Medical Policy: 08.01.07 

Original Effective Date: January 1994 

Reviewed: March 2020 

Revised: January 2021 

 

Notice:

This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

Chemical Peels

A chemical peel is a controlled removal of various layers of the skin with the use of a chemical agent. The most common use of chemical peeling is the treatment of photoaged skin. Chemical peeling has also been used for other conditions, including actinic keratoses, active acne, and acne scarring.

 

Chemical peels involve a controlled partial-thickness removal of the epidermis and the outer dermis. When skin is regenerated, a 2 to 3 mm band of dense, compact collagen is formed between the epidermis and the damaged layers of the dermis, resulting in the ablation of fine wrinkles and a reduction in pigmentation. These changes can be long-term, lasting 15 to 20 years and may be permanent in some patients. Potential local complications include scarring, infection, hypopigmentation, hyperpigmentation, activation of herpes simplex, and toxic shock syndrome.

 

Chemical peels are often categorized according to the depth of the peel, the precise depth of the peel depends on the concentration of the agent used, duration of the application, and the number of applications:

  • Epidermal peels (superficial depth): affect the epidermis and the interface of the dermis-epidermis. This depth is considered appropriate for treating mild photoaging, melasma, comedonal acne, and post-inflammatory erythema. Common chemical agents used for superficial peels include low concentrations of glycolic acid, 10% to 20% trichloroacetic acid (TCA), Jessner solution (a mixture of resorcinol, salicylic acid, lactic acid, and ethanol), tretinoin, and salicylic acid. As part of the treatment process, superficial peels generally cause mild erythema and desquamation, and healing time ranges from one to four days, depending on the strength of the chemical agent. With superficial peels, patients often undergo multiple sessions, generally six to eight peels performed weekly or biweekly.
  • Dermal peels (medium depth): extend into the epidermis to the papillary dermis. They are used for moderate photoaging, actinic keratoses, pigmentary dyschromias, and mild acne scarring. In the past, 50% TCA was a common chemical agent for medium-depth peels, but its use has decreased due to high rates of complications (e.g., pigmentary changes, scarring). Currently, the most frequently used agent is a combination of 35% TCA with Jessner solution or 70% glycolic acid. Phenol 88% alone is also used for medium-depth peels. The healing process involves mild-to-moderate edema, followed by the appearance of new, erythematous epithelium. Patients are advised to wait at least three months before resuming skincare services (e.g., superficial chemical peels) and repeat medium-depth chemical peels should not be performed for at least one year.
  • Deep chemical peels (another type of dermal peel): penetrate the mid-reticular dermis and have been used for patients with severe photodamage, premalignant skin neoplasms, acne scars, and dyschromias. The most common chemical agent used is Baker solution (which consists of 3 mL of 88% phenol, 8 drops of hexachlorophene [Septisol], 3 drops of croton oil, 2 mL of distilled water). The same depth can be achieved using 50% or greater TCA peel; however, the latter has a higher risk of scarring and pigmentation problems. Phenol is cardiotoxic, and patients must be screened for cardiac arrhythmias or medications that could potentially precipitate an arrhythmia. Phenol can also have renal and hepatic toxicities.

 

The likelihood and potential severity of adverse events increase as the strength of the chemicals and the depth of peels increases. With deep chemical peels, there is the potential for long-term pigmentary disturbances (i.e., areas of hypopigmentation), and selection of patients willing to always wear makeup is advised. Moreover, chemical peels reduce melanin protection, so patients must use protective sunscreen for 9 to 12 months after a medium to deep facial peel.

Chemical peels are a potential treatment option for actinic keratoses and moderate-to-severe acne. Actinic keratoses are common skin lesions associated with extended exposure to the sun, with an estimated prevalence in the U.S. of 11% to 26%. These lesions are generally considered to be a precursor of squamous cell carcinoma. The risk of progression to invasive squamous cell carcinoma is unclear, but estimates vary from 0.1% to 20%. For patients with multiple actinic keratoses, the risk of developing invasive squamous cell carcinoma is estimated as being between 0.15% and 80%. Treatment options include watchful waiting, medication treatment, cryosurgery, surgical resection.

