Skip to main content

Advertisement

SpringerLink
Log in

Combined Tretinoin and Glycolic Acid Treatment Improves Mouth Opening for Postburn Patients

  • Innovative Techniques
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Postburn tissue repair progresses late, with changes in the skin’s physical properties. Clinically, the skin appears dry, scaly, and dyschromic, with diminished elasticity, particularly in the presence of hypertrophic scars. Improvement of postburn skin can be obtained by using topical agents normally used in pathologies such as acne and photoaging. This study analyzed 77 patients, ages 6 to 46 years, with late perioral burn sequelae. The resulting integument was classified as grafted or restored when it epithelialized spontaneously. Topical treatment consisted of tretinoin (0.01–0.05%) and glycolic acid (5–7%) over a 3-month period. With the mouth opened maximally, the interdental (D) and interlabial (L) distances were measured using a digital caliper. Significant increases in D and L distances were observed after treatment, as compared with controls (p < 0.01). These results were similar in the restored and skin-grafted groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Agerberg G: Maximal mandibular movements in children. Acta Odontol Scand 32:147–159, 1974

    Article  CAS  PubMed  Google Scholar 

  2. Ando T, Friggi MNP: Aspectos odontológicos na infância. In: Marcondes E (ed). Pediatria básica. 8th ed. vol. 1. São Paulo: Sarvier, pp.125–132, 1991

    Google Scholar 

  3. Appa Y: Retinoid therapy: Compatible skin care. Skin Pharmacol Appl Skin Physiol 12:111–119, 1999

    Article  CAS  Google Scholar 

  4. Ash K, Lord J, Zukowski M, McDaniel D: Comparison of topical therapy for striae alba (20% glycolic acid/0.05% tretinoin versus 20% glycolic acid/ 10% L-ascorbic acid). Dermatol Surg 24:849–856, 1998

    CAS  PubMed  Google Scholar 

  5. Berardesca E, Gabba P, Farinelli N, Borroni G, Rabbiosi G: In vivo tretinoin-induced changes in skin mechanical properties. Br J Dermatol 122:525–552, 1990

    Article  CAS  PubMed  Google Scholar 

  6. Bernard FX, Pedretti N, Rosdy M, Deguercy A: Comparison of gene expression profiles in human keratinocyte monolayer cultures, reconstituted epidermis, and normal human skin: Transcriptional effects of retinoid treatments in reconstituted human epidermis. Exp Dermatol 11:59–74, 2002

    Article  CAS  PubMed  Google Scholar 

  7. Bhawan J: Short- and long-term histologic effects of topical tretinoin on photodamaged skin. Int J Dermatol 37:286–292, 1998

    Article  CAS  PubMed  Google Scholar 

  8. Carvalho DA, Mariani U, Gomez DS, Gemperli R, Ferreira MC: A study of the postburned restored skin. Burns 25:385–394, 1999

    Article  Google Scholar 

  9. Clark CP III: Alpha hydroxy acids in skin care. Clin Plast Surg 23:49–56, 1996

    PubMed  Google Scholar 

  10. Clark JA, Cheng JCY, Leung KS: Mechanical properties of normal skin and hypertrophic scar. Burns 22:443–446, 1996

    Article  CAS  PubMed  Google Scholar 

  11. Cotterill JA: Social, psychological, and psychiatric aspects of cosmetic use. In: Baran R, Maibach HI (eds) Textbook of cosmetic dermatology. Martin Dunitz: London, pp. 747–753, 1998

    Google Scholar 

  12. Cox SC, Walker DM: Establishing a normal range for mouth opening: Its use in screening for oral submucous fibrosis. Br J Oral Maxill Surg 35:40–42, 1997

    Article  CAS  Google Scholar 

  13. Dinardo JC, Grove GL, Moy LS: Clinical and histological effects of glycolic acid at different concentrations and pH levels. Dermatol Surg 22:421–424, 1996

    CAS  PubMed  Google Scholar 

  14. Ditre CM, Griffin TD, Murphy GF et al. Effects of α-hydroxy acids on photoaged skin: A pilot clinical, histologic, and ultrastructural study. J Am Acad Dermatol 34:187–195, 1996

