·铜胜肽可取代用于术后刺激和炎症的皮质类固醇或非类固醇抗炎药。
·乙酰六肽-3是一种类肉毒杆菌毒素因子，可单独使用或以注射的形式辅助使用。
·外用透明质酸，可单独使用或以注射填充剂的形式辅助使用。
化学换肤通过破坏一定深度的皮肤，以达到刺激皮肤新生、改善肤质和外观的目的。根据作用深度，通常分为浅层换肤、中层换肤或深层换肤。目前可用于浅层化学换肤试剂包括α-羟基酸（AHAS）（如，羟基乙酸[GA]）和β-羟基酸（BHAs）（如水杨酸）。β-十八碳烯氨酸（高达10%）为水杨酸的衍生物，广泛用于欧洲。三氯醋酸可用于浅层换肤（10%–20%）和中层换肤（35%）。换肤组合，如Monheit组合（Jessner溶液加TCA），Brody组合（干冰加TCA），Coleman组合（70%GA加TCA）以及Jessner溶液联合GA均可用于中层换肤。深层换肤通常使用以苯酚为基液，包括Baker-Gordon苯酚换肤和Hetter换肤（苯酚或巴豆油换肤）。
浅层换肤安全性高且耐受性良好，通常仅有轻微不适（如，短暂的灼热感、刺激和红斑）。罕有疤痕、炎症后色素过度沉着（PIH）和感染。炎症后色素过度沉着可因日照而加重，因此应叮嘱患者在恢复期注意防晒和密切注意病情发展。在中层和深层换肤中，可出现与施用换肤剂有关的分界线。矫饰在非换肤肌肤交界处的化学换肤溶液可避免这种情况。更深层的化学换肤的副作用，包括色素变化、感染、过敏反应、愈合不良、过敏症和潜在疾病恶化。防止并发症的最好方法是辨别处于危险期的患者，以及保持适当的换肤深度，以平衡疗效和已知的副作用。
许多佐剂（如，AHAs、BHAs，维甲酸，皮肤漂白制剂）可用于增强化学换肤的效果并降低PIH的发生率。化学换肤前使用AHAs和BHAs是有益的。可在浅层或中层换肤2-3周前使用含AHAs和BHAs润肤膏。这些试剂可使角质层变薄，从而让皮肤表面变得更均匀并方便化学换肤剂深层渗透。维甲酸也是优良的换肤前药物；但是，维甲酸也有增加刺激的可能性，换肤前1周停止使用维甲酸可减少这种刺激。已证明联合化学换肤和外用漂白剂治疗色素沉着过度有效。化学换肤可引起表皮剥脱，从而使美白剂渗透得更深。
对苯二酚（氢醌，HQ）是改善现有色素沉着的金标准，是体内外最有效的黑色素生成抑制剂之一，被广泛用于治疗黑素沉着病和其他色素沉着性疾病。众所周知，HQ的色素脱失活性在一定程度上与其充当酪氨酸酶替代基质的能力有关，在黑素细胞中与酪氨酸氧化对抗。联合使用浓度为4%的HQ与维甲酸是非常有效的。其它常用的脱色剂，包括曲酸、抗坏血酸（维生素C）和烟酰胺，通常用作佐剂或HQ治疗后的维持疗法。
在化学换肤和激光美容治疗中存在PIH的风险；因此，教育患者日常进行积极防晒至关重要。有几种方法可减少或消除术后黑色素形成，如抑制酪氨酸酶的合成，使用铜复合物来抑制酪氨酸酶的功能，消除聚合物形成的氧化反应，减慢黑素体转移到角化细胞的速度，或作用于上游刺激黑素生成的激素。目前，市场上绝大多数的脱色剂经由上述作用机制抑制酪氨酸酶而起作用。
皮肤美白剂多被制成更美观的乳剂。这些产品的额外特点为，其内部多种成分更为分散于乳液中。最近，有临床试验采用通过皮肤科医生的评估和设备测量肤色来研究凝胶基质配方的有效性。其它皮肤参数（如，保湿性，质地，屏障的完整性，pH值）也进行评估以便医生了解皮肤使用美白制后的皮肤健康状况。随着科技和测量技术的进步，辨别这些剂型在不同皮肤类型中的功效变得越发容易。
激光治疗的最终目标是改善肤质和肤色。对于皮肤晒伤的患者，剥脱性激光换肤确实是最有效的治疗方法。该技术热诱导全层表皮和真皮剥蚀，并反馈促进细胞因子介导的真皮胶原形成和表皮再生。各种非剥脱性方法也用于治疗光损伤皮肤。采用非剥脱性治疗，表皮不受影响，因此可减少剥脱性治疗时大面积的伤口护理和停工期的需要。已证明，联合非剥脱性激光治疗与外用药妆品比仅使用其中一个更为有效。在剥脱性激光换肤之前外用维甲酸，可显著加快术后愈合和表皮再生（图A和B）。维甲酸在夜间至少使用2周，最好在剥脱性激光治疗前3个月开始使用。术前1周，应立即停止使用。
Before(A)andafter(B)treatmentwithafractionallaserincombinationwithapre-andpostprocedureskincareregimenconsistingofretinoidsandsunscreen.