 

Acne vulgaris is the most common skin condition among adolescents, affecting an estimated 80% of teenagers aged 13 to 18 years old. Acne, particularly moderate-to-severe manifestations, can cause psychologic distress including low self-esteem, depression, and anxiety. There are a variety of oral and topical treatments for acne.

 

Chemical peeling also has a number of cosmetic uses including the treatment of photo-aged skin, uneven pigmentation, solar elastosis, and diminishing age-related wrinkles.

 

Actinic Keratoses

Clinical Context and Therapy Purpose

The purpose of dermal chemical peels for patients who have actinic keratoses is to provide a treatment option that is an alternative to or an improvement on existing therapies.

 

Patients

The relevant population of interest are individuals with actinic keratoses.

 

Interventions

The therapy being considered is dermal chemical peels.

 

Chemical peels are administered in an outpatient setting by dermatologists.

 

Comparators

The following therapies are currently being used to treat actinic keratoses: watchful waiting, medication treatment, cryosurgery, surgical resection, and photodynamic therapy.

 

Outcomes

The general outcomes of interest are destroying actinic keratosis, the durability of this effect, the development of cancerous lesions, quality of life (QOL), and the harms of associated treatment-related morbidities.

 

Systematic Reviews

Older review articles have suggested that chemical peels might be appropriate when there are numerous lesions (i.e. ≥ 10), making treatment of the individual lesions impractical.

 

Nonrandomized Trials and Case Series

Evidence consists of a nonrandomized split-face study and case series. The split-face trial found similar outcomes after a single chemical peel and after 3 weeks of treatment with fluorouracil cream 5% in 15 patients. A case series found high response rates and low recurrence rates at one year in patients with actinic keratoses treated with phenol peels.

 

Randomized Trials

In 2017, Holzer et. al. conducted a randomized, observer-blinded, intrapatient comparative study to investigate the efficacy and safety of 35% trichloroacetic acid (TCA) versus aminolaevulinic acid 20% (ALA) PDT in patients with extensive field cancerization and multiple actinic keratoses (Aks) on the face or the scalp. Twenty-eight patients with at least five AKs in two comparable anatomical areas on the head were treated with 35% TCA and ALA PDT randomly assigned to each area. Their therapeutic efficacy, adverse events and cosmetic outcome were assessed by a blinded investigator at 1, 3, 6 and 12 months after treatment. After 12-months' follow-up TCA and ALA PDT reduced the total lesion count, the primary outcome, by 31% and 58%, respectively (P = 0.006). Complete clearance of pre-existing AKs were 49% for TCA and 74% for ALA PDT (P = 0.011). Treatment failure (number of AKs greater than 50% of the baseline count) was observed in seven patients (25%) after TCA and in two patients (7%) after PDT treatment. Treatment-related pain was significantly higher for ALA PDT (visual analogue scale 7.5 ± 2.3 vs. TCA: 5.1 ± 2.6; P = 0.04), whereas scarring (n = 6, 21%) was seen only in TCA treated patients.

 

Summary of Evidence

For individuals who have actinic keratosis who receive chemical peels, the evidence includes older systematic reviews and case series that have suggested that chemical peels might be appropriate when there are numerous lesions (i.e. ≥ 10), making treatment of the individual lesions impractical. The evidence also includes nonrandomized and randomized clinical trials that suggest chemical peels are effective in treating precancerous lesions of actinic keratosis. Additional controlled studies, preferably randomized, are needed. However, clinical input in 2010 by BlueCross BlueShield Association (BCBSA) supported the use of chemical peels for treating multiple actinic keratosis.  The evidence is sufficient to determine the effects of the technology on net health outcomes.

 

Moderate to Severe Active Acne

Clinical Context and Therapy Purpose

The purpose of epidermal chemical peels for patients who have moderate-to-severe active acne is to provide a treatment option that is an alternative to or an improvement on existing therapies.

