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What is the maximum dose of botox for cervical dystonia

Botox can be a great treatment for cervical dystonia, but it’s important to know the maximum dose so you don’t accidentally overdose on it. Cervical dystonia is a neurological condition that causes spasms in the neck and shoulders region. It can cause pain and difficulty moving your head, as well as headaches and drooping eyelids. Botox is often used as a treatment because it relaxes the muscles, which relieves pain and allows people with cervical dystonia to move their heads more comfortably.

Botox is injected into specific muscles in order to stop them from contracting. The drug works by blocking nerve impulses that are sent to these muscles—and when those nerve impulses are blocked, the muscle stops contracting.

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What is the maximum dose of botox for cervical dystonia

  • *For anatomical reference only.
    Note: Muscles in purple are those approved for BOTOX® injection. ContralateralSternocleidomastoidTrapezius (upper)Scalenus anteriorSemispinalis cervicis*Multifidus* IpsilateralSplenius capitisSplenius cervicisLevator scapulaeLongissimus (capitis/cervicis)Rectus capitis posterior major*Obliquus capitis inferior*
  • LATEROCOLLIS
  • ANTEROCOLLIS
  • RETROCOLLIS

Muscles listed in purple boxes are those approved for BOTOX® injection1,3

*For anatomical reference only.
Note: Muscles in purple are those approved for BOTOX® injection.

Cervical Dystonia dosing information

  • BOTOX® dosing in initial and sequential treatment sessions should be tailored to each individual patient based on his or her head and neck position, localization of pain, muscle hypertrophy, patient response, and adverse event history. The initial dose for a patient without prior use of BOTOX® should be at a lower dose, with subsequent dosing adjusted based on individual response1
  • The recommended dilution is 200 Units/2 mL, 200 Units/4 mL, 100 Units/1 mL, or 100 Units/2 mL with preservative-free 0.9% Sodium Chloride Injection, USP. Limiting the total dose injected into the sternocleidomastoid muscle to 100 Units or less may decrease the occurrence of dysphagia. In general, no more than 50 Units per site should be administered. Localization of the involved muscles with electromyographic guidance may be useful1
  • In treating adult patients for 1 or more indications, the maximum cumulative dose should not exceed 400 Units in a 3-month interval1
  • An understanding of standard electromyographic techniques may be useful for the treatment of cervical dystonia. Physicians administering BOTOX® must understand the relevant neuromuscular and structural anatomy of the area involved and any alterations to the anatomy due to prior surgical procedures and disease, especially when injecting near the lungs1
  • Clinical improvement generally begins within the first 2 weeks after injection, with maximum clinical benefit at approximately 6 weeks post injection. In clinical studies, most subjects were observed to have returned to pretreatment status by 3 months post treatment1

BOTOX® Important Information

WARNING: DISTANT SPREAD OF TOXIN EFFECT

Postmarketing reports indicate that the effects of BOTOX® and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses and approved indications, cases of spread of effect have been reported at doses comparable to those used to treat Cervical Dystonia and spasticity and at lower doses.

Indications
Adult Bladder Dysfunction:

Overactive Bladder
BOTOX® for injection is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

Detrusor Overactivity Associated With a Neurologic Condition
BOTOX® is indicated for the treatment of urinary incontinence due to detrusor overactivity associated with a neurologic condition (eg, SCI, MS) in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

Pediatric Detrusor Overactivity Associated With a Neurologic Condition

BOTOX® is indicated for the treatment of neurogenic detrusor overactivity (NDO) in pediatric patients 5 years of age and older who have an inadequate response to or are intolerant of anticholinergic medication.

Chronic Migraine

BOTOX® is indicated for the prophylaxis of headaches in adult patients with Chronic Migraine (≥ 15 days per month with headache lasting 4 hours a day or longer).

Limitations of Use

Safety and effectiveness have not been established for the prophylaxis of episodic migraine (14 headache days or fewer per month) in 7 placebo-controlled studies.

Spasticity

BOTOX® is indicated for the treatment of spasticity in patients 2 years of age and older.

Limitations of Use

BOTOX® has not been shown to improve upper extremity functional abilities or range of motion at a joint affected by a fixed contracture.

Cervical Dystonia

BOTOX® is indicated for the treatment of adults with Cervical Dystonia to reduce the severity of abnormal head position and neck pain associated with Cervical Dystonia.

Blepharospasm and Strabismus

BOTOX® is indicated for the treatment of Strabismus and Blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and older.

Primary Axillary Hyperhidrosis

BOTOX® is indicated for the treatment of severe primary axillary hyperhidrosis that is inadequately managed with topical agents.

Limitations of Use

The safety and effectiveness of BOTOX® for hyperhidrosis in other body areas have not been established. Weakness of hand muscles and blepharoptosis may occur in patients who receive BOTOX® for palmar hyperhidrosis and facial hyperhidrosis, respectively. Patients should be evaluated for potential causes of secondary hyperhidrosis (eg, hyperthyroidism) to avoid symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of the underlying disease.

Safety and effectiveness of BOTOX® have not been established for the treatment of axillary hyperhidrosis in pediatric patients under age 18.

IMPORTANT SAFETY INFORMATION (continued)
CONTRAINDICATIONS

BOTOX® is contraindicated in the presence of infection at the proposed injection site(s) and in patients who are hypersensitive to any botulinum toxin product or to any of the components in the formulation.

BOTOX® is contraindicated for intradetrusor injection in patients with a urinary tract infection, or in patients with urinary retention, or post-void residual (PVR) urine volume > 200 mL who are not routinely performing clean intermittent self-catheterization (CIC).