治疗前（A）和治疗后（B），点阵激光联合含维甲酸和防晒霜的术前和术后皮肤护理。
非剥脱性治疗后，外用维甲酸也可有效减少红斑和增加皮肤厚度。已证实，在激光治疗前使用维甲酸，可降低术后粟丘疹、色素沉着过度的风险，也可使角质层变薄让激光束更好的渗入。剥脱性换肤术后，应停止使用维甲酸数周，使表皮新生和充分愈合。
下附英文原文：
PracticePoints
·Copperpeptidescouldpotentiallybeusedinplaceofcorticosteroidsornonsteroidalanti-inflammatorydrugsforpostprocedureirritationandinflammation.
·Acetylhexapeptide-3isatopicalvariationofbotulinumtoxintobeusedonitsownoradjunctivelywiththeinjectableform.
·Topicalhyaluronicacidcanbeusedonitsownoradjunctivelywithinjectablefillers.
Today’scosmeticpatientwantstolookmoreyouthfuleverydaywithoutspendingalotofmoney,feelinganypain,orhavinganypostproceduredowntime.Withcontinuedtechnologicalimprovements,dermatologistshavebeenabletoprovideourpatientswiththemoreyouthfulappearancetheydesire;however,manyoftheseproceduresstillarecostly,painful,andmayrequiresomedowntime.Newcosmeceuticaltherapiescanbeusedasadjunctstotheseprocedures,makingantiagingregimenslesshealingtime.Inthisarticle,theuseofcosmeceuticalsinconjunctionwithchemicalpeels,lasers,andinjectableswillbediscussed.
ChemicalPeels
Chemicalpeelsareusedtocreateaninjuryofspecificskindepthwithagoalofstimulatingnewskingrowthandimprovingsurfacetextureandappearance.Theygenerallyareclassifiedassuperficial,medium,ordeepaccordingtothedepthofaction.Currentlyavailableagentsforsuperficialchemicalpeelsincludeα-hydroxyacids(AHAs)(eg,glycolicacid[GA])andβ-hydroxyacids(BHAs)(eg,salicylicacid).β-Lipohydroxyacid(upto10%),aderivativeofsalicylicacid,iswidelyusedinEurope.Trichloroaceticacid(TCA)canbeusedforsuperficialpeels(10%–20%)andformedium-depthpeels(35%).CombinationpeelssuchasMonheitcombination(JessnersolutionplusTCA),Brodycombination(solidCO2plusTCA),Colemancombination(GA70%plusTCA),andJessnersolutionwithGAcanbeusedasmedium-depthpeels.Deeppeelstypicallyareperformedwithphenol-basedsolutions,includingtheBaker-GordonphenolpeelandtheHetterpeel(phenolorcrotonoilpeel).
Specificagentsforchemicalpeelsshouldbeselectedbasedonthedisorderbeingtreatedandshouldbeadministeredusinganappropriatepeeldepthdeterminedbythehistologiclevelorseverityofskinpathologytomaximizetreatmentsuccess.However,otherconsiderations,suchasskincharacteristics,areaofskintobetreated,safetyconcerns,healingtime,andpatientadherencealsoshouldbetakenintoaccounttoachievethebestoverallresults.Althoughmanyofthedeeperpeelsrecentlyhavebeenreplacedbylaser-basedablativetreatments,superficialtomedium-depthpeelsstillarecommonlyusedinthetreatmentoffinelines,uneventexture,anddyspigmentation.
Superficialpeelsarereasonablysafeandwelltolerated,usuallywithonlymilddiscomfort(eg,transientburning,irritation,erythema).Scarring,postinflammatoryhyperpigmentation(PIH),andinfectionarerarewithsuperficialpeels.Postinflammatoryhyperpigmentationcanbeexacerbatedbysunexposure,makingitimportantforpatientstobeeducatedaboutsunprotectionandcloselymonitoredduringtherecoveryphase.Inmediumanddeeppeels,linesofdemarcationrelatedtotheadministrationtechniquecanoccur.Featheringthechemicalpeelsolutionatjunctionswithnonpeeledskincanhelptoavoidthiseffect.Sideeffectsassociatedwithdeeperchemicalpeelscanincludepigmentarychanges,infections,allergicreactions,improperhealing,hypersensitivity,andunderlyingdiseaseexacerbation.Thebestwaytopreventcomplicationsistoidentifypatientswhoareatriskandmaintainanappropriatepeeldepththatbalancesefficacywithknownadverseevents.