 

Patients

The relevant population of interest are individuals with moderate-to-severe active acne.

 

Interventions

The therapy being considered is epidermal chemical peels.

 

Comparators

The following therapies are currently being used to treat active acne: topical or oral medications.

 

Outcomes

The general outcomes of interest are the resolution of severe acne and the harms of treatment-related morbidities.

 

The relevant follow-up is within weeks for the efficacy of treatment.

 

Randomized Controlled Trials

In 2014, Kaminaka et. al. conducted a randomized, double-blind, placebo-controlled, split-face comparative study to determine the safety and efficacy of glycolic acid (GA) peels in the treatment of moderate acne vulgaris in Asian skin. Twenty-six patients with moderate acne were treated with 40% GA (pH 2.0) on half of the face and placebo on the other half. The procedure was performed five times at 2-week intervals. The GA sides had statistically significant reductions in acne lesions at each time point from baseline values. There were statistically significant differences between the GA and placebo sides. The GA sides had better responses for non-inflammatory lesions than for inflammatory lesions. In bioengineering measurements, sebum levels were statistically significantly reduced after the initiation of therapy on both sides at weeks 8 and 10, but there were no statistically significant differences between the two sides. The authors concluded, 40% of the GA peels significantly improved moderate acne in this study.

 

Dayal et. al. (2017) compared the efficacy of 30% salicylic acid (SA) versus Jessner’s solution (JS) peels in treatment of mild to moderate facial acne in Indian patients. A total of 40 patients with mild to moderate AV were enrolled for 12 weeks and were randomly divided into two groups: group 1, 30% SA peels and group 2, JS peels were performed 2 weeks apart with total of six peels in 12-week duration. Clinical improvement was assessed objectively using Michaelsson acne scores (MAS) and clinical photographs. Side effects were observed at each visit. At the end of therapy, improvement in MAS and percentage decrease in MAS were significantly higher in group 1 as compared to group 2. Likewise, decrease in mean comedone counts in group 1 was significantly higher as compared to group 2. However, there was no statistically significant difference in the decrease in mean papule and pustule counts between the two groups. Both the groups tolerated the peels well. The authors concluded, 30% SA peels were more effective than JS peels in treatment of noninflammatory lesions, that is, comedones and in overall improvement of mild-to-moderate facial acne vulgaris.

 

Several RCTs have compared two types of chemical peels. Most were conducted outside of the U.S. and used split-faced designs. Among the trials comparing two chemical peel interventions, salicylic acid was used as the chemical peel agent in all but one trial.

 

Summary of Evidence

For individuals who have moderate to severe active acne who receive epidermal chemical peels, the evidence includes randomized controlled trials which suggest that chemical peels in the treatment of moderate to severe active acne are effective. However, no studies were identified comparing chemical peel agents with conventional acne treatment. Clinical input in 2010 by BlueCross BlueShield Association (BCBSA) supported the use of chemical peels as a second-line treatment of active moderate to severe acne. The evidence is sufficient to determine the effects of the technology on net health outcomes.

 

Dermabrasion

Clinical Context and Therapy Purpose

The purpose of dermabrasion for patients who have actinic keratoses is to provide a treatment option that is an alternative to or an improvement on existing therapies.

 

Patients

The relevant population of interest are individuals with actinic keratoses.

 

Interventions

The therapy being considered is dermabrasion.

 

Comparators

The following therapies are currently being used to treat actinic keratosis: watchful waiting, medication treatment, cryosurgery, surgical resection, and photodynamic therapy.

 

Outcomes

The general outcomes of interest are destroying actinic keratosis, the durability of this effect, the development of cancerous lesions, quality of life (QOL), and the harms of associated treatment-related morbidities.

 

Dermabrasion is a surgical procedure that resurfaces the texture of the skin by removing its top layer using a mechanical instrument such as a high-speed rotary abrasive wheel to remove the layers of skin. Dermabrasion is also referred to as abrasion, salabrasion, microdermabrasion, dermaplaning or sanding the skin. Laser brasion (Tunable Dye, CO² and Ruby lasers) and chemobrasion (phenol, trichloroacetic acid and glycolic acid) are modalities of treatment that are used in place of conventional dermabrasion.

