An Overview of Chemical Peels

AESTHETIC FOCUS An overview of chemical peels BY VICTORIA SMITH hemical peels form an his results in England, using phenol for the only penetrate into the epidermis, are important part of most treatment of scarring. Interestingly, despite similar to a good exfoliation, giving an aesthetic and cosmetic this publication date, he had actually been instant brightening and smoothing of the C practices. They are an using phenol peels since 1903 [4]. It is not skin. Light chemical peels are suitable affordable procedure for patients and surprising that these doctors used phenol for those with mild sun damage with significant results can be achieved. in the early days of skin peels, particularly pigmentation, mild acne scarring, dry Generally chemical peels are a safe in patients with scarring, as in current day skin, post inflammatory pigmentation, procedure, but only if used correctly practice this is classed as a ‘deep peel’. very fine lines and wrinkles and ‘dull’ skin. and with caution. Over recent years we The use of chemical peels really These are a great introduction into skin have seen a surge in skin peels used in started to gain momentum in the 1960s peels, particularly for patients who are clinics and the range of skin conditions as modified solutions of phenol were new into aesthetics and are quite nervous. and disorders they can treat is now developed and histological assessment Discomfort during the treatment is unlikely considerable. As professionals it is comparisons were drawn between phenol although some patients may experience important to understand the different and TCA. Scientific work continued into some mild stinging or tingling to the skin. As types of peels in order to be able to make the 70s and 80s and at the same time, the stated above, downtime after a superficial an informed decision about which one use of alpha hydroxy acids (AHAs) was peel is minimal, and some patients (not should be used for which patient and developed by Van Scott and Yu for more all) may experience light shedding of the how they should be used. superficial treatment [3]. skin for three to five days which is usually well accepted. The beauty of a superficial History of chemical peels Different types of chemical peels peel is that normal life can continue almost Skin peels have a very long history. Early Chemical peels are a means of rejuvenating immediately and any light shedding can records show that they were used by the skin by removing the keratin layer usually be disguised with make-up. ancient Egyptians when women used to of dead skin cells that sits on the skin’s Superficial skin peels tend to be made apply sour milk to their skin. This sour milk epidermal surface and also by stimulating from AHAs or beta hydroxy acids (BHAs). contained lactic acid, an alpha hydroxy acid, the production of new healthy epidermal AHAs originate from milk and fruit sugars, which rejuvenates the skin. In addition, they cells. They are designed to introduce a the most commonly used are glycolic used other substances such as animal controlled injury to the skin to a specific and lactic acid. These acids penetrate the oils and alabaster to improve the skin’s depth. As the healing occurs there will be skin well and have significant scientific texture [1]. an improvement in the skin’s texture and research to support their efficacy. Other In Roman times, people were conscious appearance. This technique stimulates AHAs that are starting to feature more in of their skin and would use fruit such as epidermal growth, with collagen chemical peels as these treatments evolve grapes to exfoliate their skin. The active stimulation in the underlying dermis, are malic, citric and tartaric acid [6]. BHAs ingredient responsible for the use of giving a tightening effect and a more even such as salicylic acid, have been used for grapes was tartaric acid. Other treatments distribution of melanin [5]. some time and seem to be used less, as the included poultices containing substances Skin peels are classified by their depth growth of peeling with AHAs develops [3]. such as sulphur, mustard and limestone, of penetration. They are divided into three A study comparing both AHA and BHA in which were used to fade freckles and to categories: superficial, medium and deep the treatment of acne vulgaris was reported even the skin. These ancient records show peels. The depth to which each specific by Kesseler in 2008, and showed that both us that skin care has been important, peel penetrates when applied to the skin were effective [7]. particularly to women, through much affects the clinical outcomes achieved. Not of history. In 1874, a dermatologist in surprisingly, the deeper the penetration of Medium peels Vienna called Ferdinand von Hebra, used the peel, the greater the