WARNINGS AND PRECAUTIONS

Spread of Toxin Effect
See Boxed Warning.

No definitive serious adverse event reports of distant spread of toxin effect associated with BOTOX® for Blepharospasm at the recommended dose (30 Units and below), severe primary axillary hyperhidrosis at the recommended dose (100 Units), Strabismus, or for Chronic Migraine at the labeled doses have been reported.

Lack of Interchangeability Between Botulinum Toxin Products
The potency Units of BOTOX® are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of BOTOX® cannot be compared to nor converted into Units of any other botulinum toxin products assessed with any other specific assay method.

Serious Adverse Reactions With Unapproved Use
Serious adverse reactions, including excessive weakness, dysphagia, and aspiration pneumonia, with some adverse reactions associated with fatal outcomes, have been reported in patients who received BOTOX® injections for unapproved uses. In these cases, the adverse reactions were not necessarily related to distant spread of toxin, but may have resulted from the administration of BOTOX® to the site of injection and/or adjacent structures. In several of the cases, patients had preexisting dysphagia or other significant disabilities. There is insufficient information to identify factors associated with an increased risk for adverse reactions associated with the unapproved uses of BOTOX®. The safety and effectiveness of BOTOX® for unapproved uses have not been established.

Hypersensitivity Reactions
Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, urticaria, soft-tissue edema, and dyspnea. If such a reaction occurs, further injection of BOTOX® should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent, and consequently, the causal agent cannot be reliably determined.

Increased Risk of Clinically Significant Effects With Preexisting Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis (ALS), or neuromuscular junction disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should be monitored when given botulinum toxin. Patients with known or unrecognized neuromuscular disorders or neuromuscular junction disorders may be at increased risk of clinically significant effects, including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia, and respiratory compromise from therapeutic doses of BOTOX® (see Warnings and Precautions).

Dysphagia and Breathing Difficulties
Treatment with BOTOX® and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing (see Boxed Warning).

Pulmonary Effects of BOTOX® in Patients With Compromised Respiratory Status Treated for Spasticity or for Detrusor Overactivity Associated With a Neurologic Condition
Patients with compromised respiratory status treated with BOTOX® for spasticity or detrusor overactivity associated with a neurologic condition should be monitored closely.

Corneal Exposure and Ulceration in Patients Treated With BOTOX® for Blepharospasm
Reduced blinking from BOTOX® injection of the orbicularis muscle can lead to corneal exposure, persistent epithelial defect, and corneal ulceration, especially in patients with VII nerve disorders.

Retrobulbar Hemorrhages in Patients Treated With BOTOX® for Strabismus
During the administration of BOTOX® for the treatment of Strabismus, retrobulbar hemorrhages sufficient to compromise retinal circulation have occurred. It is recommended that appropriate instruments to decompress the orbit be accessible.

Bronchitis and Upper Respiratory Tract Infections in Patients Treated for Spasticity
Bronchitis was reported more frequently as an adverse reaction in adult patients treated for upper limb spasticity with BOTOX® (3% at 251 Units to 360 Units total dose) compared to placebo (1%). In adult patients with reduced lung function treated for upper limb spasticity, upper respiratory tract infections were also reported more frequently as adverse reactions in patients treated with BOTOX® (11% at 360 Units total dose; 8% at 240 Units total dose) compared to placebo (6%). In adult patients treated for lower limb spasticity, upper respiratory tract infections were reported more frequently as an adverse reaction in patients treated with BOTOX® (2% at 300 Units to 400 Units total dose) compared to placebo (1%). In pediatric patients treated for upper limb spasticity, upper respiratory tract infections were reported more frequently as an adverse reaction in patients treated with BOTOX® (17% at 6 Units/kg and 10% at 3 Units/kg) compared to placebo (9%). In pediatric patients treated for lower limb spasticity, upper respiratory tract infection was not reported with an incidence greater than placebo.

Autonomic Dysreflexia in Patients Treated for Detrusor Overactivity Associated With a Neurologic Condition
Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in adult patients treated with BOTOX® 200 Units compared with placebo (1.5% vs 0.4%, respectively).

Urinary Tract Infections in Patients With Overactive Bladder
BOTOX® increases the incidence of urinary tract infection. Clinical trials for overactive bladder excluded patients with more than 2 UTIs in the past 6 months and those taking antibiotics chronically due to recurrent UTIs. Use of BOTOX® for the treatment of overactive bladder in such patients and in patients with multiple recurrent UTIs during treatment should only be considered when the benefit is likely to outweigh the potential risk.

Urinary Retention in Adults Treated for Bladder Dysfunction
Due to the risk of urinary retention, treat only patients who are willing and able to initiate catheterization post treatment, if required, for urinary retention.

In patients who are not catheterizing, post-void residual (PVR) urine volume should be assessed within 2 weeks post treatment and periodically as medically appropriate up to 12 weeks, particularly in patients with multiple sclerosis or diabetes mellitus. Depending on patient symptoms, institute catheterization if PVR urine volume exceeds 200 mL and continue until PVR falls below 200 mL. Instruct patients to contact their physician if they experience difficulty in voiding as catheterization may be required.

Overactive Bladder
In clinical trials, 6.5% of patients (36/552) initiated clean intermittent catheterization for urinary retention following treatment with BOTOX® 100 Units, as compared to 0.4% of patients (2/542) treated with placebo. The median duration of catheterization for patients treated with BOTOX® 100 Units was 63 days (minimum 1 day to maximum 214 days), as compared to a median duration of 11 days (minimum 3 days to maximum 18 days) for patients receiving placebo.

Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than nondiabetics. In clinical trials, 12.3% of patients (10/81) with diabetes developed urinary retention following treatment with BOTOX® 100 Units vs 0% of patients (0/69) treated with placebo. In patients without diabetes, 6.3% of patients (33/526) developed urinary retention following treatment with BOTOX® 100 Units vs 0.6% of patients (3/516) treated with placebo.

Adult Detrusor Overactivity Associated With a Neurologic Condition
In clinical trials, 30.6% of adult patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection required catheterization for urinary retention following treatment with BOTOX® 200 Units, as compared to 6.7% of patients (7/104) treated with placebo. The median duration of postinjection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days), as compared to a median duration of 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).

Among adult patients not using CIC at baseline, those with multiple sclerosis were more likely to require CIC post injection than those with spinal cord injury.

Human Albumin and Transmission of Viral Diseases
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (vCJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), but if that risk actually exists, the risk of transmission would also be considered extremely remote. No cases of transmission of viral diseases, CJD, or vCJD have ever been identified for licensed albumin or albumin contained in other licensed products.

ADVERSE REACTIONS

Adverse reactions to BOTOX® for injection are discussed in greater detail in the following sections: Boxed WarningContraindications, and Warnings and Precautions.

Overactive Bladder
The most frequently reported adverse reactions for overactive bladder occurring within 12 weeks of injection include urinary tract infection (BOTOX® 18%, placebo 6%); dysuria (BOTOX® 9%, placebo 7%); urinary retention (BOTOX® 6%, placebo 0%); bacteriuria (BOTOX® 4%, placebo 2%); and residual urine volume (BOTOX® 3%, placebo 0%).

A higher incidence of urinary tract infection was observed in patients with diabetes mellitus treated with BOTOX® 100 Units and placebo than nondiabetics.

The incidence of UTI increased in patients who experienced a maximum post-void residual (PVR) urine volume ≥ 200 mL following BOTOX® injection compared to those with a maximum PVR < 200 mL following BOTOX® injection, 44% vs 23%, respectively.

Adult Detrusor Overactivity Associated With a Neurologic Condition
The most frequently reported adverse reactions within 12 weeks of BOTOX® injection for detrusor overactivity associated with a neurologic condition include urinary tract infection (BOTOX® 24%, placebo 17%); urinary retention (BOTOX® 17%, placebo 3%); and hematuria (BOTOX® 4%, placebo 3%).

The following adverse event rates were reported at any time following initial injection and prior to reinjection or study exit (median duration of 44 weeks of exposure): urinary tract infections (49%), urinary retention (17%), constipation (4%), muscular weakness (4%), dysuria (4%), fall (3%), gait disturbance (3%), and muscle spasm (2%).

Pediatric Detrusor Overactivity Associated With a Neurologic Condition
The most frequently reported adverse reactions during the 12 weeks following BOTOX® injection of 200 Units for pediatric detrusor overactivity associated with a neurologic condition include bacteriuria (20%), urinary tract infection (7%), leukocyturia (7%), and hematuria (3%).

The most common adverse reactions in patients who received BOTOX® 6 Units/kg and less than a total dose of 200 Units were urinary tract infection (UTI), bacteriuria, and hematuria.

These patients were not adequately managed with at least one anticholinergic agent and were using clean intermittent catheterization at baseline.

Chronic Migraine
The most frequently reported adverse reactions following injection of BOTOX® for Chronic Migraine include neck pain (9%), headache (5%), eyelid ptosis (4%), migraine (4%), muscular weakness (4%), musculoskeletal stiffness (4%), bronchitis (3%), injection-site pain (3%), musculoskeletal pain (3%), myalgia (3%), facial paresis (2%), hypertension (2%), and muscle spasms (2%).

Adult Upper Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® for upper limb spasticity include pain in extremity, muscular weakness, fatigue, nausea, and bronchitis.

Adult Lower Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® for lower limb spasticity include arthralgia, back pain, myalgia, upper respiratory tract infection, and injection-site pain.

Pediatric Upper Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® in pediatric upper limb spasticity include upper respiratory tract infection (includes upper respiratory tract infection and viral upper respiratory tract infection), injection-site pain, nausea, constipation, rhinorrhea, nasal congestion, and seizure (includes seizure and partial seizure).

Pediatric Lower Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® in pediatric lower limb spasticity include injection-site erythema, injection-site pain, oropharyngeal pain, ligament sprain, skin abrasion, and decreased appetite.

Cervical Dystonia
The most frequently reported adverse reactions following injection of BOTOX® for Cervical Dystonia include dysphagia (19%), upper respiratory infection (12%), neck pain (11%), and headache (11%).

Blepharospasm
The most frequently reported adverse reactions following injection of BOTOX® for Blepharospasm include ptosis (21%), superficial punctate keratitis (6%), and eye dryness (6%).

Strabismus
The most frequently reported adverse events following injection of BOTOX® for Strabismus include ptosis (15.7%) and vertical deviation (16.9%).

Primary Axillary Hyperhidrosis
The most frequently reported adverse events (3%-10% of adult patients) following injection of BOTOX® for severe primary axillary hyperhidrosis in double-blind studies include injection-site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety.

Postmarketing Experience
Adverse reactions that have been identified during postapproval use of BOTOX® are discussed in greater detail in Postmarketing Experience (Section 6.3 of the Prescribing Information).

There have been spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility or anaphylaxis, after treatment with botulinum toxin. There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors, including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.

DRUG INTERACTIONS

Co-administration of BOTOX® and other agents interfering with neuromuscular transmission (eg, aminoglycosides, curare-like compounds) should only be performed with caution as the effect of the toxin may be potentiated. Use of anticholinergic drugs after administration of BOTOX® may potentiate systemic anticholinergic effects. The effect of administering different botulinum neurotoxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of BOTOX®.