 

The procedure is most often performed for the purpose of removing acne scars, tattoos or fine wrinkles and is performed in an office setting using a local anesthetic. Depending on the severity of the lesion and area being treated, a second treatment may be required for complete results. Following treatment the individual can expect discoloration and scabbing to occur, which will last for five to seven days. Discoloration and swelling can last for two to three months while the area is healing. Scarring after the skin has healed is rare.

 

Dermabrasion has proven effective in treating multiple recalcitrant actinic keratoses (AK) lesions in cases where numerous AK lesions (e.g., more than 10) have been documented and where lesions are diffuse with severe actinic damage. In general, AK lesions are precancerous skin lesions that occur on the epidermis (outer layer of skin) and result from long-term exposure to the sun. Microscopically, AK lesions show varying degrees of atypia and abnormal maturation and may be further classified as atrophic, hyperkeratotic, bowenoid, acantholytic, lichenoid and pigmented. AKs are the most commonly treated type of premalignant lesion and are considered precursor lesions to squamous cell carcinoma. In general, treatment of AK lesions is divided into lesion-directed therapy or field therapy.  Lesion directed therapy targets a specific lesion while field therapy is used to treat areas involving subclinical lesions and areas involving multiple clinical lesions making it impractical to treat each lesion separately. Topical field therapies that have proven effective for AK lesions include 5-fluorouracil, imiquimod, diclofenac, ingenol gel, photodynamic therapy, dermabrasion and chemical peels.  Dermabrasion also has a number of cosmetic applications such as diminishing age-related wrinkles and skin discolorations, minor scars and scaring from acne.

 

Dermabrasion is contraindicated in patients with active acne, as active stages of acne pose a greater risk of infection and may exacerbate skin inflammation.

 

Microdermabrasion is a non-invasive, non-surgical cosmetic procedure that can be performed either by a physician or in some cases by the individual in a home setting. The non-invasive treatment exfoliates or removes the top layer of skin (i.e. stratum corneum) and is frequently performed to diminish the signs of aging. Dermabrasive procedures that resurface the superficial layer of skin, including but not limited to those used to reduce signs of aging, are considered cosmetic.

 

Summary of Evidence

Dermabrasion have been proven safe and effective for treatment of actinic keratoses when lesions are diffuse making targeted treatment impractical, and when other conventional methods of treatments have either failed, are not tolerated, or are contraindicated.  The evidence is sufficient to determine the effects of the technology on net health outcomes.

 

Policy Guidelines and Position Statements

American Academy of Dermatology

In 2016, the American Academy of Dermatology published a guideline on the management of acne vulgaris makes include the following statement regarding chemical peels: "Miscellaneous Therapies and Physical Modalities: Studies exist suggesting that chemical peels may improve acne. However, large, multicenter, double blinded control trials comparing peels to placebo and comparing different peels are lacking. Glycolic acid and salicylic acid chemical peels may be helpful for non-inflammatory (comedonal) lesions. However, multiple treatments are needed and the results are not long lasting. In the opinion of the work group, chemical peels may result in mild improvement in comedonal acne."

 

National Comprehensive Cancer Network (NCCN)

Squamous Cell Skin Cancer Version 1.2020
Identification and Management of High-Risk Patients

Treatment of Precancers (Diffuse Actinic Keratoses, Field Cancerization)

  • Actinic keratoses should be treated at first development
    • Accepted treatment modalities include cryotherapy, topical 5-fluorouracil with or without calcipotriol (calcipotriene), topical imiquimod, topical ingenol mebutate, photodynamic therapy (e.g. aminolevulinic acid [ALA], porfimer sodium), and C&E. For hyperkeratotic actinic keratoses, pretreatment with topical tazarotene, curettage, or topical keratolytics (topical urea, lactic acid, and salicylic acid) prior to above therapies may be considered.
    • Other modalities may be considered include topical diclofenac (category 2B), chemical peel (trichloracetic acid), and ablative skin resurfacing (e.g. laser, dermabrasion).
  • Actinic keratoses that have an atypical clinical appearance or do not respond to appropriate therapy should be biopsied for histological evaluation.
  • Ablative laser vermilionectomy may be of value in the treatment of extensive actinic cheilitis.