    Article  CAS  PubMed  Google Scholar 

  15. Garcia A, Fulton JE: The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg 22:443–447, 1996

    CAS  PubMed  Google Scholar 

  16. Garg HG, Siebert JW, Garg A, Neame PJ: Inseparable iduronic acid-containing proteoglycan PG (IdoA) preparations of human skin and postburn scar tissues: Evidence for elevated levels of PG (IdoA)-I in hypertrophic scar by N-terminal sequencing. Carbohydrate Res 284:223–228, 1996

    Article  CAS  Google Scholar 

  17. Hansen DA: Treatment of hypertophic scars with retinoic acid. South African Medical Journal (SAMJ) 22:1114, 1979

    Google Scholar 

  18. Harris DWS, Buckley CC, Ostlere LS, Rustin MHA: Topical retinoic acid in the treatment of fine acne scarring. Br J Dermatol 125:81–82, 1991

    Article  CAS  PubMed  Google Scholar 

  19. Hopkinson I, Anglin IE, Evans DL, Harding KG: Collagen VII expression in human chronic wounds and scars. J Pathology 182:192–196, 1997

    Article  CAS  Google Scholar 

  20. Humphries JD, Parry EJ, Watson REB, Garrod DR, Griffiths CEM: All-trans retinoic acid compromises desmosome expression in human epidermis. Br J Dermatol 139:577–584, 1998

    Article  CAS  PubMed  Google Scholar 

  21. Ingervall B: Range of movement of mandible in children. Scand J Dent Res 78:311–322, 1970

    CAS  PubMed  Google Scholar 

  22. Janssen de Limpens AMP: The local treatment of hypertrophic scars and keloid with topical retinoic acid. Br J Dermatol 103:319–323, 1980 [Presented at the 3rd Congress of the European Section of the International Confederation of Plastic and Reconstructive Surgery, 1977]

  23. Jenkins SC, Henke J: Retinoic acid modifies scars from self-injury by burning. Am J Psychiatry 150:1125, 1993

    CAS  PubMed  Google Scholar 

  24. Jorgensen PH, Bang C, Andreassen TT: Mechanical properties of skin graft wounds. Br J Plast Surg 46:565–569, 1993

    Article  CAS  PubMed  Google Scholar 

  25. Kang S, Kim KJ, Griffiths CEM, et al. Topical treatment (retinoic acid) improves early stretch marks. Arch Dermatol 132:519–526, 1996

    Article  CAS  PubMed  Google Scholar 

  26. Kang S, Voorhees JJ: Topical retinoids. In: Fredberg EM et al. (eds) Fitzpatrick’s dermatology in general medicine. 5th ed. vol. 2. McGraw-Hill, New York, USA pp. 2726–2733, 1999

    Google Scholar 

  27. Kligman AM, Dogadkina D, Lavker RM: Effects of topical tretinoin on non–sun-exposed protected skin of the elderly. J Am Acad Dermatol 29:25–33, 1993

    Article  CAS  PubMed  Google Scholar 

  28. Kligman LH, Sapadin AN, Schwartz E: Peeling agents and irrritants, unlike tretinoin, do not stimulate collagen synthesis in the photoaged hairless mouse. Arch Dermatol Res 288:615–620, 1996

    Article  CAS  PubMed  Google Scholar 

  29. Krusche T, Worret W: Mechanical properties of keloids in vivo during treatment with intralesional triamcinolone acetonide. Arch Dermatol Res 287:289–293, 1995

    Article  CAS  PubMed  Google Scholar 

  30. Leyden JJ: Treatment of photodamaged skin with topical tretinoin: An update. Plast Reconstr Surg 102:1667–1671, 1998

    Article  CAS  PubMed  Google Scholar 

  31. Mezitis M, Rallis G, Zachariades N: The normal range of mouth opening. J Oral Maxillofac Surg 47:1028–1029, 1989

    Article  CAS  PubMed  Google Scholar 

  32. Moy LS, Howe K, Moy RL: Glycolic acid modulation of collagen production in human skin fibroblast cultures in vitro. Dermatol Surg 22:439–441, 1996

