Peeling

Chemical peel
Chemical peeling is a procedure, where a chemical agent of a defined strength is applied to the skin, which causes a controlled destruction of the layers of the skin that is followed by regeneration and remodelling, with improvement of texture and surface abnormalities. The objective of chemical peeling is to cause destruction at the required depth, followed by remodelling without scarring. The concept of skin peeling by chemicals to beautify the skin has been used since time immemorial. Cleopatra used sour milk, containing lactic acid and French women used old wine containing tartaric acid as beauty baths. The modern era of chemical peeling began with MacKee, a dermatologist who used phenol to treat facial scars. Initially, peeling formulas were closely guarded secrets and these procedures attracted interest because of the remarkable results that were achieved. Finally, scientific investigations were undertaken by plastic surgeons and dermatologists like Stegman. The alpha-hydroxy acids were studied by Van Scottand Yu. Since then various agents have been used for chemical peeling with newer agents being added day-to-day.

Where do chemical peels stands today:

There has been an explosive interest in procedural techniques for skin rejuvenation and the trend is increasingly for procedures that are noninvasive or minimally invasive, requiring little downtime. The majority of the chemical peeling procedures fit into this category. The long-term experience with chemical peels has shown them to be safe and effective for a variety of common conditions like dyschromias, photoaging and acne.

According to a recent report by the National Ambulatory Medical Care Survey in US, today botulinum toxin injections, chemical peels and fillers are the three most common office based cosmetic procedures being performed.

The advent of non-ablative lasers and light therapy systems initially led to a decline in the use of chemical peels. However, as compared to chemical peeling, many of these newer techniques are still in the learning phase and long­term effects are unknown. Newer, safer and more effective peeling agents, such as mandalic acid, lactic acid, phytic acid, pyruvic acid, etc. continue to attract attention of cosmetic dermatologists, the world over. This has led to resurgence in the use of chemical peels. Lasers on the other hand are still very expensive to acquire and maintain. Till these newer non-ablative light therapies, become more predictable, affordable and widely available, chemical peels continue to be an extremely useful armamentarium in the treatment of common conditions such as skin rejuvenation, photo aging, melasma and acne.

Principle of chemical peel: The basic principle of chemical peeling is to cause injury to the skin at the required depth, allowing regeneration to take place, without causing permanent scarring.

Indications of Chemical Peels :

Pigmentary disorders·

  • Melasma
  • Post-inflammatory hyperpigmentation
  • Freckles
  • Lentigens
  • Facial melanoses

Acne

  • Superficial acne scars
  • Post-acne pigmentation
  • White and black comedones
  • Acne excorie
  • Acne vulgaris – mild to moderately severe acne

Aesthetic

  • Photo-aging
  • Fine superficial wrinkling
  • Dilated pores
  • Superficial scars

Epidermal growths

  • Seborrheic keratoses
  • Actinic keratoses
  • Warts
  • Milia
  • Sebaceous hyperplasia
  • Dermatoses papulosa nigra

Contraindications

  1. Active bacterial, viral, fungal or herpetic infection
  2. Open wounds
  3. History of drugs with photosensitising potential
  4. Preexisting inflammatory dermatoses such as psoriasis, atopic dermatitis
  5. Uncooperative patient (patient is careless about sun exposure or application of medicine)
  6. Patient with unrealistic expectations.
  7. For medium depth and deep peels-history of abnormal scarring, keloids, atrophic skin, and isotretinoin use in the last six months.

Peeling Agents

  1. Alpha-hydroxy acids Mono carboxylic acids: Glycolic acid ,Lactic acid ,Bicarboxylic acid: Malic acid , Tricarboxylic acid: Citric acid.
  2. Beta-hydroxy acids, BHA (salicylic acid)
  3. Trichloroacetic acid (TCA)
  4. Alpha-keto acids (pyruvic acid)
  5. Resorcinol
  6. Jessners solution: (Salicylic acid 14 g, Lactic acid 14 g, Resorcinol 14 g with Ethanol to make 100 mL)
  7. Retinoic acid
  8. Phenol.

Classification of peels according to the histological depth of necrosis:

  1. Very Superficial light peels : Necrosis up to the level of stratum corneum. Agents used: TCA 10%, GA 30-50%, Salicylic acid 20-30%, Jessner′s solution 1-3 coats, Tretinoin 1-5%.
  2. Superficial light peels : Necrosis through the entire epidermis up to basal layer. Agents used: TCA 10-30%, GA 50-70%, Jessner′s solution 4-7 coats
  3. Medium depth peels : Necrosis up to upper reticular dermis. Agents used: TCA 35-50%, GA 70% plus TCA 35%, 88% phenol un-occluded, Jessner′s solution plus TCA 35%, solid CO 2 plus TCA 35%
  4. Deep peels : Necrosis up to mid-reticular dermis. Agents used: Baker-Gordon phenol peel

Type and concentration of the peel depends on the type and concern of skin of patient. Chemical peeling is a simple office procedure used for the treatment of dyschromias, photoaging, and superficial scarring that can lead to excellent cosmetic improvement, when repeatedly performed in carefully selected patients. Although various depths of peels have been described, superficial and medium depth peels are safer for Indian patients. Deep chemical peels should be avoided because of the risk of permanent pigmentary changes. The type, depth and concentration of the peel should be selected according to the pathology of the condition . Chemical peels are not one-time procedures and should be repeated with maintenance peels with a gap of 1 month to achieve maximum improvement and prevent recurrence. With the advent of lasers and newer techniques, the use of chemical peels has declined; however, its simplicity as an office procedure, minimal morbidity, easy availability and cost-effectiveness ensure that it still holds an important place as a tool to treat dyschromias and photoaging. Careful patient selection, priming of the skin, standardization of peels, postpeel care and maintenance programs are essential to achieve excellent cosmetic results.

Who should get peeling Treatment?

Peeling treatment is one of those treatments that is good for everyone. Its like giving your skin a regular work out as it helps remove the dead layer and stimulates your cells to produce younger, fresher and brighter looking cells. It is a safe and effective treatment and revitalizes your skin cells even with 1 session.

How many sessions of Peeling treatment are recommended?

Depending upon your skin and skin problem, we usually recommend 4-6 sessions, done at gaps of 3-4 weeks.

If your face has been looking dull, tanned or missing its usual glow, then this treatment is PERFECT for you!