Chemical peel
Encyclopedia
A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 using a chemical solution that causes the dead skin to slough off and eventually peel off. 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.

Alpha hydroxy acid peels

Alpha hydroxy acid
Alpha hydroxy acid
α-Hydroxy acids, or alpha hydroxy acids , are a class of chemical compounds that consist of a carboxylic acid substituted with a hydroxyl group on the adjacent carbon. They may be either naturally occurring or synthetic. AHAs are well-known for their use in the cosmetics industry...

s (AHAs) are naturally occurring carboxylic acid
Carboxylic acid
Carboxylic acids are organic acids characterized by the presence of at least one carboxyl group. The general formula of a carboxylic acid is R-COOH, where R is some monovalent functional group...

s such as glycolic acid
Glycolic acid
Glycolic acid is the smallest α-hydroxy acid . This colorless, odorless, and hygroscopic crystalline solid is highly soluble in water. It is used in various skin-care products. Glycolic acid is found in some sugar-crops...

, 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 acid
Citric acid
Citric acid is a weak organic acid. It is a natural preservative/conservative and is also used to add an acidic, or sour, taste to foods and soft drinks...

s (citrus-derived), glycolic acid
Glycolic acid
Glycolic acid is the smallest α-hydroxy acid . This colorless, odorless, and hygroscopic crystalline solid is highly soluble in water. It is used in various skin-care products. Glycolic acid is found in some sugar-crops...

 (derived from sugar cane), lactic acid
Lactic acid
Lactic acid, also known as milk acid, is a chemical compound that plays a role in various biochemical processes and was first isolated in 1780 by the Swedish chemist Carl Wilhelm Scheele. Lactic acid is a carboxylic acid with the chemical formula C3H6O3...

 (although derived from milk, this is still considered a "fruit acid"), malic acid
Malic acid
Malic acid is an organic compound with the formula HO2CCH2CHOHCO2H. It is a dicarboxylic acid which is made by all living organisms, contributes to the pleasantly sour taste of fruits, and is used as a food additive. Malic acid has two stereoisomeric forms , though only the L-isomer exists...

 (derived from apples) and tartaric acid
Tartaric acid
Tartaric acid is a white crystalline diprotic organic acid. It occurs naturally in many plants, particularly grapes, bananas, and tamarinds; is commonly combined with baking soda to function as a leavening agent in recipes, and is one of the main acids found in wine. It is added to other foods to...

 (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.
  • 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. High strength peels are good in terms of efficacy but they irritate more. Some glycolic peels claim the use of strontium nitrate
    Strontium nitrate
    Strontium nitrate is an inorganic compound with the formula Sr2. This colourless solid is used as an colorant in pyrotechnics.- Preparation:Strontium nitrate is typically generated by the reaction of nitric acid on strontium carbonate.....

     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
  • Lactic acid: This acid is derived from either sour milk or bilberries. This peel will remove dead skin cells, and promote healthier skin.
  • 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.
  • Tartaric acid: This is derived from grape extract and is capable of delivering the same benefits as the above peels.


AHA peels are not indicated for treating wrinkles.

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
Beta hydroxy acid
A beta hydroxy acid or β-hydroxy acid is an organic compound that contains a carboxylic acid functional group and hydroxy functional group separated by two carbon atoms...

 (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. Studies show that BHA peels control oil, acne as well as remove dead skin cells to a certain extent better than AHAs 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
Salicylic acid
Salicylic acid is a monohydroxybenzoic acid, a type of phenolic acid and a beta hydroxy acid. This colorless crystalline organic acid is widely used in organic synthesis and functions as a plant hormone. It is derived from the metabolism of salicin...

, lactic acid, and resorcinol
Resorcinol
Resorcinol is a dihydroxy benzene. It is the 1,3-isomer of benzenediol with the formula C6H42.-Nomenclature:Benzene-1,3-diol is the name recommended by the International Union of Pure and Applied Chemistry in its 1993 Recommendations for the Nomenclature of Organic Chemistry.-Production:It is...

 in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.

Retinoic acid peel

Retinoic acid
Retinoic acid
Retinoic acid is a metabolite of vitamin A that mediates the functions of vitamin A required for growth and development. Retinoic acid is required in chordate animals which includes all higher animals from fishes to humans...

 is derived from retinoid
Retinoid
The retinoids are a class of chemical compounds that are related chemically to vitamin A. Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth....

s. 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. 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
Trichloroacetic acid
Trichloroacetic acid is an analogue of acetic acid in which the three hydrogen atoms of the methyl group have all been replaced by chlorine atoms....

 (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 scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...

ring.

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
Phenol
Phenol, also known as carbolic acid, phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid. The molecule consists of a phenyl , bonded to a hydroxyl group. It is produced on a large scale as a precursor to many materials and useful compounds...

 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
Croton oil
Croton oil is an oil prepared from the seeds of Croton tiglium, a tree belonging to the natural order Euphorbiales and family Euphorbiaceae, and native or cultivated in India and the Malay Archipelago. Small doses taken internally cause diarrhea. Externally, the oil can cause irritation and swelling...

 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. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.

Phenol peels are used to:
  • correct blotches caused by sun exposure or aging
  • smooth out coarse deep wrinkles
  • remove precancerous growths


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. Chemical peels are risky and need to be administered by certified dermatologists. The possible complications include prolonged erythema, pigmentary changes, milia
Milia
A Milium , also called a milk spot or an oil seed, is a keratin-filled cyst that can appear just under the epidermis or on the roof of the mouth. Milia are commonly associated with newborn babies but can appear on people of all ages...

 (white heads), skin atrophy and textural changes.

Anesthesia

Light chemical peels like AHA and glycolic acid peels are usually done in medical offices. There is minimal discomfort
Discomfort
Discomfort may refer to:* Pain, an unpleasant sensation* Suffering, an experience of unpleasantness...

 so usually no anesthetic is given because the patient feels only a slight stinging when the solution
Solution
In chemistry, a solution is a homogeneous mixture composed of only one phase. In such a mixture, a solute is dissolved in another substance, known as a solvent. The solvent does the dissolving.- Types of solutions :...

 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
Tranquilizer
A tranquilizer, or tranquilliser , is a drug that induces tranquility in an individual.The term "tranquilizer" is imprecise, and is usually qualified, or replaced with more precise terms:...

 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
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

 usually feels a warm or burning sensation.

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
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...

, usually intravenous. Recent phenol peel formulas can be applied locally (chemical blepharoplasty or cheiloplasty)without any kind of anaesthesia.
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