Chemical peel

A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off.^[1] The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical peel is derived. Some types of chemical peels can be purchased and administered without a medical license, however people are advised to seek professional help from a dermatologist, esthetician, plastic surgeon, or otolaryngologist on a specific type of chemical peel before a procedure is performed.

Types

There are several types of chemical peels,^[1]

Alpha hydroxy acid peels

Alpha hydroxy acids (AHAs) are naturally occurring carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.

There are five usual fruit acids: citric acids (citrus-derived), glycolic acid (derived from sugar cane), lactic acid (although derived from milk, this is still considered a "fruit acid"), malic acid (derived from apples) and tartaric acid (derived from grapes). Many other alpha hydroxy acids exist and are used.

• Citric acid: Usually derived from lemons, oranges, limes and pineapples. These peels are simple and effective, although not incredibly invasive or capable of significant improvement with one treatment.^{[citation needed]}
• Glycolic acid: Formulated from sugar cane, this acid creates a mild exfoliating action. Glycolic acid peels work by loosening up and exfoliating the superficial top layer. This peel also stimulates collagen growth.^{[citation needed]} High strength peels are good in terms of efficacy but they irritate more. Some glycolic peels claim the use of strontium nitrate in order to try to reduce skin irritation. Nevertheless, strontium nitrate is a product which is strictly prohibited in cosmetic products since it has a high toxic potential ^[2]
• Lactic acid: This acid is derived from either sour milk or bilberries. This peel will remove dead skin cells, and promote healthier skin.^{[citation needed]}
• Malic acid: This peel is the same type of mildly invasive peel derived from the extracts of apples. It can open up the pores, allow the pores to expel their sebum and reduce acne.^{[citation needed]}
• Tartaric acid: This is derived from grape extract and is capable of delivering the same benefits as the above peels.^{[citation needed]}

AHA peels are not indicated for treating wrinkles.^[3][4]

AHA peels may cause stinging, cause skin redness, cause mild skin irritation, cause dryness, and take multiple treatments for desired results.

Beta hydroxy acid peels

It is becoming common for beta hydroxy acid (BHA) peels to be used instead of the stronger alpha hydroxy acid (AHA) peels due to BHA's ability to get deeper into the pore than AHA^{[citation needed]}. Studies show that BHA peels control oil, acne as well as remove dead skin cells to a certain extent better than AHAs^{[citation needed]} due to AHAs only working on the surface of the skin. Salicylic acid is a Beta Hydroxy Acid.

Jessner's peel

Jessner's peel solution, formerly known as the Coombe's formula,was pioneered by Dr Max Jessner, a German-American dermatologist. Dr Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes.^{[citation needed]} It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.

Retinoic acid peel

Retinoic acid is derived from retinoids. This type of facial peel is also performed in the office of a plastic surgeon or a dermatologist in a medical spa setting. This is a deeper peel than the beta hydroxy acid peel and is used to remove scars as well as wrinkles and pigmentation problems.^{[citation needed]} It is usually performed in conjunction with a Jessner; which is performed right before, in order to open up the skin, so the retinoic acid can penetrate on a deeper level. The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time.

Trichloroacetic acid peels

Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.

Trichloroacetic acid peels:

• are preferred for darker-skinned patients over Phenol
• smooth out fine surface wrinkles
• remove superficial blemishes
• correct skin pigment problems

Trichloroacetic acid peels may:

• require pre-treatment with Retin-A or AHA creams
• require repeat treatment to maintain results
• require the use of sunblock for several months (this is a must)
• take several days to heal depending on the peel depth

Phenol peels

Phenol is the strongest of the chemical solutions and produces a deep skin peel. Some publications claim that phenol peel affect could be due to the action of croton oil and that phenol would not be effective without this oil. In reality, many phenol peel solutions exist that do not contain croton oil. This last is only a penetration enhancer, acting at the epidermal very superficial layers. Croton oil is not the only penetration enhancer that can be used. Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure.^{[dubious – discuss]} Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.^{[citation needed]}

Phenol peels are used to:

• correct blotches caused by sun exposure or aging
• smooth out coarse deep wrinkles
• remove precancerous growths^{[dubious – discuss]}

Phenol peels may:

• pose a risk of arrythmias if applied without following strict rules
• permanently remove facial freckles
• many formulas cause permanent skin lightening by reducing the ability to produce pigment
• require increased protection from the sun for lifes

Complications of Chemical Peels

The deeper the peels the more complications that can arise.^[1] Chemical peels are risky and need to be administered by certified dermatologists. The possible complications include prolonged erythema, pigmentary changes, milia (white heads), skin atrophy and textural changes.^[1]

Anesthesia

Light chemical peels like AHA and glycolic acid peels are usually done in medical offices. There is minimal discomfort so usually no anesthetic is given because the patient feels only a slight stinging when the solution is applied. No pain killer is needed.

Medium peels like TCA are also performed in the doctor’s office or in an ambulatory surgery center as an outpatient procedure and are a bit more painful. Frequently, the combination of a tranquilizer like Valium and a pain pill usually suffice. TCA peels often do not require anesthesia even if the solution itself has - at the contrary of phenol - no numbing effect on the skin. The patient usually feels a warm or burning sensation.^[5]

Phenol is the classic deep chemical peel. Old phenol peel solutions are very painful and most practitioners will perform it under either general anesthesia, administered by an MD-anesthesiologist or nurse anesthetist. More recent formulas easily allow a simple heavy sedation, usually intravenous. Recent phenol peel formulas can be applied locally (chemical blepharoplasty or cheiloplasty)without any kind of anaesthesia.

See also

• List of cutaneous conditions

References

1. ^ ^{a b c d} Chemical Peels | The Ageing Skin
2. ^ ingredients prohibited in cosmetic products - strontium nitrate - Annex/part, Ref # II/403
3. ^ Textbook of Chemical Peelings, P.Deprez, Chapt 8, Informa Healthcare
4. ^ Textbook of Cosmetic Dermatology, R.Baran, Chapt 54, Informa Healthcare
5. ^ Halaas YP: Medium depth peels. Facial Plas Surg Clin North Am 2004 Aug; 12(3):297-303