Manyadjunctiveagents(eg,AHAs,BHAs,retinoids,skin-bleachingpreparations)canbeusedtoenhancechemicalpeelsanddecreasetheincidenceofPIH.α-HydroxyacidsandBHAscanbebeneficialwhenappliedpriortochemicalpeels.MoisturizerscontainingAHAsandBHAscanbeusedfor2to3weeksbeforesuperficialormedium-depthchemicalpeels.Theseagentscausethinningofthestratumcorneum,therebycreatingamoreuniformcutaneoussurfaceandallowingfordeeperpenetrationofthechemicalpeelingagent.Retinoidsalsoaresuperiorprepeelingagents;however,retinoidsalsocanincreasethelikelihoodofirritation,whichcanbeminimizedbydiscontinuingretinoidsfor1weekfollowingchemicalpeels.Acombinationofchemicalpeelsandtopicalbleachingagentshasbeenshowntobeeffectiveintreatinghyperpigmentation.Thechemicalpeelcausessuperficialexfoliation,whichallowsthelighteningagenttopenetratemoredeeply.
Hydroquinone(HQ)isthegoldstandardforimprovementofexistingpigmentation.Itisoneofthemosteffectiveinhibitorsofmelanogenesisbothinvitroandinvivoandiswidelyusedforthetreatmentofmelanosisandotherhyperpigmentarydisorders.ItiswidelyacceptedthatthedepigmentationactivityofHQmaypartlyberelatedtoitsabilitytoactasanalternatesubstrateoftyrosinase,therebycompetingfortyrosineoxidationinactivemelanocytes.UsingHQata4%concentrationandcombiningitwithretinoidsisquiteefficacious.Othercommonlyuseddepigmentingagentsincludekojicacid,ascorbicacid(vitaminC),andniacinamide,whichoftencanbeusedasadjunctswithormaintenancetherapyafterHQtreatment.
TheriskforPIHisimminentforchemicalpeelsandcosmeticlasertreatments;therefore,itiscrucialtoeducatepatientsabouttheimportanceofdailyandaggressivesunprotection.Thereareseveralmethodsofreducingoreliminatingpostproceduremelaninformation,suchasinhibitingtyrosinasesynthesis,usingcomplexcoppertoinhibittyrosinasefunction,eliminatingoxidationreactionsthatleadtopolymerformation,slowingdownthetransferofmelanosomestokeratinocytes,oractingupstreamonthehormonethatstimulatesmelanogenesis.Mostofthedepigmentingagentspresentlyonthemarketactbyinhibitingtyrosinaseviaoneofthesemechanisms.
Skin-lighteningagentsareprimarilyformulatedasemulsionsthathaveahigheraestheticappeal.Manyoftheingredientsgetbetterdispersionswithemulsions,whichisanaddedfeatureoftheseproducts.Recently,gel-basedformulationsalsoarebeingconsideredfortheirsuitabilityincertainskintypes.Efficacystudiesforskin-lighteningformulationsarebeingcarriedoutthroughclinicaltrialsthatutilizedevicesthatmeasureskincolorinadditiontothedermatologist’sassessment.Otherskinparameters(eg,moisturization,texture,barrierintegrity,pH)alsoarebeingevaluatedtogivephysiciansapictureofskinhealthaftertheuseofskin-lighteningagents.Withadvancesintechnologyandmeasurementtechniques,itisbecomingeasiertoidentifytheefficacyoftheseformulationsindifferentskintypes.
Lasers
Theultimategoaloflasertherapyoftenistoimprovethecanvasandcoloroftheskin.Ablativelaserresurfacingisreliablythemosteffectiveprocedureforsun-damagedskin.Thistechniquecausesthermallyinducedfull-thicknessepidermalanddermaldenudation,whichinturnfacilitatescytokine-leddermalcollagenformationandreepithelialization.Variousnonablativemodalitiesalsoareusedfortreatingphotodamagedskin.Theepidermisremainsunaffectedbythesenonablativemethods,thusdecreasingtheneedforextensivewoundcareanddowntimethatisrequiredwithablativetreatments.Combiningnonablativelasertreatmentswithtopicalcosmeceuticalshasbeenprovenmoreeffectivethanusingeithermethodalone.Theuseoftopicalretinoidspriortoablativelaserresurfacingoftenresultsinremarkablyfasterpostprocedurehealingandreepithelialization(Figure).Retinoidsarebestappliednightlyforatleast2weeksandoptimallyfor3monthsbeforeablativelasertreatment.Applicationshouldbediscontinuedfor1weekimmediatelypriortotheprocedure.
Topicalretinoidsalsoareeffectiveinreducingerythemaandincreasingdermalthicknessafternonablativetreatments.Whenusedpriortolasertreatments,retinoidshavebeenshowntodecreasetheriskforpostoperativemiliaandhyperpigmentationaswellastoallowforbetterpenetrationofthelaserbeamsecondarytoathinnerstratumcorneum.Followingablativeresurfacing,retinoiduseshouldbediscontinuedforseveralweekstoallowforreepithelializationandadequatehealing.