changes achieved. Medium depth peels, such as TCA, are peeling techniques to treat pigmentation However, the depth of peel also represents used as a stand-alone treatment or as conditions such as melasma, freckles and the amount of injury caused to the skin part of a combined or blended peel, e.g. Addison’s disease. In 1882 in Germany, and so will have an effect on the length Jessner or modified Jessner peel. TCA is Paul G Unna described the use of salicylic of downtime, or ‘healing time’. Hence used in various strengths. Those less than acid, resorcinol, trichloroacetic acid (TCA) increasing depth will increase the risk of 20% work well on superficial lines and and phenol on the skin. It was following possible complications. wrinkles but not so successfully on deeper his reports that other authors started lines or scars, whereas TCA greater than publishing their work [1,2,3]. Superficial peels 25% can cause deep epidermal necrosis In 1917, during World War I, Douglass Superficial peels are the ‘lightest’ peels and increasing the potential of complications. Montgomery made reference to his use are really the only type of peel that can be Even more concentrated, TCA 35-50% of phenol under bandages for healing and used as a ‘lunchtime peel’. As they are so is one of the more commonly used peels ‘beautifying’ the skin [1]. However it was not superficial there is rarely any downtime for the treatment of actinic keratosis, until 1952 that George MacKee published as a result of the treatment. These peels pigmentation and severe photoageing pmfa news | AUGUST/SEPTEMBER 2016 | VOL 3 NO 6 | www.pmfanews.com AESTHETIC FOCUS “As aesthetic practitioners it is important that we really understand what a patient is hoping to achieve from their skin peel and that we are able to inform them of all the options available.” Before After Before After [5,8,9]. scarring (acne or following a trauma), wrinkles and scarring. Phenol is usually The depth reached by TCA peels is irregularities of skin texture and used in combination with croton oil in affected by a number of factors: pigmentation disorders. When applied to various concentrations and once applied, • The type of skin (thicker skin can the skin, these agents penetrate sufficiently it penetrates to the dermis and even the tolerate the higher concentrations). to destroy the epidermis and part, or all, of reticular dermis, maximising the effect for • The strength of the TCA (15-20% the papillary dermis. The healing process new collagen production. After a phenol penetrates only the epidermis, 45% following a medium peel such as TCA is peel the epithelial layer takes about 5-10 penetrates the upper reticular dermis). approximately one week, although this will days to form but, unlike many of the lighter • The combined use of retinoic acid vary with the strength of TCA used, how peels that are applied and removed, the (0.025%-0.1%) enhances penetration much is applied and how long it is left on for. phenol peel requires a mask to be placed and results. TCA peels should be used with caution in on the skin for approximately 24 hours • Cleansing the skin before application dark skin patients as they have been known and various antiseptic ointments and with an active cleansing substance or to cause post inflammatory pigmentation occlusive dressings are required in addition mild cleanser affects the aggressiveness or scarring [5]. to antibiotics to prevent infection. It can of the peel. take up to three months for healing to be • Lower concentrations of TCA can Deep peels complete and the final result to be seen [8]. be used if blended with other active Deep peels are used less commonly As phenol is absorbed into the agents with the aim of giving the same nowadays. This might be because they circulation, it increases the risk of results whilst reducing the risks of cannot be performed within a typical cardiotoxicity in the form of arrhythmias. complications. aesthetic clinic environment as they As a result cardiopulmonary monitoring Blended peels tend to be used for treating require sedation or anaesthetic. Also the is required, as is intravenous hydration. mild sun damage, acne and acne scarring. continuous development of superficial and As such, these peels are performed in a It is possible to get the desired results with medium peels, and the practice of having hospital environment, commonly in an these peels but, as they are less aggressive more and more frequent treatments, operating theatre, and often as an addition than TCA alone, there is less recovery time means that patients can get the desired to other surgical procedures [5]. or shedding of the skin [9]. There are many results without the downtime that is Phenol is an aromatic hydrocarbon different blends available, such as TCA with associated with deeper peels.

Load more