Introduction to chemical peel

1. Chemical Peels

2. WHAT IS CHEMICAL
PEELING
* A method of skin resurfacing.
* Accelerating skin exfoliation by using irritant
chemicals.
* Also called “CHEMICAL RESURFACING” ,
“CHEMEXFOLIATION”.

3. * It allows rapid, predictable, and uniform thickness
of chemoablation, ultimately resulting in
improvement in the clinical appearance of skin.
WHAT IS CHEMICAL
PEELING

6. SKIN CELL
TURNOVER

7. SKIN CELL
TURNOVER

8. * The goal of chemical peel is to remove a predictable,
uniform thickness of skin, which subsequently
allows for normal wound healing and skin
rejuvenation to occur.
CHEMICAL
PEEL

9. * Chemical peels remove the outer skin layers through
keratolysis and keratocoagulation
* Keratolytic agents, such as lactic acid and glycolic
acids, penetrates through stratum corneum and
disrupt corneocyte adhesion by breaking intercellular
desmosomal bonds
* Keratocoagulants, such as TCA, destroy surface cells
by protein denaturation and keratinocyte coagulation
Mechanism of Action

11. ACCORDING TO THE
LEVEL/DEPTH OF INJURY:
* Light/Superficial Peels –
Epidermis
* Medium Peels – Papillary
Dermis
* Deep Peels - Reticular Dermis
CLASSIFICATION

12. 1. Type of peeling agent
2. Concentration of the peeling agent
3. Layers of the agent applied
4. Applications technique
5. Application time
6. Patient’s skin type (thick sebaceous or thin dry)
VARIABLES DETERMINING
DEPTH OF A PEEL

13. Superficial Peel – Very Light Peels
INJURY IS LIMITED TO ST. CORNEUM AND ONLY CREATE
EXFOLIATION.
* AHA (GLYCOLIC 30-50%, LACTIC 10-30%, MANDELIC 40%)
* 10 - 15% TCA
* TRETINOIN
* BHA (SALICYLIC ACID)

14. INJURY TO THE ENTIRE EPIDERMIS DOWN TO THE
BASAL LAYER, STIMULATING REGENERATION OF
FRESH NEW EPITHELIUM.
* 70% GLYCOLIC ACID
* JESSNER’S SOLUTION
* 20 - 30% TCA
Superficial Peel – Light Peels

15. INJURY THROUGH THE ENTIRE EPIDERMIS DOWN TO
THE PAPILLARY DERMIS.
* 35% TCA
* JESSNER’S + 35% TCA
* 70% GLYCOLIC ACID + 35% TCA
MEDIUM DEPTH
PEEL

16. INJURY THROUGH THE PAPILLARY DERMIS TO THE
UPPER RETICULAR DERMIS AND MAY EXTEND TO MID
RETICULAR DERMIS.
* TCA >50% (SCARRING)
* PHENOL CONTAINING PREPARATION
DEEP
PEELS

17. * Glycolic acid (AHA)
* Salicylic Acid (BHA)
* Lactic Acid
* Jessner’s Peel ( A Combination of Salicylic acid,
resorcinol and lactic acid mixed in alcohol)
* TCA (Trichloracetic Acid)
* Retinoids
TYPES OF CHEMICAL PEEL

18. ALPHA HYDROXY ACID (AHA)
* AHAs are primarily derived from fruits
ACID DERIVATIVE
● Glycolic - Sugar Cane
● Lactic - Milk
● Malic - Apples, Pears
● Tartaric - Grapes
● Citric - Citrus
● Mandelic - Almonds

19. * Most popular & commonly used AHA
* Present in various concentration up to 70%
* Typically have a pH of 2.5 to 3
* Non-self-neutralizing AHA
* Time application is critical, should be rinsed off with
5% sodium bicarbonate within 2-3min.
* Can be used for tx of acne, mild photo aging &
melasma
GLYCOLIC
ACID

