Chemical peeling is a
- simple office procedure
- safe & effective in learned hands
- affordable to most
Principle of Chemical Peeling
- Procedure where in a chemical agent of defined strength is applied to the skin
- Causes a controlled destruction of the layers of the skin;
- Followed by regeneration & remodelling of collagen
- With improvement of texture & 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
Depth of peels
- 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 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.
Getting down to Peels
- 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 closely between peels.
Pre Peel Preparation
- Preparing 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 .
1 week prior
- Stop electrolysis, waxing, depilatories, masks, hair dyes, bleaching, straightening etc.
- Glycolic and salicylic acid based face washes
- No make up/cologne/shaving on peel day
- Test peel- Retroauricular area
Post peel care
The aim of good postoperative care is to prevent or minimize complications and ensure early recovery. This 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.
- In the postpeel 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.
- 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.
- Clear instructions must be given to the patient for the postprocedure period.
- They should be told to use broad-spectrum sunscreens and only bland moisturizers until peeling is complete.
- They should avoid peeling or scratching the skin.
Where to use to chemical peeling treatment :
- +Pigmentary Disorders
- Postinflammatory hyperpigmentation
- Facial melanoses
- Superficial acne scars
- Postacne pigmentation
- Comedonal acne
- Acne excoriιe
- Acne vulgaris-mild to moderately severe acne
- Fine superficial wrinkling
- Dilated pores
- Superficial scars
- +Epidermal growths
- Seborrheic keratoses
- Actinic keratoses
- Sebaceous hyperplasia
- Dermatoses papulosa nigra
Where not use chemical peel--
- 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.