A chemical peel is a skin-resurfacing procedure in which a chemical solution is applied to the skin to peel away the accumulation of dead cells on the surface of the skin, enhancing cell renewal and increasing the moisture content of the skin [1-10]. It also helps to stimulate collagen regeneration making skin healthier. The skin can peel or flake off a few days after the peel revealing healthier, smoother and more radiant skin. Recommended home care products help to stimulate skin renewal and sun protection [3,11].

Moderate to severe psoriasis is associated with a higher incidence of cardiovascular risk factors such as diabetes mellitus, obesity, smoking, and the metabolic syndrome [1,2]. Psoriasis patients with longstanding skin lesions suffer increased morbidity and mortality [2]. There has been an active inquiry that whether psoriasis has been associated with an increased venous thromboembolic risk [3].

Various hormones are secreted after exposure to stress, including adrenocorticotropic hormone, cortisol, and adrenaline. The secretion of ß-endorphin (ß-End) is also induced by stress in animals [1,2] and humans [3,4]. ß-End is a 31-amino-acid opioid synthesized in the arcuate nucleus that inhibits several central nervous system functions. In the periphery, endorphins are synthesized in the intermediate pituitary or its vestigial region. Immune cells also synthesized ß-End [5], and the regulation of the immune system by ß-End has been reported. Natural cytotoxicity (NK cell efficacy) was stimulated by ß-End [6].

Palmoplantar keratodermas (PPK) may be categorized as acquired or hereditary. Acquired PPK have been associated with paraneoplastic syndromes and HIV/AIDS [1]. Inherited PPK are further classified by their distribution of epidermal involvement. The three classes of inherited PPKs are diffuse keratodermas, focal keratodermas and punctate keratodermas. These three classes of inherited PPKs can manifest in three ways; simple manifestation remains limited to the skin; complex manifestation includes lesions of nonvolar skin, hair, teeth, nails and sweat glands and syndromic manifestation can involve other organ systems, deafness, and/or cancer [2].

Acrodermatitis Chronica Atrophicans Herxheimer (ACA) is a tick-born disease that has initially been described 1902 by Herxheimer. The disease is a late manifestation of infection in most cases by Borrelia afzelii, although B. garinii and Bb sensu strictu have been isolated in a few cases. In Germany the major vector organism is Ixodes rhicinus. The disease starts with an edematous early stage with livid erythema. Here the number of differential diagnoses is large and covers such different disorders like chronic venous insufficiency with stasis dermatitis, myxedema, dermatoliposclerosis, and scleroderma [1, 2].

Palmoplantar keratodermas (PPK) may be categorized as acquired or hereditary. Acquired PPK have been associated with paraneoplastic syndromes and HIV/AIDS [1]. Inherited PPK are further classified by their distribution of epidermal involvement. The three classes of inherited PPKs are diffuse keratodermas, focal keratodermas and punctate keratodermas. These three classes of inherited PPKs can manifest in three ways; simple manifestation remains limited to the skin; complex manifestation includes lesions of nonvolar skin, hair, teeth, nails and sweat glands and syndromic manifestation can involve other organ systems, deafness, and/or cancer [2].