Chemical peeling is a common dermatological procedure performed without any surgical instruments. This relatively painless, office procedure has been shown to yield excellent cosmetic results in properly selected cases of hypermelanosis, scars & photoageing
Of the various agents used for the purpose of peeling salicylic acid (in low concentration), tretinoin and alpha hydroxy acids(Glycolic acid<10%) can be used directly by the patient.
Peeling agents for the physician use are TCA (tricarboxylic acid), alpha hydroxy acids( Glycolic acid 20% -70%), Phenol and carbon dioxide slush.
Chemical Peels are classified depending on the level/depth the peeling agent achieves.
Superficial(Injury down to papillary dermis)- CO2 slush or liquid nitrogen spray,Alpha Hydroxy acids(5-30%),TCA 10-30%Salicylic acid ,Glycolic acid,Tretinoin
Medium Depth (Injury down to upper reticular dermis)-TCA45%,Solid Co2+35%TCA,70% Glycolic acid +35% TCA,89% Phenol solution
Deep (Injury down to mid reticular dermis)- TCA>50%
The chief indications for chemical peeling are to improve total photoageing changes of the skin, including rhytides, pigmentary dyschromias & actinic keratoses and to improve scars caused by acne and trauma.
Contraindications to chemical peeling include abnormal scarring, a history of delayed wound healing, immunosuppression, a history of therapeutic radiation including atrophy, and the use of isotretinoin therapy within the last 6 months for medium and depth chemical peeling. Active bacterial or herpetic infection is a contraindication and those with a history should be treated with antiherpetic medication.
Relative contraindications include active skin disease such as psoriasis, seborrheic dermatitis, atopic dermatitis and other eczematous conditions that may interfere with the healing of the peel. They should be all well controlled on topical medication prior to the initiation of the peeling procedure.
A peel should never be performed on skin which has previously been peeled within the following time frame
Superficial (1 week)
Medium depth(4- 6 months)
Deep peel (1 year).
Alpha hydroxy acids(AHA) Lactic acid and glycolic acids found respectively in milk and sugar cane are readily available and used for superficial chemical peeling. Glycolic acid is highly water-soluble and is available in concentration from 20% to 70%. Glycolic acid is the most commonly used chemical peel suitable for all skin types.
Superficial chemical peel with glycolic acid is relatively painless and requires no anesthesia.
There are three phases to the peel procedure:
Phase 1 is the pre - peel discussion and preparation with the client. Client is advised to apply glycolic acid cream (10% - 12%) over face once or twice daily with care not to apply near eyes and mouth. This is done for 2 weeks.
Phase 2 is the peel procedure; no cologne is to be applied on the day of the procedure.
Face is cleansed with the prepeel cleanser; glycolic acid solution is applied and removed with a neutralizer after a specific period.
Patient may experience mild burning, itching or redness during the procedure
Phase 3 consists of advice regarding sun protection.
The peel is repeated after 3 weeks.
Problems: Usually well tolerated. Sometimes if the proper sun protection is not followed, there maybe darkening of the skin which might take some time to resolve. | |
