San Diego Dermatology Symposium
Chemical Peels: San Diego Dermatology Symposium 2020 Highlights
In his review of chemical peels, Dr. Rullan began with a reminder of the pre-peel evaluation (skin thickness, skin phototype, and goals of treatment) as well as skin prep, including topicals and antiviral prophylaxis. He emphasized the importance of patient comfort during and after a chemical peel, advocating for prescription analgesics for deeper peels as well as use of cold compresses, cooling devices, and soothing topicals. Dr. Rullan then began a review of chemical peels, ranging from very superficial to deep. He provided insight into his peels of choice for various dermatologic indications. For acne, he prefers 20-30% salicylic acid and Jessner’s, while for melasma he opts for 70% glycolic acid gel, 25% glycolic solution, 20-30% salicylic acid, or RevePeel Enlighten. For photo-aging, he prefers superficial-to-medium depth peels including trichloroacetic acid (TCA) 10-15% alone or Jessner’s + 10-15% TCA, or if opting for a true medium depth peel he uses Jessner’s + TCA 35% or a light phenol peel with croton oil 0.1% and phenol 30%. He also discussed spot treatment of actinic keratoses with croton/phenol or 50-60% TCA peels.
Dr. Rullan also discussed various aspects of deep chemical peels including certain cosmetic outcomes such as lip augmentation/eversion and upper eyelid tightening. With the addition of pre-operative clonidine, reduced use of epinephrine, and adequate pain control, Dr. Rullan has performed over 400 2-day phenol peels without cardiac complications such as arrhythmias. Finally, Dr. Rullan reviewed potential complications from chemical peels and stressed the importance of knowing your endpoints, using proper technique, and taking appropriate prophylactic measures to minimize these risks.
Acne Scars: San Diego Dermatology Symposium 2020 Highlights
When it comes to acne scars, Dr. Rullan emphasizes the concept of “defect-oriented therapy,” in which the choice of therapy depends on the specific type of scar. Ice pick scars are best treated with chemical reconstruction of skin scars (CROSS), which can be done with either trichloroacetic acid (TCA) 30-60-90-100% or carboxylic acid 88%. Dr. Rullan prefers the latter because it has less risk of scar widening. A cotton tip applicator or fine tip brush can be used for spot treatment of individual scars, and in his experience this treatment can be performed in all skin types with minimal risk of post-inflammatory hyperpigmentation. For rolling scars, he recommends subcision as the treatment of choice, with the goal of “breaking the tethers” under the skin. He uses an 18- or 22-gauge cannula rather than the Nokor needle. For boxcar scarring, multiple treatment options exist including CROSS, microneedling, fractionated erbium or CO2 laser resurfacing, and even 2-day phenol chemabrasion for more severe, generalized scarring. Finally, for atrophic scars, filler remains the preferred treatment.
Dr. Rullan shared his sequential combination regimen for acne scars in all skin types, as follows: 1) CROSS, 2) tumescent anesthesia (using 20-gauge spinal needle), 3) subcision, 4) microneedling or fractionated erbium or CO2 laser, and 5) fillers (after 2-4 sessions of steps 1-4). He repeats this regimen every 1-3 months, for a total of 2-4 treatments.
Dr. Peter Rullan’s appearance on The Eric and Lizz Show
DR. PETER RULLAN IN PRINT
- PRullan;R.Barr;G.Cole: Arch Dermatol, , Sep 1984; 120: 1179 – 1183 “The Effects of Cyclosporin on Murine Allergic Contact Dermatitis
- Artecoll- my personal experience- The Journal of Facial Plastic Surgery Dec.2004
- The 2-day Phenol Chemabrasion Technique for deep wrinkles and acne scars-Am J Cosmetic Surg: 2004;21:199-210. (about an innovative chemical peel using non-secret formulas to correct very challenging cosmetic problems)
- Reply, to a Letter to the Editor, Am J Cosm Surg- Aug 2005 (on the Phenol peel).
- “Artecoll: A Long Lasting Injectable Wrinkle Filler Material: Report of a Controlled, Randomized, Multicenter Clinical Trial of 251 Subjects”( co-author)-Plast. Reconstr. Surg. 114:964, 2004.
