I n my practice, we’ve been using a unique, new cosmeceutical procedure that has helped us a great deal in treating patients who have melasma, acne and photodamaged skin. I use this procedure in conjunction with typical treatments for these conditions. The Clay-Peel masque integrates amino fruit acids (AFAs). These agents are specially treated amino acids derived from filaggrin, the main moisture retention mechanism of human skin, and they’re the main active ingredients of the masque. The esthetician in my practice administers this procedure, which takes about 30 minutes to perform. Typically, my patients undergo treatment every 2 to 3 weeks for a series of six peels. I’ve treated many of my patients who have melasma with this procedure. About 50% of my melasma patients undergo these peels at one point or another in their treatment regimen. The results of these procedures may last up to 4 to 6 months. When considering the cost of this treatment regimen, it’s comparable to microdermabrasion or light peel procedures and much less expensive than laser treatments. This article will detail the reasons to consider adding this procedure to your practice and the ease with which you can accomplish this. History of the Procedure In the 1990s, glycolic and other alpha hydroxy acids became popular and were incorporated into many dermatology and cosmetic surgery practices. Benefits to patients included the ability to reduce signs of photodamage and improve acne. Although popular with patients, improvement was limited by the strength of the alpha hydroxy component and typically the benefits were somewhat short-lived. Additionally, a distinctly unpleasant burning sensation was associated with these clinically effective concentrations. Lastly, once the procedure became popular, many salons and “home remedy” options were introduced, some of which resulted in terrible results and stigmatized the properly performed procedures. Subsequent to this, in the late 1990s, the microdermabrasion technique and attendant machinery were developed. This procedure allowed better penetration of skin, more effective exfoliation, in some cases, and improvement in some forms of acne post-inflammatory hyperpigmentation. This procedure has gained popularity and has a following among patients but still hasn’t captured the ability to reduce the results of photodamage that some of the deeper peels manage. Additionally, more salons are offering less-effective microdermabrasion techniques, resulting in a decrease in consumer respect for the physician or the reputation of the medical spa offering these procedures. Developing an Effective Product What we all want for our patients (and ourselves) is an effective antioxidant that can be safely applied to skin of any type with the power to rapidly reduce melasma and other excess pigmentation but without irritation or other problems. If this antioxidant could also rapidly improve the tone and texture of the skin while reducing visible signs of aging that would only enhance the properties and utility of this product. This is the product that Marvin Klein, M.D., a board certified dermatologist, set out to develop and brought to market. AFAs have been used since 1997, and the idea that they could be used in tandem with clay is a newer concept and one that was quite challenging to develop from a chemical standpoint. After researching and clinically testing this marriage of AFAs and clay, Dr. Klein developed an at-home cleansing/AFA kit and subsequently the Clay-Peel in 2002. The strength of the AFAs in the Clay-Peel work on skin needing a higher level of exfoliation that ordinary glycolic peels or microdermabrasion simply can’t offer. Extensive research and clinical usage has documented the ability to do this with repeatedly reliable results over years of tests. Why AFAs Do the Job so Well The fully patented AFAs are potent and safe cosmeceuticals because they have a small enough molecular weight to cross the keratin barrier and a molecular size almost identical to glycolic acid and the smaller alpha hydroxy acids. AFAs utilize the same amino acids produced in normal skin by the polypeptide, filaggrin, and the same amino acids that enter the stratum granulosum and constitute what arguably is the main moisture retention system of the skin. AFAs are designed to retain their amino groups, which allows them to be used at a very low pH without irritation. Additionally, they’re kept at a pH that is low enough to rapidly improve pigmentary problems on any skin type without causticity or post-inflammatory hyperpigmentation. The AFA Clay-Peel is the latest chapter in the AFA saga. It’s based on an additional patented technology involving the addition of specially treated rare earthen (clays) to the AFAs. The combination of treated rare earth types, patented by Dr. Klein, was found to act synergistically to improve the cosmeceutical properties of the AFAs while even further reducing causticity. In clinical practice, this procedure and the AFAs in general have been very well received by the dermatology and plastic surgery community with thousands of patients undergoing the procedure. We’ve been gratified to hear excellent comments from our physician users and their patients as well. Performing the Procedure This procedure is performed by a licensed esthetician in our office. The patient is instructed to not use her at-home product or products the night before or day of the procedure. This also includes the use of retinoids and hydroquinones. Patients are able to cleanse on the day of the procedure. Men are advised to not shave immediately prior to the peel. • Step 1: Applying the Mask. The esthetician uses non-latex gloves while applying the two-step AFA Clay-Peel and cleanses the patient’s face with AFA Cleanser, making sure make-up is removed but taking care not to rub or abrade the skin. After the AFA Clay is applied evenly to the skin while avoiding contact with the eyes (typically a thick layer is necessary), the mask is left on for 5 to 10 minutes. Prior to removing the mask, a light spray of AFA Toner Mist is applied, which helps to loosen the AFA Clay. The Clay is removed with a wet sponge, soft cloth or gauze. Misting or blotting the skin oftentimes helps with any remaining mask. If necessary, some patients gently rinse at the sink with tepid water. After removal, the skin is patted dry prior to the peel portion. • Step 2: Applying the Gel. The AFA Peel portion is applied with a thin layer of gel to the skin. Starting at the periphery of the face, not rubbing, and spreading inward while avoiding the eyes, the peel is left on for anywhere from 15 seconds to 2 minutes. If signs of irritation or redness or frost develop the peel is discontinued and copious amounts of water are applied. In our practice, patients have tolerated this procedure extremely well and it has been very well received. The only patients that have had any sort of reaction were those who mistakenly used a retinoid prior to the procedure. Even those patients did quite well, although they had some peeling for 2 to 3 days after the procedure. • Step 3: The Finishing Touches. Once the peel has finished, the patient is sprayed with the AFA Toner, the AFA Moisturizer appropriate to their skin type is applied and sunblock is placed on the patient. We encourage our patients to achieve maximal benefit by avoiding make-up for four hours after the procedure. Additionally, AFA Gels (at home), retinoids and hydroquinone containing treatments are to be avoided for 48 hours post-procedure. An Easy, Effective Adjunct to Therapy As can be seen from the photos, which are both regular photographs as well as ultraviolet photographs (which are shown on page 78), the results can be phenomenal. This type of result is not one that we have seen with standard peels or microdermabrasion and are certainly not seen as fast as the results with the Clay-Peel. Additionally, the company has patented this technology and it is unlikely to be at the salon next door due to the proprietary nature of the process. The AFA Clay-Peel is a new technology that can rapidly, completely and safely reduce photodamage while reducing visible signs of aging and restoring a healthy tone and texture to the skin. We’ve found it to be a safe and effective adjunct to traditional therapies for melasma, acne and photodamaged skin. *Dr. Schlessinger has no financial interest in the Clay-Peel.