Please see BOTOX® full Prescribing Information, including Boxed Warning and Medication Guide.

BOTOX® Important Information

IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING

WARNING: DISTANT SPREAD OF TOXIN EFFECT

Postmarketing reports indicate that the effects of BOTOX® and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses and approved indications, cases of spread of effect have been reported at doses comparable to those used to treat Cervical Dystonia and spasticity and at lower doses.

Indications
Adult Bladder Dysfunction:

Overactive Bladder
BOTOX® for injection is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

Detrusor Overactivity Associated With a Neurologic Condition
BOTOX® is indicated for the treatment of urinary incontinence due to detrusor overactivity associated with a neurologic condition (eg, SCI, MS) in adults who have an inadequate response to or are intolerant of an anticholinergic medication.

Pediatric Detrusor Overactivity Associated With a Neurologic Condition

BOTOX® is indicated for the treatment of neurogenic detrusor overactivity (NDO) in pediatric patients 5 years of age and older who have an inadequate response to or are intolerant of anticholinergic medication.

Chronic Migraine

BOTOX® is indicated for the prophylaxis of headaches in adult patients with Chronic Migraine (≥ 15 days per month with headache lasting 4 hours a day or longer).

Limitations of Use

Safety and effectiveness have not been established for the prophylaxis of episodic migraine (14 headache days or fewer per month) in 7 placebo-controlled studies.

Spasticity

BOTOX® is indicated for the treatment of spasticity in patients 2 years of age and older.

Limitations of Use

BOTOX® has not been shown to improve upper extremity functional abilities or range of motion at a joint affected by a fixed contracture.

Cervical Dystonia

BOTOX® is indicated for the treatment of adults with Cervical Dystonia to reduce the severity of abnormal head position and neck pain associated with Cervical Dystonia.

Blepharospasm and Strabismus

BOTOX® is indicated for the treatment of Strabismus and Blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and older.

Primary Axillary Hyperhidrosis

BOTOX® is indicated for the treatment of severe primary axillary hyperhidrosis that is inadequately managed with topical agents.

Limitations of Use

The safety and effectiveness of BOTOX® for hyperhidrosis in other body areas have not been established. Weakness of hand muscles and blepharoptosis may occur in patients who receive BOTOX® for palmar hyperhidrosis and facial hyperhidrosis, respectively. Patients should be evaluated for potential causes of secondary hyperhidrosis (eg, hyperthyroidism) to avoid symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of the underlying disease.

Safety and effectiveness of BOTOX® have not been established for the treatment of axillary hyperhidrosis in pediatric patients under age 18.

IMPORTANT SAFETY INFORMATION (continued)
CONTRAINDICATIONS

BOTOX® is contraindicated in the presence of infection at the proposed injection site(s) and in patients who are hypersensitive to any botulinum toxin product or to any of the components in the formulation.

BOTOX® is contraindicated for intradetrusor injection in patients with a urinary tract infection, or in patients with urinary retention, or post-void residual (PVR) urine volume > 200 mL who are not routinely performing clean intermittent self-catheterization (CIC).

WARNINGS AND PRECAUTIONS

Spread of Toxin Effect
See Boxed Warning.

No definitive serious adverse event reports of distant spread of toxin effect associated with BOTOX® for Blepharospasm at the recommended dose (30 Units and below), severe primary axillary hyperhidrosis at the recommended dose (100 Units), Strabismus, or for Chronic Migraine at the labeled doses have been reported.

Lack of Interchangeability Between Botulinum Toxin Products
The potency Units of BOTOX® are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of BOTOX® cannot be compared to nor converted into Units of any other botulinum toxin products assessed with any other specific assay method.

Serious Adverse Reactions With Unapproved Use
Serious adverse reactions, including excessive weakness, dysphagia, and aspiration pneumonia, with some adverse reactions associated with fatal outcomes, have been reported in patients who received BOTOX® injections for unapproved uses. In these cases, the adverse reactions were not necessarily related to distant spread of toxin, but may have resulted from the administration of BOTOX® to the site of injection and/or adjacent structures. In several of the cases, patients had preexisting dysphagia or other significant disabilities. There is insufficient information to identify factors associated with an increased risk for adverse reactions associated with the unapproved uses of BOTOX®. The safety and effectiveness of BOTOX® for unapproved uses have not been established.

Hypersensitivity Reactions
Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, urticaria, soft-tissue edema, and dyspnea. If such a reaction occurs, further injection of BOTOX® should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent, and consequently, the causal agent cannot be reliably determined.

Increased Risk of Clinically Significant Effects With Preexisting Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis (ALS), or neuromuscular junction disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should be monitored when given botulinum toxin. Patients with known or unrecognized neuromuscular disorders or neuromuscular junction disorders may be at increased risk of clinically significant effects, including generalized muscle weakness, diplopia, ptosis, dysphonia, dysarthria, severe dysphagia, and respiratory compromise from therapeutic doses of BOTOX® (see Warnings and Precautions).

Dysphagia and Breathing Difficulties
Treatment with BOTOX® and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing (see Boxed Warning).

Pulmonary Effects of BOTOX® in Patients With Compromised Respiratory Status Treated for Spasticity or for Detrusor Overactivity Associated With a Neurologic Condition
Patients with compromised respiratory status treated with BOTOX® for spasticity or detrusor overactivity associated with a neurologic condition should be monitored closely.

Corneal Exposure and Ulceration in Patients Treated With BOTOX® for Blepharospasm
Reduced blinking from BOTOX® injection of the orbicularis muscle can lead to corneal exposure, persistent epithelial defect, and corneal ulceration, especially in patients with VII nerve disorders.