 

Fewer high quality data are available regarding the efficacy and safety of several other treatments that are sometimes used and may be considered for treating actinic keratoses: chemical peels (trichloroacetic acid) and ablative skin surfacing (e.g. dermabrasion, laser). These studies have all confirmed that laser resurfacing or chemical peel significantly reduced the quantity of actinic keratoses, although in some studies they were less effective than PDT or 5-FU. The use of chemical peels and ablative skin resurfacing varies widely across NCCN institutions.

 

Basal Cell Skin Cancer Version 1.2020

NCCN recommendations for low risk basal cell skin cancer (BCC) include: 1) C&E in areas without hair growth (i.e. excluding terminal hair bearing regions such as the scalp, pubic and axillary regions, and beard area in men provided that treatment be changed to excision if the adipose is reached; 2) standard excision if lesion can be excised with 4-mm clinical margins and with closure techniques such as linear closure, second intention healing or skin graft; and 3) RT for non-surgical candidates, generally limited those older than 60 years of age because of risk of long term toxicity.

 

If margins are positive after excision, patients should receive adjuvant therapy.

 

The NCCN Panel discussed the use of alternative therapies as first line treatment in patients with low risk, superficial BCC where surgery or radiation is contraindicated or impractical. These include 5-FU, imiquimod, PDT with porifimer sodium or ALA, or vigorous cryotherapy. Data suggest that the cure rate of these approaches may be lower compared with surgery. On the other hand, panelist experience indicated that they may be effective for anatomically challenging locations, and recurrence are often small and manageable. Panelists agreed that these therapies may be considered for superficial BCCs based on patient preference.

 

The current NCCN guideline does not include or indicate the use of chemical peels or dermabrasion in the treatment of low risk basal cell skin cancer.

 

Regulatory Status

U.S. Food and Drug Administration clearance or approval of chemical agents used in peeling may not be relevant because these agents are prepared in-office, may have predated Food and Drug Administration approval, and/or may be considered cosmetic ingredients.

 

Dermabrasion is considered a noninvasive surgical procedure and as such is not regulated by the FDA. However, devices, such as those used for microdermabrasion, are regulated by the FDA.

 

Prior Approval:

Not applicable

 

Policy:

See also medical policy 10.01.02 Cosmetic/Reconstructive Services

 

Chemical Peels

Dermal chemical peels used for the treatment of actinic keratoses lesions that are diffuse (e.g. ≥ 10 lesions), making targeted therapy impractical is considered medically necessary.

 

Epidermal chemical peels used to treat moderate to severe active acne in patients who have failed to respond to a trial of topical and/or oral antibiotic acne therapy is considered medically necessary.

 

Chemical peels for all other indications not meeting the above criteria is considered not medically necessary as the use of chemical peels has not been proven effective compared to other conventional methods of treatment for all other skin conditions.

 

Dermabrasion

Dermabrasion for the treatment of actinic keratoses lesions that are diffuse (e.g. ≥ 10 lesions), making targeted therapy impractical is considered medically necessary.

 

Dermabrasion for the treatment of active acne is considered not medically necessary, as this treatment is contraindicated in patients with active acne, as active stages of acne pose a greater risk of infection and may exacerbate skin inflammation.

 

Dermabrasion for all other indications not meeting the above medical necessity criteria is considered not medically necessary as the use of dermabrasion has not been proven effective compared to other conventional methods of treatment for all other skin conditions.