    CAS  PubMed  Google Scholar 

  33. Peacock Jr EE, Cohen IK In: McCarthy JG (ed) Plastic surgery. Vol. 1. WB Saunders: New York, pp. 161–185, 1990

    Google Scholar 

  34. Poh-Fitzpatrick MB: kin care of the healed burned patient. Clin Plast Surg 19:745–751, 1992

    CAS  PubMed  Google Scholar 

  35. Pownell PJ, Rohrich RJ: Burn reconstruction. Selected Readings Plast Surg 8:10–37, 1998

    Google Scholar 

  36. Salles AG: Efeito do tratamento combinado com tretinoína e ácido glicólico na abertura bucal de pacientes com seqüela de queimadura. Dissertação (Mestrado). Faculdade de Medicina da Universidade de São Paulo, São Paulo, 2002, 144 p

  37. Schmidt JB, Donath P, Hannes J, Perl S, Neumayer R, Reiner A: Tretinoin-iontophoresis in atrophic acne scars. Int J Dermatol 38:149–153, 1999

    Article  CAS  PubMed  Google Scholar 

  38. Scott PG, Dodd CM, Tredget EE, Ghahary A, Rahemtulla F: Chemical characterization and quantification of proteoglycans in human postburn hypertrophic and mature scars. Clin Sci 90:417–425, 1996

    Article  CAS  PubMed  Google Scholar 

  39. Scott PG, Dodd CM, Tredget EE, Ghahary A, Rahemtulla F: Immunohistochemical localization of the proteoglycans decorin, biglycan, and versican and transforming growth factor-β in human postburn hypertrophic and mature scar. Histopathology 26:423–431, 1995

    Article  CAS  PubMed  Google Scholar 

  40. Sheppard IM, Sheppard SM: Maximal incisal opening: A diagnostic index? J Dental Med 20:13–15, 1965

    CAS  Google Scholar 

  41. Thacker JG, Stalnecker MC, Allaire PE, Edgerton MT, Rodeheaver GT, Edlich RF: Practical applications of skin biomechanics. Clin Plast Surg 4:167–171, 1977

    CAS  PubMed  Google Scholar 

  42. Ueno CM, Maio M, Salles AG, Fontana C, Ferreira MC: Tratamento da hipercromia pós-queimaduras em adultos. Arqu Catar de Med 29(Suppl 1):78–80, 2000

    Google Scholar 

  43. Varani J, Perone P, Griffiths CEM, Inman DR, Fligiel SEG, Voorhees JJ: All-trans retinoic acid (RA) stimulates events in organ-cultured human skin that underlie repair. J Clin Invest 94:1747–1756, 1994

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Wang C, Huang C, Hu CS, Chan H: The effect of glycolic acid on the treatment of acne in asian skin. Dermatol Surg 23:23–29, 1997

    CAS  PubMed  Google Scholar 

  45. Weinstein GD, Nigra TP, Pochi PE, et al. Topical tretinoin for treatment of photodamaged skin: A multicenter study. Arch Dermatol 127:659–665, 1991

    Article  CAS  PubMed  Google Scholar 

  46. Wood GD, Branco JA: A comparison of three methods of measuring maximal opening of the mouth. J Oral Surg 37:175–177, 1979

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Claudia Garcia and R. C. Farmácia Dermatológica, for manufacturing the topical products.

Author information

Authors and Affiliations

  1. Division of Plastic Surgery and Burns Unit, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil

    Alessandra Grassi Salles M.D., Rolf Gemperli M.D., Paula Nunes Toledo Speech Therapist & Marcus Castro Ferreira M.D.

Authors
  1. Alessandra Grassi Salles M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rolf Gemperli M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paula Nunes Toledo Speech Therapist
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcus Castro Ferreira M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandra Grassi Salles M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Salles, A.G., Gemperli, R., Toledo, P.N. et al. Combined Tretinoin and Glycolic Acid Treatment Improves Mouth Opening for Postburn Patients. Aesth Plast Surg 30, 356–362 (2006). https://doi.org/10.1007/s00266-004-0151-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-004-0151-0

Keywords

Search

Navigation