Retrobulbar Hemorrhages in Patients Treated With BOTOX® for Strabismus
During the administration of BOTOX® for the treatment of Strabismus, retrobulbar hemorrhages sufficient to compromise retinal circulation have occurred. It is recommended that appropriate instruments to decompress the orbit be accessible.

Bronchitis and Upper Respiratory Tract Infections in Patients Treated for Spasticity
Bronchitis was reported more frequently as an adverse reaction in adult patients treated for upper limb spasticity with BOTOX® (3% at 251 Units to 360 Units total dose) compared to placebo (1%). In adult patients with reduced lung function treated for upper limb spasticity, upper respiratory tract infections were also reported more frequently as adverse reactions in patients treated with BOTOX® (11% at 360 Units total dose; 8% at 240 Units total dose) compared to placebo (6%). In adult patients treated for lower limb spasticity, upper respiratory tract infections were reported more frequently as an adverse reaction in patients treated with BOTOX® (2% at 300 Units to 400 Units total dose) compared to placebo (1%). In pediatric patients treated for upper limb spasticity, upper respiratory tract infections were reported more frequently as an adverse reaction in patients treated with BOTOX® (17% at 6 Units/kg and 10% at 3 Units/kg) compared to placebo (9%). In pediatric patients treated for lower limb spasticity, upper respiratory tract infection was not reported with an incidence greater than placebo.

Autonomic Dysreflexia in Patients Treated for Detrusor Overactivity Associated With a Neurologic Condition
Autonomic dysreflexia associated with intradetrusor injections of BOTOX® could occur in patients treated for detrusor overactivity associated with a neurologic condition and may require prompt medical therapy. In clinical trials, the incidence of autonomic dysreflexia was greater in adult patients treated with BOTOX® 200 Units compared with placebo (1.5% vs 0.4%, respectively).

Urinary Tract Infections in Patients With Overactive Bladder
BOTOX® increases the incidence of urinary tract infection. Clinical trials for overactive bladder excluded patients with more than 2 UTIs in the past 6 months and those taking antibiotics chronically due to recurrent UTIs. Use of BOTOX® for the treatment of overactive bladder in such patients and in patients with multiple recurrent UTIs during treatment should only be considered when the benefit is likely to outweigh the potential risk.

Urinary Retention in Adults Treated for Bladder Dysfunction
Due to the risk of urinary retention, treat only patients who are willing and able to initiate catheterization post treatment, if required, for urinary retention.

In patients who are not catheterizing, post-void residual (PVR) urine volume should be assessed within 2 weeks post treatment and periodically as medically appropriate up to 12 weeks, particularly in patients with multiple sclerosis or diabetes mellitus. Depending on patient symptoms, institute catheterization if PVR urine volume exceeds 200 mL and continue until PVR falls below 200 mL. Instruct patients to contact their physician if they experience difficulty in voiding as catheterization may be required.

Overactive Bladder
In clinical trials, 6.5% of patients (36/552) initiated clean intermittent catheterization for urinary retention following treatment with BOTOX® 100 Units, as compared to 0.4% of patients (2/542) treated with placebo. The median duration of catheterization for patients treated with BOTOX® 100 Units was 63 days (minimum 1 day to maximum 214 days), as compared to a median duration of 11 days (minimum 3 days to maximum 18 days) for patients receiving placebo.

Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than nondiabetics. In clinical trials, 12.3% of patients (10/81) with diabetes developed urinary retention following treatment with BOTOX® 100 Units vs 0% of patients (0/69) treated with placebo. In patients without diabetes, 6.3% of patients (33/526) developed urinary retention following treatment with BOTOX® 100 Units vs 0.6% of patients (3/516) treated with placebo.

Adult Detrusor Overactivity Associated With a Neurologic Condition
In clinical trials, 30.6% of adult patients (33/108) who were not using clean intermittent catheterization (CIC) prior to injection required catheterization for urinary retention following treatment with BOTOX® 200 Units, as compared to 6.7% of patients (7/104) treated with placebo. The median duration of postinjection catheterization for these patients treated with BOTOX® 200 Units (n = 33) was 289 days (minimum 1 day to maximum 530 days), as compared to a median duration of 358 days (minimum 2 days to maximum 379 days) for patients receiving placebo (n = 7).

Among adult patients not using CIC at baseline, those with multiple sclerosis were more likely to require CIC post injection than those with spinal cord injury.

Human Albumin and Transmission of Viral Diseases
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (vCJD). There is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), but if that risk actually exists, the risk of transmission would also be considered extremely remote. No cases of transmission of viral diseases, CJD, or vCJD have ever been identified for licensed albumin or albumin contained in other licensed products.

ADVERSE REACTIONS

Adverse reactions to BOTOX® for injection are discussed in greater detail in the following sections: Boxed WarningContraindications, and Warnings and Precautions.

Overactive Bladder
The most frequently reported adverse reactions for overactive bladder occurring within 12 weeks of injection include urinary tract infection (BOTOX® 18%, placebo 6%); dysuria (BOTOX® 9%, placebo 7%); urinary retention (BOTOX® 6%, placebo 0%); bacteriuria (BOTOX® 4%, placebo 2%); and residual urine volume (BOTOX® 3%, placebo 0%).

A higher incidence of urinary tract infection was observed in patients with diabetes mellitus treated with BOTOX® 100 Units and placebo than nondiabetics.

The incidence of UTI increased in patients who experienced a maximum post-void residual (PVR) urine volume ≥ 200 mL following BOTOX® injection compared to those with a maximum PVR < 200 mL following BOTOX® injection, 44% vs 23%, respectively.