20. * Used as a very superficial peeling agent in concentrations up
to 50%
* Frequently combined with other superficial peeling agents
in blended peels
* After application to skin, forms lactate which function as a
humectant -> moisturizing effect
* Used for treatment of photodamage, superficial
hyperpigmentation and fine rhytides
LACTIC ACID

21. Mandelic Acid
• More uniform penetration through lipid-rich
areas of skin
• Demonstrated efficacy in treatment of
superficial erythema and dyspigmentation,
efficacy in reduction of cutaneous sebum
production
• Results are more subtle than that of glycolic acid
peels, but with less side effects and downtime

22. Retinoids
• Derivative of vitamin A
• Increase exfoliation by reducing corneocyte cohesion
and stimulating epidermal cellular turnover.
• Also inhibits melanogenesis, increase collagen
production
• Can be used alone, but more often used as ‘booster’
peels, add on to other superficial peels.
• Leaves a temporary yellow discoloration on face after
application

24. * Beta Hydroxy Acid (BHA) found in
willow bark
* Found in concentrations up to 30% in
superficial peels
* Have visible clinical endpoint on skin
with fine white powder (pseudofrost)
* Highly lipophilic -> able to penetrate
and dissolve sebum, effective for acne
Salicylic Acid

25. * Also has anti-inflammatory effects
* Suitable for sensitive skin conditions
such as rosacea
* Produce less stinging sensation upon
application
Salicylic Acid

26. * Jessner’s Peel is a popular superficial-depth chemical
peel that work to improve skin health by helping
remove and heal skin damage that is more extensive
than regular ‘wear & tear’
* Consists of 3 main ingredients:
* Lactic acid (assists in the exfoliation of the skin)
* Salicylic acid (aids in penetration)
* Resorcinol (assists in the treatment of acne)
JESSNER’S PEEL

27. * 14-14-14 keeps peel solution from
separating
* Good choice for patients with acne &
melasma
* After application, erythema ->
powdery whitening of skin due to SA
* Neutralization not required
* Modified Jessner is available where
the resorcinol is substituted by Citric
acid 8%
JESSNER’S PEEL
14%
Salicylic
Acid
14% Lactic
Acid
Jessner’s
Peel
14%
Resorcinol
in Alcohol
base

28. 1. Helps to smooth out various fine lines & wrinkles
2. Reduce the appearance of acne scarring
3. Reduce the appearance of large pores
4. Improve the overall complexion of the face
5. May lighten areas of skin discoloration in some cases
6. Help loosen & reduce acne
7. Assist with treatment of melasma
8. Restores skin to a more healthy, youthful glow
JESSNER’S PEEL

29. Different concentrations:
10-15% TCA: Intra-epidermal superficial peel. Improves fine
wrinkles and dyschromias to give smooth healthy
appearance
30-35% TCA: papillary dermis, medium depth peel.
70% TCA: Deep peel
*Be cautious with dark skin.
TRICHLOROACETIC ACID (TCA)

30. • Causes visible whitening of skin upon application
known as frosting -> coagulation of epidermal
proteins and keratinocytes
• Degree of frosting corresponds to TCA depth of
penetration in skin.
• Unlike the white pseudofrost of SA, true frosting
cannot be wiped off the skin.
TCA

31. * Level I frosting erythema with a stringy or blotchy
frosting
* Level II frosting is defined as white-coated frosting
with erythema showing through
* Level III frosting, which is associated with
penetration through the papillary dermis, is a solid
white enamel frosting with little or no background of
erythema.
DEPTH OF CHEMICAL PEEL

33. Mask Peel
• Blended peel consisting of 30% Glycolic Acid, 2%
Salicylic Acid and Bentonite Clay
• pH ~ 2
• Purifies the epidermis
• Brightens dull complexion
• Decreases sebum production
• Tightens pores
• Regulates oily skin and dilated pores

34. Choice of Chemical Peel
• Salicylic, glycolic acids and retinoids – Oily skin
and acneic conditions
• Lactic acid for dehydration
• Mandelic, lactic and salicylic acid for sensitive
skin and rosacea
• Jessner’s and TCA peels typically used for more
advanced photoaging changes including
wrinkles.