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 15780 Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis)
  • 15781 Dermabrasion; segmental, face
  • 15782 Dermabrasion; regional, other than face
  • 15788 Chemical peel, facial; epidermal
  • 15789 Chemical peel, facial; dermal
  • 15792 Chemical peel, nonfacial; epidermal
  • 15793 Chemical peel, nonfacial; dermal

 

Selected References:

  • Morganroth, GS; Leffell, DT. Nonexcisional treatment of benign and premalignant cutaneous lesions. Clinics in Plastic Surgery 1993; 20:91-104.
  • Brodland, DG; Roenigk, RK. Trichloroacetic acid chemexfoliation (chemical peel) for extensive premalignant actinic damage of the face and scalp. Mayo Clinic Proceedings 1988; 63:887-96.
  • Van Scott, EJ; Yu, RJ. Alpha hydroxy acids: Procedures for use in clinical practice. Cutis 1989; 43:222-28.
  • Kaminsky A. Less common methods to treat acne. Dermatology. 2003;206(1):68-73.
  • American Academy of Dermatology: Actinic Keratosis: Diagnosis, Treatment and Outcome
  • Centers for Medicare and Medicaid Services National Coverage Determination (NCD) for Treatment of Actinic Keratosis (250.4).
  • American Academy of Dermatology Acne: Diagnosis, Treatment and Outcome (a to z)
  • American Academy of Dermatology: Guidelines of Care for Acne Vulgaris Management. J Am Acad Dermatol 2007;56:561-63
  • American Society of Plastic Surgeons Chemical Peel.
  • American Society of Plastic Surgeons Dermabrasion.
  • Skin Cancer Foundation Actinic Keratosis.
  • American Skin Association Acne.
  • American Skin Association Actinic Keratoses.
  • UpToDate Treatment of Actinic Keratosis, Joseph Jorizzo, M.D., Topic last updated April 5, 2018.
  • UpToDate Light-based, Adjunctive, and Other Therapies for Acne Vulgaris, Jeffrey S. Dover, M.D., FRCPC, Priya Batra, M.D.. Topic last updated August 6. 2015.
  • Medscape Reference Drugs Diseases and Procedures, Dermabrasion. Updated December 13, 2013.
  • Medscape Reference Drugs Diseases and Procedures, Acne Vulgaris, Updated May 13, 2013.
  • National Comprehensive Cancer Network (NCCN) Basal Cell Cancer, Version 1.2020.
  • National Comprehensive Cancer Network (NCCN) Squamous Cell Skin Cancer, Version 2.2020.
  • British Association of Dermatologists, Guidelines for the Management of Actinic Keratoses 2007. British Journal of Dermatology 2007 156, pp 222-230
  • American Academy of Dermatology, Guidelines of Care for Acne Vulgaris Management, 2007. Journal of American Academy of Dermatology 2007;56:651-63
  • Kaminaka C, Uede M, Matsunaka H, et al. Clinical evaluation of glycolic acid chemical peeling in patients with acne vulgaris: a randomized, double-blind, placebo-controlled, split-face comparative study. Dermatol Surg. Mar 2014;40(3):314-322. PMID 24447110
  • Levesque A, Hamzavi I, Seite S, et al. Randomized trial comparing a chemical peel containing a lipophilic hydroxy acid derivative of salicylic acid with a salicylic acid peel in subjects with comedonal acne. J Cosmet Dermatol. Sep 2011;10(3):174-178. PMID 21896127 
  • Ilknur T, Demirtasoglu M, Bicak MU, et al. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther. Oct 2010;12(5):242-245. PMID 20825257
  • Kessler E, Flanagan K, Chia C, et al. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris. Dermatol Surg. Jan 2008;34(1):45-50; discussion 51. PMID 18053051
  • Kaminaka C, Yamamoto Y, Yonei N, et al. Phenol peels as a novel therapeutic approach for actinic keratosis and Bowen disease: prospective pilot trial with assessment of clinical, histologic, and immunohistochemical correlations. J Am Acad Dermatol. Apr 2009;60(4):615-625. PMID 19293009