Adult Detrusor Overactivity Associated With a Neurologic Condition
The most frequently reported adverse reactions within 12 weeks of BOTOX® injection for detrusor overactivity associated with a neurologic condition include urinary tract infection (BOTOX® 24%, placebo 17%); urinary retention (BOTOX® 17%, placebo 3%); and hematuria (BOTOX® 4%, placebo 3%).

The following adverse event rates were reported at any time following initial injection and prior to reinjection or study exit (median duration of 44 weeks of exposure): urinary tract infections (49%), urinary retention (17%), constipation (4%), muscular weakness (4%), dysuria (4%), fall (3%), gait disturbance (3%), and muscle spasm (2%).

Pediatric Detrusor Overactivity Associated With a Neurologic Condition
The most frequently reported adverse reactions during the 12 weeks following BOTOX® injection of 200 Units for pediatric detrusor overactivity associated with a neurologic condition include bacteriuria (20%), urinary tract infection (7%), leukocyturia (7%), and hematuria (3%).

The most common adverse reactions in patients who received BOTOX® 6 Units/kg and less than a total dose of 200 Units were urinary tract infection (UTI), bacteriuria, and hematuria.

These patients were not adequately managed with at least one anticholinergic agent and were using clean intermittent catheterization at baseline.

Chronic Migraine
The most frequently reported adverse reactions following injection of BOTOX® for Chronic Migraine include neck pain (9%), headache (5%), eyelid ptosis (4%), migraine (4%), muscular weakness (4%), musculoskeletal stiffness (4%), bronchitis (3%), injection-site pain (3%), musculoskeletal pain (3%), myalgia (3%), facial paresis (2%), hypertension (2%), and muscle spasms (2%).

Adult Upper Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® for upper limb spasticity include pain in extremity, muscular weakness, fatigue, nausea, and bronchitis.

Adult Lower Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® for lower limb spasticity include arthralgia, back pain, myalgia, upper respiratory tract infection, and injection-site pain.

Pediatric Upper Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® in pediatric upper limb spasticity include upper respiratory tract infection (includes upper respiratory tract infection and viral upper respiratory tract infection), injection-site pain, nausea, constipation, rhinorrhea, nasal congestion, and seizure (includes seizure and partial seizure).

Pediatric Lower Limb Spasticity
The most frequently reported adverse reactions following injection of BOTOX® in pediatric lower limb spasticity include injection-site erythema, injection-site pain, oropharyngeal pain, ligament sprain, skin abrasion, and decreased appetite.

Cervical Dystonia
The most frequently reported adverse reactions following injection of BOTOX® for Cervical Dystonia include dysphagia (19%), upper respiratory infection (12%), neck pain (11%), and headache (11%).

Blepharospasm
The most frequently reported adverse reactions following injection of BOTOX® for Blepharospasm include ptosis (21%), superficial punctate keratitis (6%), and eye dryness (6%).

Strabismus
The most frequently reported adverse events following injection of BOTOX® for Strabismus include ptosis (15.7%) and vertical deviation (16.9%).

Primary Axillary Hyperhidrosis
The most frequently reported adverse events (3%-10% of adult patients) following injection of BOTOX® for severe primary axillary hyperhidrosis in double-blind studies include injection-site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety.

Postmarketing Experience
Adverse reactions that have been identified during postapproval use of BOTOX® are discussed in greater detail in Postmarketing Experience (Section 6.3 of the Prescribing Information).

There have been spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility or anaphylaxis, after treatment with botulinum toxin. There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors, including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.

DRUG INTERACTIONS

Co-administration of BOTOX® and other agents interfering with neuromuscular transmission (eg, aminoglycosides, curare-like compounds) should only be performed with caution as the effect of the toxin may be potentiated. Use of anticholinergic drugs after administration of BOTOX® may potentiate systemic anticholinergic effects. The effect of administering different botulinum neurotoxin products at the same time or within several months of each other is unknown. Excessive neuromuscular weakness may be exacerbated by administration of another botulinum toxin prior to the resolution of the effects of a previously administered botulinum toxin. Excessive weakness may also be exaggerated by administration of a muscle relaxant before or after administration of BOTOX®.

Best chemical peel for hyperpigmentation on black skin

chemical peels for dark skin

Can people with dark skin even get chemical peels?

A friend, family member, or even your dermatologist may recommend a chemical peel to clear up a troublesome skin condition. Chemical peels are cosmetic treatments that are applied to the face and neck to remove damaged skin cells. Your board-certified dermatologist will combine different acids to create a solution suitable for your skin concern. The solution is then applied in a simple procedure. The result is smooth, blemish-free skin, based on the type of peels used.

Chemical peels slough off dead surface skin, so there needs to be care when using the treatment. There’s a common misconception that people with dark skin cannot get chemical peels. It’s understandable since there are some cases of damaged skin and a condition called post-inflammatory hyperpigmentation (dark spots). However, these are the exception and not the norm. In a study, only 4% of African American patients received some unwanted side effects.

It all boils down to the type of peel and your doctor’s experience in dealing with dark skin. At Eternal Dermatology + Aesthetics, we perform hundreds of chemical peels every year, particularly on dark skin. So in this article, we’ll cover the type of chemical peels available and how they can impact Skin Of Color. We’ll also give you some tips to make the process as smooth as possible.

