling agent. In addition, he emphasizes many important and often unrecognized features, such as the strengths of and interactions between the various agents. The second part of the book is perhaps its most valuable. It delves into the most intricate procedural aspects of chemical peels and post-peel care. Here again, the European experience offers a different perspective from that in the United States. There is a section on the utilization of herbs, as well as the use of traditional tyrosinase-inhibiting agents to prevent pigment dyschromia, and novel compounds of agents including tretinoin and urea. The central text focuses on practical issues of choosing the appropriate peeling agent and discusses them in sections highlighted by their specic characteristics as supercial, mid-, or deep-penetrating agents. Novel approaches to traditional techniques, such as a variation on simple trichloroacetic

acid peels using saponified stabilized solution with adjuvant additives to induce full dermal regeneration to the papillary dermis, may be somewhat confusing to American physicians. These techniques are not commonly used by physicians in the United States, but may be equated to the more frequently utilized Jessners trichloroacetice acid or solid carbon dioxide peels. There are helpful tables that outline the chemical structures and clinical characteristics of each agent. The section on alpha hydroxy acids is particularly well organized and emphasizes the importance of buffers and neutralization protocols. This approach helps the dermatologist customize treatment protocols in terms of the number of treatments, different depths of penetration, and specific facial rejuvenation approach. The author mentions new, innovative treatment programs for enhanced results. Some utilize phytic acid solution complexed with alpha hydroxy acids, and require no neutralization. In addition, there is an emphasis on the treatment of acne, striae distensae, and scars, and the utilization of combination procedures with intense pulsed light, lasers, and fillers. Safety and toxicity considerations are thoroughly covered and include a section on the recognition and management of arrhythmias. Novel approaches to post-peel care, such as the utilization of bismuth subgallate powder masks, are also emphasized. There are productive tips on the prevention and management of complications relating to wound care, healing, and the identication of high-risk groups. In terms of areas for improvement, I would have liked to see the inclusion of data from more clinical studies (where they exist). For US physicians, the differential nomenclature used by the European author and the inclusion of named commercial products could be confusing. The European avor, however, was more of a plus than a minus, given the different approaches discussed by the author. Overall, I found this book to be a useful, in-depth reference, which I recommend for any dermatologist interested in improving their sophistication in the art and science of chemical skin peeling. Neil S. Sadick, MD New York, New York

doi:10.1016/j.jaad.2007.05.011

1104

DECEMBER 2007

J AM ACAD DERMATOL