  • de Berker D, McGregor JM, Hughes BR. Guidelines for the management of actinic keratoses. Br J Dermatol. Feb 2007;156(2):222-230. PMID 17223860
  • Zaenglein A, Pathy A, Schlosser B, et. al. Guidelines for Care for the Management of Acne Vulgaris. American Academy of Dermatology. J Am Acad Dermatol 2015.12.037
  • Costa C, Scalvenzi, Ayala R, et. al. How to treat actinic keratosis? An update. J Dermatol Case Rep. Jun 30 2015:9(2):29-35.PMID 26236409
  • Padilla RS, Sabastian S, Jiang Z, et. al. Gene expression patterns of normal human skin, actinic keratosis and squamous cell carcinoma: a spectrum of disease progression. Arch Dermatol Mar 2010;146(3):288-293. PMID 20231500
  • Purdy S, de Berker D. Acne vulgaris. BMJ Clin Evid. Jan 5 2011;2011. PMID 21477388
  • Abdel Meguid AM, Elaziz Ahmed, Attalla DA, Omar H. Trichloroacetic acid versus salicylic acid in the treatment of acne vulgaris in dark-skinned patients. Dermatol Surg Dec 2015;41(12):1398-1404. PMID 26551771
  • Dayal S, Amrani A, Sahu P, et. al. Jessner’s solution vs. 30% salicylic acid peels: a comparative study of the efficacy and safety to mild-to-moderate acne vulgaris. J Cosmet Dermatol. Aug 25 2016. PMID 27557589
  • Zaenglein AL, Pathy AL, Schlosser BJ, et. al. Guideline of care for the management of acne vulgaris. J Am Acad Dermatol. May 2016;74(5):945-973 e933. PMID 26897386
  • UpToDate. Photaging. Anna L Chien M.D., Sewon Kang M.D. Topic last updated January 21, 2019.
  • UpToDate. Management of Acne Scars. Nazanin Saedi M.D., Nathan Uebelhoer M.D. Topic last updated August 22, 2017.
  • UpToDate. Postinflammatory Hyperpigmentation. Nazanin Saedi M.D. Topic last updated June 29, 2018.
  • UpToDate. Treatment of Acne Vulgaris. Emmy Graber M.D., MBA. Topic last updated October 11, 2018.
  • Patel L, McGrougther, Chakrabarty K. Evaluating evidence for atrophic scarring treatment modalities. Journal of Royal Society of Medicine Open 2014, DOI:10.1177/2054270414540139. PMID 25352991
  • Bhate K, Williams HC. What’s new in acne? An analysis of systematic reviews published in 2011-2012. Clin Exp Dermatol 2014 Apr;39(3):273-7. PMID 24635060
  • Nguyen T. Dermatology procedures: microdermabrasion and chemical peels. FP Essent 2014 Nov;426:16-23. PMID 25373032
  • Waldman A, Bolotin D, Arndt KA, et. al. ASDS Guidelines Task Force: Consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, energy devices and skin surgery during after isotretinoin use. Dermatol Surg Oct 2017;43910):1249-1262. PMID 28498204
  • Holzer G, Pinkowicz A, Radakovic S, et. al. Randomized controlled trial comparing 35% trichloracetic acid peel and 5-aminolaevulinic acid photodynamic therapy for treating multiple actinic keratosis. Br J Dermatol 2017 May;176(5):1155-1161. PMID 28012181
        

 

Policy History:

  • January 2021 - Interim Review, Policy Revised
  • March 2020 - Annual Review, Policy Revised
  • June 2019 - Interim Review, Policy Revised
  • March 2019 - Annual Review, Policy Revised
  • March 2018 - Annual Review, Policy Renewed
  • March 2017 - Annual Review, Policy Revised
  • March 2016 - Annual Review, Policy Revised
  • April 2015 - Annual Review, Policy Renewed
  • May 2014 - Annual Review, Policy Revised
  • July 2013 - Annual Review, Policy Revised
  • November 2012 - Annual Review, Policy Renewed
  • November 2011 - Annual Review, Policy Renewed
  • November 2010 - Annual Review, policy Renewed

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

*CPT® is a registered trademark of the American Medical Association.