Key uses of peels

Why would you use a chemical peel anyway? There are hundreds, if not thousands of skincare products on the market to deal with almost every skincare concern. So is a peel really necessary? Most skincare products send ingredients to the surface level of your skin. These can work over a long period, but the results may not be as expected. That said, chemical peels treat several conditions, which include:

  • Acne and Acne Scars: Some skin care products can clear our acne but is powerless to stop some of the scars left behind. A chemical peel can help break up and remove acne scarring.
  • Wrinkles and fine lines: Over time, our skin stops producing collagen, which helps with elasticity. That lack of elasticity creates wrinkles and fine lines on the top layer of our skin when we frown. Chemical peels can reduce the appearance of wrinkles, by stimulating new collagen formation.
  • Uneven skin tones, also called Hyperpigmentation: Our skin is exposed to external and internal stressors like pollution, sun damage, hormones, or a skin injury. These changes can impact different parts of our face, giving the appearance of an uneven skin tone. A chemical peel can produce smooth, even skin.
  • Melasma: Melasma is a skin condition that causes dark patches on the cheeks, forehead, or chin. People with dark skin tones are more likely to have melasma. It is also sometimes a result of pregnancy, stress, or thyroid conditions. Chemical peels can even skin tones while you work on the underlying cause of melasma.

A chemical peel gives your skin a reset by removing the outermost layer of your skin. Think of a snake shedding its skin, revealing a new, beautiful layer.

Why there’s a major concern with dark skin

People of color, dark skin or the many beautiful shades of brown make up roughly 1/3 of our population. While skin looks different on the outside, the genetic makeup of skin is about the same on the inside.

We all have the same melanocytes, the cells that produce melanin.

However, people of color produce far more melanin at the surface level. Melanin is the compound that determines hair color and skin color. But it also protects the skin from the harmful ultraviolet rays of the sun.

One significant advantage is that darker skin tones are far more protected from ultraviolet light than lighter skin tones (which could be the reason why many POCs believe that sunscreen is not necessary. Hint, it is.)

On the flip side, dark skin is more likely to react negatively to skin damage with conditions like melasma, hyperpigmentation, textural changes, and much more. In addition, since chemical peels essentially damage and remove layers of skin, there is a belief that you could get an unwanted reaction.

There is also a concern that people of color are not properly represented in the dermatology space. So many would choose to avoid certain procedures due to a lack of experience, taking the ‘better safe than sorry approach.’ There have been significant strides to address this issue. Today, more and more doctors and aestheticians understand how to help darker skin tones. Furthermore, there is a growing contingent of dermatologists of color. Now, your dermatologist would be able to choose the right peel for your skin concern.

Types of chemical peels

Before you get a chemical peel, it’s essential to understand both the types of peels and what’s in your peels. This knowledge will help you to understand what’s happening during your peel and if what your provider is suggesting is right for you. Chemical peels are classified as superficial peels, medium-depth peels, and deep peels.

  • Superficial peels target the uppermost layer of your skin called the stratum corneum or epidermis. These peels can go all the way to the top of an area called the papillary dermis.
  • Medium-depth peels impact the middle layer of your skin, called the dermis. This layer starts at the papillary dermis and goes to the middle of the reticular dermis. Medium-depth peels are much more potent at removing dead skin cells and breaking up scars.
  • Deep peels get deep into the middle layer of your skin and can break up deep acne scars and hyperpigmentation. Anyone opting for deep peels do so under the advice of a board-certified dermatologist. These peels have long healing times and must be done with caution.

Your peel will be an alpha-hydroxy acid (AHAs) or a beta-hydroxy acid (BHAs). AHAs are acids derived from plants and animals. At different concentrations, these can exfoliate your skin, brighten your skin, increase blood flow and collagen production. BHAs are oil-based organic compounds that can unclog pores, reduce oil, clear acne, and much more.

Superficial Chemical Peels

acid

Your superficial peels will contain AHAs or a combination of AHAs and BHAs. Glycolic acid and salicylic acids are the most common types of superficial peels. These ingredients are in many skin care products. However, your dermatologist will use a higher concentration in the chemical peel. Other types of superficial peels include tretinoin or Trichloroacetic acid (TCA) between 10% to 30% strength. Some dermatologists may perform a low concentration Jessner’s peel, which is a combination of lactic acid, resorcinol, and salicylic acid.

Medium-depth Peels

Medium peels contain stronger versions of AHAs or BHAs to reach dead skin cells and uneven skin tones. These peels start with stronger TCA, between 35% to 40%. Glycolic acid and Jessner’s solution also work for medium peels at stronger concentrations. Phenol peels, a combination of powerful acids, can also help. This special peel is used at lower concentrations since it’s often reserved for deep peels.

Deep Chemical Peels

These peels help in special cases of severely damaged skin, deep wrinkles, or blotchy skin. Phenol is a popular choice for deep peels. Some deep peels may also comtaIn 50% or higher TCA. These peels require preparation in the weeks before to ensure faster healing and better success.

Here are the best chemical peel for dark skin.

So which one of these peels is best for dark skin? As we mentioned, people of all shades can get chemical peels. Darker skin, pigmented skin, or People of Color need the right peels to effectively tackle their skin concerns while being safe to use.

Superficial peels are the best options for dark skin. Your doctor may first try low levels of glycolic acid and salicylic acid. Studies show glycolic acid and salicylic acid are safe and effective. These, along with retinol and Jessner peels, have the lowest skin complications with the best results. Research shows that TCA peels at 25% and above caused the most damage to dark skin. If your doctor is using TCA peels, it will be likely at a lower concentration to test your sensitivity.

Sensitivities still exist

Even with surface peels, the sensitivity levels vary from person to person. Skin complications are possible with glycolic acid, salicylic acid, or Jessner. Using the lowest concentration first can help the dermatologist gauge your sensitivity to the acid. Over several weeks, your dermatologist will perform three or more peels, slowly increasing the concentration of acids each time. You should see the best results with the lowest chances of side effects using this method.

