- The power of peeling
- Downside to peeling
- Where do peels stand today?
- Why do we use chemical peels?
- Key points
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 remodeling, with improvement of texture and surface abnormalities. The objective of chemical peeling is to cause destruction at the required depth, followed by remodeling 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.1 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.2 The alpha-hydroxy acids were studied by Van Scott and Yu.3 Since then various agents have been used for chemical peeling with newer agents being added day-to-day.
THE POWER OF PEELING
Chemical peeling has several advantages:
- It is a simple office procedure, and does not require an elaborate OT setup.
- The procedure is easy to learn and practice, with a short learning curve, particularly for beginners.
- It is safe and effective with minimal complications.
- Superficial peels are noninvasive and can be used as lunchtime procedures.
- No significant postoperative care is required, except for deep peels.
- Except for phenol peels, there is no risk of systemic toxicity.
- Chemical agents are easy to procure and are stable.
- There is a wide array of chemical agents that can be used for peeling, hence treatment can be individualized, according to skin type.
- Unlike lasers, no machines and maintenance is required, hence affordable to every physician.
- Procedure and chemicals are inexpensive and easily affordable to most patients.
- Chemical peeling has been well studied and there is vast long-term experience with peeling agents.
- It can be combined with other modalities such as lasers and dermabrasion.
DOWNSIDE TO PEELING
However, chemical peeling also has few disadvantages.
- Complications such as hyperpigmentation and scarring can occur.
- Except for deep peels, it is a slow process. Multiple sessions are required with superficial peels, to achieve acceptable cosmetic results.
- Results are not permanent and maintenance peels are often required.
- Post-peel, pigmentary changes are common in inexperienced hands, especially in darker skins.
- Skin needs to be primed with medical therapy before peeling and adjunctive therapy is essential to maintain results.
- Deep peels with phenol have a high risk of permanent pigmentary changes in darker skins.
WHERE DO PEELS STAND 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, chemical peeling and fillers are the two most common office based cosmetic procedures being performed.4
The advent of nonablative 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 long-term effects are unknown. Newer, safer and more effective peeling agents, such as mandelic 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.5 Lasers on the other hand are still very expensive to acquire and maintain. Till these newer nonablative 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, photoaging, melasma and acne.
WHY DO WE USE CHEMICAL PEELS?
Chemical peeling is a versatile tool that can help build a good cosmetic practice. Though lasers have caused a large impact, partially fuelled by media hype, chemical peels can still be considered as a simple and effective modality, in any cosmetic physician's repertoire. Often it is not possible for physicians to buy three different lasers to treat each problem. Chemical peels can treat photodamaged skin, pre-skin cancers, acne, melasma and other dyschromias, thus allowing treatment of a number of different problems without any special equipment.6 New advances in peel approaches, including combination, sequential and segmental peels, safer and lower-strength peeling agents, added to the menu of options, are allowing clinicians to tailor their practices to patients’ needs, often without added costs. Chemical peels are thus not only a part of the cosmetic scene of the past, but also a definite cornerstone of the future.
Chemical peeling is a simple and safe office procedure. A thorough knowledge of peeling agents and their mechanisms of action are essential for all physicians practicing cosmetic dermatology. The nuances of peeling, particularly in darker skins, where lasers carry a higher risk of complications, fill a gap in the treatment of common conditions such as facial melanoses, photoaging, acne and skin rejuvenation.
- Chemical peeling is a useful office procedure for the treatment of common conditions such as dyschromias, skin rejuvenation and acne.
- It has a short learning curve and can be easily practiced, even by beginners.
- It is safe and effective with minimal complications.
- Inexpensive and affordable to doctor and patient alike.
- Brody H. History of chemical peels. In Baxter S (Ed): Chemical peeling and resurfacing. 2nd edn. Mosby Year Book; St. Louis: 1997;1–5.
- Stegman SJ. A comparative histologic study of the effects of the three peeling agents and dermabrasion on normal and sun damaged skin. Aesth Plast Surg 1982;6: 123.
- Van Scott EJ, Yu RJ. Hyperkeratinization, corneocyte adhesion and hydroxy acids. J Am Acad Dermatol 1984;11: 867–879.
- Housman TS, Hancox JG, Mir MR, et al. What specialties perform the most common outpatient cosmetic procedures in the United States? Dermatol Surg 2008;34(1):1–7.
- Sapijaszko MJA. Chemical Peels - A Re-emerging Art. Skin Care Guide.com
- Hantash B, Stewart DB, Cooper ZA, et al. Facial resurfacing for nonmelanoma skin cancer prophylaxis. Arch Dermatol 2006;142:976–982.