- J. of Facial Plastic Surgery, Dec 2004- “My Personal Experience with Artecoll” (Dr. Rullan was one of the 8 leading investigators for an FDA-study in the use of a permanent filler for wrinkles)
- “Artefill: A lon-Lasting Injectable Wrinkle Filler Material-Summary of the US Food and Drug Administration Trials and a Progress Report on the 4-to-5 year Outcomes.”-Plast Reconstr.Surg. 118(3S) Suppl:64S-76S, Sept. 2006 (co-author)
- “Avoiding and Treating Dermal Filler Complications”. Plast Reconst. Surg. 118(S)Suppl:92S-107S, September 2006 (co-author)
- “1st PMMA World Congress” Proceedings- submitted to Cosmetic Dermatology 10/07
- “Triamcinolone mesotherapy for inducing cosmetic fat atrophy”- with Dr Doris Hexsler of Brazil, submitted for publication Derm Surg Journal
- Same topic, Poster, at the AAD 2009 Annual meeting, San Francisco 3/8/9
- “The use of Enbrel for Atopic Dermatitis-Two case reports”….Published in the Journal of Drugs in Dermatology.(JDD)for 9/09.
- “Gelfoam for Secondary Wound healing after Mohs surgery”- accepted for publication JDD June 2010
- “Using a handheld phototherapy module for treating patients with psoriasis and vitiligo”. PRullan, Cosm Derm July 2010; Vol23,No7,p321-326
- Mathes’ Textbook “ Plastic Surgery”, Vol. 2 Head and Neck Part I, Chapter 51 on “Resurfacing”, pages 379-80..refers to my work on Phenol Peels. (2006).
- Chapter on “Chemical Peels in darker skin types and non-caucasians”: Clinics in Facial Plastic Surgery –co-author with Amir Karam, MD; Facial Plast Surg Clin N am – (2009)
- Book, Rubin & Tung, Chemical Peels: Chapter: Peeling Darker Skin Types ( co-author with Dr. Hexsel) 2010
- The Aging Face: Surgical Options, textbook, Author, Chapter on “Chemical Peels for the Aging Face” ( Editors, M Goldman and A. Karam).. inpress)
- Arch. of Dermatology, 1983- “The effect of cyclosporine on murine allergic contact dermatitis” (1st article on the use of this non-steroidal medication to stop autoimmune skin conditions)
- “Rosacea Symptoms Can Be Minimized” 2016 The Savvy Patient
- Dermatology Times: Picking The Best Peel. Written by Randy Dotinga, March 2017.
DR. JENNIFER RULLAN IN PRINT
- Cutis Journal Manuscript Number 12–85R1 Accepted for publication 12/2012
Rullan J, et al. “Lichen Planus Pemphigoides Associated With Pregnancy Mimicking Herpes Gestationalis”
- Rullan J, et al. “Cutaneous Manifestations of Connective Tissue Diseases” and “Cutaneous Manifestations of Pulmonary Disease.” Ed. Nestor Sanchez. Atlas of Dermatology in Internal Medicine. NY: Springer, 2012. 1-30.
- Rullan J, et al. “Skin Cancer Awareness and Sun Protective Behavior in Hispanics.” Galenus (a publication of MW World PR Corp.) 2012;24(3):48.
- Rullan P, Villbona C, Rullan JM, et al. “Use of Gelatin Sponges in Mohs Micrographic Surgery Defects and Staged Melanoma Excisions: A Novel Approach to Secondary Wound Healing”. Journal of Drugs in Dermatology 2011;10(1):68-73.
- Rullan J, Iriarte I, Mariel M, et al. “Skin Cancer Awareness and Sun Protective Behavior in Hispanics.”. Caribbean Journal of Dermatology and Therapeutics 2009;5:4-11.*written in English and in Spanish
- Rullan J, Alonso N. “Furuncular Nodule in Ornithoogist after Tick Bite: A Case Report and Simple Review”. Caribbean Journal of Dermatology and Therapeutics 2010;7:60-63. *written in English and in Spanish
- Rullan P, Rullan J, et al. “Two Day Phenol Chemabrasion for Acne Scars and Deep Wrinkles”. American Journal of Cosmetic Surgery 2004; 21: 199-210.
DR. JENNIFER RULLAN’S SPECIAL APPEARANCES
- Presenter at National Psoriasis Foundation’s annual More than Skin Deep event. (Sept.6,2014)
- San Diego Medical Chair for the National Psoriasis Foundation’s Walk to Cure Psoriasis. (Oct.11,2014)
- Appeared in Lubriderm commercial for Univision’s “Despierta America” with “La Familia De Hoy” . (Nov. 2014)
- A Handheld Broadband UV Phototherapy Module For The Treatment Of Patients With Psoriasis &Vitiligo
- The 2-Day Light Phenol Chemabrasion for Deep Wrinkles and Acne Scars
- Skin Cancer Awareness and Behavior ~ Risk Assessment in Hispanics
- Evaluación sobre la conciencia y las conductas de riesgo asociadas al cáncer de piel en hispaos
Jennifer Rullan on Univision’s Dispierta America-La Familia de Hoy
- “Rosacea Symptoms Can Be Minimized”