Medium depth peels must be used with caution.

Medium peels can be used in specific circumstances. Lighter brown skin types, for instance, can see significant improvement in conditions like scarring, melasma, and hyperpigmentation. Like superficial peels, doctors will first try the peel at a lower concentration then increase the potency in future sessions. Darker skin is at significant risk of post-inflammatory hyperpigmentation and scarring. Hyperpigmentation and other issues tend to improve after three months with your dermatologist’s help.

Avoid these peels at all costs.

Deep peels or phenol peels should not be used on skin of color. There i a high risk of scarring and hyperpigmentation. If there is deep scarring or skin damage, there are other solutions your dermatologist can use which are both safe and effective. For peels of all types, discuss any concerns you may have. Your doctor will outline the risks and steps needed to address them.

Protecting yourself before and after your peel.

If you have acne, scars, hyperpigmentation, or other skin concerns, you can benefit from a chemical peel. People with dark skin, however, should focus on superficial peels. To minimize the risk and improve the effectiveness of your peel, your doctor will provide some instructions to prepare your skin before your session.

Your dermatologist will prescribe a combination of a skin-lightening agent, including hydroquinone, kojic acid,  arbutin and glycolic acid (between 5% and 10%). Sunscreen is vital during this time to protect against further skin damage. 

After your chemical peel, you’ll need to do some work too:

  • After the peel, you’ll feel some redness, burning, dryness, and minor swelling. These are normal symptoms and should resolve within a few days.
  • Make sure to apply a dermatologist-recommended sunscreen and moisturizer twice daily. Use a gentle, fragrance-free cleanser to clean your face.
  • As your skin begins to peel, it’s sensitive to sunlight and damage, so protect it at all costs.
  • Avoid picking or pulling the peeled skin since you can transfer bacteria onto your face. Let it slough off naturally.
  • Avoid exfoliants and makeup while your skin heals for the best results.
  • You may break out, which is normal. The acne should resolve during the healing process.

Make sure to take enough time between each session for the skin to heal completely.

Chemical peels for dark skin- Choose the right peel for you.

Remember, chemical peels for dark skin are possible. They are safe and effective but only when administered correctly. Superficial peels are best for dark skin. Your dermatologist will gradually increase the concentration of acids to gauge your skin’s sensitivity. If your doctor believes that you need a medium peel, there will be a gradual increase in potency. For the best results with minimum side effects, follow the instructions before and after your chemical peel.

Anyone with dark skin interested in chemical peels should seek out a dermatologist with expertise in treating skin of color. At Eternal Dermatology + Aesthetics, our lead dermatologist, Ife Rodney MD, FAAD, is skilled in providing chemical peels on all skin types. As a dermatologist of color, Dr. Rodney understands what you need to get the best results. Feel free to reach out to us to schedule your chemical peel consultation today.

Strongest at home chemical peel

woman after getting chemical peel

There’s no question about it: Everyone needs a good dermatologist. Not just for the life-saving skin checks, but for the instant glow of their in-office products and treatments that can be tough to capture at home. One of the most popular of these transformative treatments: the chemical peel. They’re strong, so real chemical peels are only available from the pros—but there are at-home chemical peels that capture the same effects on a smaller, safer scale.

How do chemical peels work?

Chemical peels vary in strength and ingredients, but most aim to deeply exfoliate the skin to reduce fine lines(opens in new tab) and wrinkles, improve brightness(opens in new tab), and lift away unwanted discoloration and brown spots.(opens in new tab) 

When choosing a DIY peel, it’s smart to consider your skin type, says NYC-based dermatologist Dendy Engelman. “Look at the acids in the peel, and make sure they target the issue you are trying to remedy.”

How are at-home chemical peels different from in-office treatments?

At-home chemical peels formulas have lower concentrations of the same acids, making them ideal for slathering them on yourself. “In-office peels have stronger concentrations of acids, meaning greater immediate results,” says Engelman. “These need to be administered by a licensed practitioner, because of the potential to burn or irritate the skin,” she says. At-home peels are safer and milder. 

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Are there risks to at-home chemical peels?

It’s critical to follow the directions on over-the-counter chemical peel products. Warns dermatologist Dennis Gross, who pioneered the at-home chemical peel: “Due to a wave of how-to YouTube videos and consumer accessibility to professional products through vendors like Amazon, I am seeing more and more instances of serious damage done to skin—all in a patient’s own bathroom,” He notes: “But higher concentrations of acid must be administered by a licensed professional; they can damage skin if they’re not neutralized properly.”

So what concentration of acid is safe? Well, the Cosmetic Ingredient Review Expert Panel recommends that companies use glycolic and lactic alpha-hydroxy acids in concentrations of 10 percent or less, in solutions with a pH of 3.5 or greater, when formulating consumer products. That said, many products feature higher doses.

“The biggest challenge is to not overwork the skin,” says Engelman.” Excessive exfoliation will expose skin, weaken skin-barrier function and trigger inflammation. If the barrier function is damaged, skin becomes vulnerable to infection from microorganisms, such as bacteria and fungus, and leads to sensitivity and irritation.”

During our reporting on at-home skincare treatments, we noted that two chemical peel products labeled with the same acid concentration won’t necessarily affect your complexion in the same way. The benefits, effects, and risks of each product comes down to a range of factors, including the ingredients; whether the acid is buffered with an ingredient to increase the pH level; and how long he product remains on the skin. It should go without saying, but leave the chemical peels that are formulated for salons and spas to the professionals. Also, bear in mind that chemical peels will make your skin more sensitive to sun damage, so make sure to slather on the SPF.

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