Chemical Peeling

• Procedure wherein a chemical agent of defined strength is applied to the skin
• Causes controlled destruction of the layers of the skin
• Followed by regeneration & remodeling of collagen
• With the improvement of texture & skin surface abnormalities

• Alpha hydroxy  acids: Glycolic, lactic, mandelic, pyruvic
• Beta hydroxy acids: Salicylic acid
• TCA, Phenol
• Combinations – AHA cocktails – phytic peel
• AHA+ BHA 
• Newer peels – Yellow peel, Arginine peel
• Additional agents in combination peels-Kojic acid, phenol, licorice 

• Very Superficial: Exfoliation of Stratum corneum with no epidermal necrosis.                     

GA 30-50%, 1-2 min, TCA 10% 

• Superficial: Necrosis of part or entire epidermis, not below the basal layer. 

GA 50-70% – 2-10 min, TCA 10-30%,  Salicylic acid 20-50%           

• Medium: Necrosis of epidermis, papillary dermis, up to upper reticular dermis.

GA 70% – 3-30 min, TCA 35-50%

• Deep: Necrosis of epidermis, papillary dermis; up to mid-reticular dermis.

Phenol 88%

• Evaluate the patient  to assess the outcomes you  can offer
• Gauge the expectation of the patient
• COUNSEL the patient
• Prime the patient during the acne/ pigmentation therapy
• Re-evaluate between priming and actual peels
• Plan your peel type as you evaluate – keep multiple options open
• Documentation and photographs.
• Read the patient outcome carefully between peels.

• Preparation of the skin before starting chemical peel. It is the first step in performing safe & effective peels.
• Priming agents: Tretinoin, AHAs ( glycolic, lactic acid), Hydroquinone.
• Alternatives – Kojic acid, Arbutin, Licorice. 

• Patients should stop electrolysis, waxing, depilatories, masks, hair dyes, bleaching, straightening, etc.
• Glycolic and salicylic  acid-based face washes
• No makeup/cologne/shaving on peel day
• Test peel- Retroauricular area

Proper postoperative care aims to prevent or minimize complications and ensure early recovery. This step is most important in dark-skinned patients in whom pigmentary alterations are common. A careful maintenance program is essential to maintain the results of chemical peeling in most patients.

1. In the post-peel period, edema, erythema, and desquamation occur. In superficial peels, this lasts for 1-3 days, whereas in deeper peels, it lasts for 5-10 days.
2. Mild soap or a non-soap cleanser may be used. If there is crusting, a topical antibacterial ointment should be used to prevent bacterial infection.
3. Clear instructions must be given to the patient for the postprocedure period.
4. Patients should be told to use broad-spectrum sunscreens and only bland moisturizers until peeling is complete.
5. Patients should avoid peeling or scratching the skin.

• Active bacterial, viral, fungal or herpetic infection
• Open wounds
• H/O (history of) drugs with photosensitizing potential
• Preexisting inflammatory dermatoses such as psoriasis, atopic dermatitis
• Uncooperative patient (patient is careless about sun exposure or application of medicine)
• Patient with unrealistic expectations.
• For medium depth and deep peels-history of abnormal scarring, keloids, atrophic skin, and isotretinoin use in the last six months should be taken.

Acne vulgaris is the most common skin disorder in adolescents and young adults. It carries a significant psychological and economic burden on the patients and society. A wide range of therapeutic options is available, including topicals and systemic therapies. Chemical peeling is a skin resurfacing procedure intended to regenerate healthy skin from the application of exfoliative agents. Salicylic acid containing peels are most useful in case of active acne.

Acne pigmentation- Chemical peel at present is one of the most favorable modalities for acne pigmentation management. Various peels are available for pigmentation—glycolic acid, trichloroacetic acid, lactic acid, etc.

Acne scar-Cross trichloroacetic acid application is very cost-effective and rewarding in the case of ice picks and shallow acne scars.

A chemical peel is a stepping stone in the management of hyperpigmentation. Phenolic, glycolic, TCA, retinoic acid peel are commonly used in a hyper pigmentary condition such as melasma, post-inflammatory pigmentation.