35. INDICATION FOR CHEMICAL PEELING
1. Rejuvenation of chronic
chrono- and photoaging
2. Acne and acneiform eruptions
3. Dyspigmentation
4. Acne scars
5. Enlarged pores

36. 1. Allergy to chemical peel constituents
2. Pregnancy / lactating
3. Aspirin allergy (for salicylic acid peels)
4. Active infection / open wound
5. Suspected cancer in treatment area
6. Isotretinoin use within the last 6 months
7. Deep chemical peel, dermabrasion, radiation therapy in
the treatment area in past 6 months
CONTRAINDICATION

37. Preprocedure
• Review patient’s medical and cosmetic history
• Examine treatment area and the presence of
wrinkles, acne, scars, vascular or pigmented
lesions, oiliness/dryness, and other skin
conditions
• Advice patients to discontinue tanning and direct
sun exposure 2 weeks prior to procedure and for
the duration of treatments

38. • Preprocedure retinoid use 4-6 weeks preceding peel
prepares the skin by decreasing stratum corneum
thickness, which ultimately allows for a more even
application and uniformity of peel penetration
• One to two weeks prior to treatment, advice
patients to discontinue products containing high
strength AHAs (e.g, Glycolic and lactic acids) and
prescription retinoids (e.g, Retin A, Renova, and
Differin) to allow epidermal healing, ensure skin
intact at the time of peel procedure.
Preprocedure

39. Patch Testing
• Patients with history of multiple allergies or
sensitivities to preservatives and or fragrances
may have an increased risk of allergic reaction
• Patch test done at sites located discretely near
treatment area, behind ear or dorsum of forearm
• Site is evaluated 3 days after placement and is
deemed positive if excessive erythema, urticarial,
vesiculation, report of excessive pruritus or pain
or other unusual response.

40. Steps for Performing Chemical
Peel
1. Preparation (Position, drape, cleanse
and degrease skin, apply eye protection
and apply petrolatum)
2. Chemical peel application
3. Termination (Neutralization if indicated)
4. Topical product application

41. Precautions
• Common areas of pooling include oral
commissures, marionette lines,
nasolabial folds, lateral canthal creases
• Application of petrolatum to these
areas as a barrier to protect them from
overtreatment is recommended.

45. Desirable Clinical Endpoints
• For superficial peels depend on the agent
used. In most cases mild erythema is the
desired endpoint.
• For TCA, Level 1 Frosting is the desired
endpoint.
• Peels with salicylic acid, including Jessner’s
peel, typically form a fine white precipitate.

46. Undesirable Clinical Endpoints
• Excessive patient discomfort with pain
• Blistering
• “Frosting” or whitening of the skin for certain peels
*Frosting or whitening is a desirable endpoint with
salicylic acid and TCA, but not with AHAs.

47. Termination of Chemical Peel
• Chemical peel procedure is terminated
when:
Desired endpoints are achieved
Desired number of minutes for peeling has
been reached
Undesired endpoints occur

48. • Erythema, dryness, mild edema, and skin
sensitivity are common in the first 3-5 days
postprocedure
• Desquamation typically started on Day 3-5 post
procedure and ranged from skin flaking to skin
sloughing and peeling
• If peeling occurs, usually started in the midface
proceeding towards the periphery, can persist
up to 2 weeks
POST CARE

49. • Postpeel regimen would include daily use of gentle
cleanser, broad-spectrum sunscreen of SPF 30 or
greater and moisturizer
• If erythema is marked immediately after treatment,
hydrocortisone (0.5% to 2.5%) may be applied twice
daily until resolution.
• Makeup may be worn 24 hours after procedure
• Strict sun and tanning bed avoidance for 2 weeks.
POST CARE

50. Treatment Intervals
• Very superficial peels or microdermabrasion
are usually every 2 weeks
• Superficial chemical peels are typically
performed every 4 weeks
• Medium peels every 4-6 months

51. Thank you