Chemical Peel

• A chemical peel damages the skin in a controlled manner, producing a superficial wound.
• As the natural healing process repairs the damage, the skin's appearance is improved.
• The nature of the chemicals applied to the skin determines the depth at which the damage occurs.
• The type of chemical peel used depends on the nature of the skin problem to be treated.
• Skin problems that respond best to chemical peels are due to chronic sun damage from ultraviolet light.
• Since most skin peels damage the skin, there is a period of recuperation necessary.
• As with any surgical procedure, there are risks, which include scarring, infection, and undesirable color changes.
• Currently, dermatologists often use chemical peels in conjunction with other destructive techniques like laser to diminish the signs of sun damage or acne scarring.

A chemical peel involves the application of toxic chemical solutions to the skin in a controlled manner, producing controlled tissue death. The desired depth of the wound is dependent upon the condition to be treated. After the peel, the skin regenerates. The damaged skin regenerates from deeper layers of the epidermis and from the superficial dermis.

Chemical peels are broadly defined by the depth of damage in the skin that they produce. They are categorized as superficial (lunchtime peel), medium, and deep. Superficial peels do not damage skin below the epidermis, the most superficial skin layer. Medium peels may reach to the superficial layer of the dermis, the deeper layer of the skin. Deep peels generally reach the deeper layers of the dermis. The depth of damage depends on the nature and concentration of the chemicals in the peeling solution and the length of time they are permitted to interact with the skin. Popular chemicals in peeling solutions include retinoids (tretinoin dissolved in propylene glycol), alpha-hydroxy acids (lactic acid and glycolic acid), beta-hydroxy acids (salicylic acid), trichloroacetic acid, and phenol (carbolic acid). Jessner's solution, a combination of resorcinol (14 g), salicylic acid (14 g), and lactic acid (85%) in ethanol (95%).

If performed correctly in appropriate patients, the appearance of the treated skin will have a more youthful texture with a uniform coloration that will blend with their untreated skin.

As a rule, so-called over-the-counter peels do not damage the skin and therefore cannot produce the same sort of results that a peel performed by a physician is likely to achieve. On the other hand, they are safe products and are unlikely to produce any skin damage. The so-called "microdermabrasion" is similarly non-invasive.

The most common candidate for a chemical peel is a person with sun-damaged skin, uneven pigmentation, and/or actinic keratoses. Sun damage results in fine wrinkling, skin thinning, sun spots (liver spots or solar lentigines, fine lines, freckles, age spots), and a precursor to skin cancers called actinic keratoses. Skin peels also treat acne scarring.

Individuals with darkly pigmented skin should be very cautious about having chemical peels. This is because there is a significant chance that the pigmentation of the newly healed skin will be substantially different from their current skin color.

The risks, side effects, and complications of chemical peels include scarring, infection, reactivation of herpes simplex infections, and a substantial contrast in coloration of the treated skin. All patients will have a recuperation period, the length of which depends upon the depth of the peel. Deep peels can result in substantial periods of healing on the order of weeks. Deep peels generally require extensive local anesthesia, conscious sedation, and occasionally general anesthesia, which carries its own risks.

Superficial peels rarely require anesthesia but are accompanied by a burning sensation when the solution is applied. This can be relieved by the application of cool compresses and fan-aided evaporation. Deeper peels often require extensive local anesthesia, systemic sedation, and rarely, general anesthesia. The peeling process begins with the application of a defatting solvent (acetone or alcohol), which is wiped uniformly over the area to be treated. The peeling solution is then applied for the appropriate time period and then halted by the application of a neutralizing solution. Doctors apply bandages to the treated area, and the patient goes home to convalesce. Recovery time depends on the type of peel and can last as long as months. Since peels are generally considered as cosmetic procedures most are not covered by standard health insurance policies.

Often it is suggested to pretreat patients with tretinoin cream for a period prior to the peel. People who get cold sores (herpes simplex infections) should start on antiviral medications like acyclovir (Zovirax) one week prior to treatment and continue taking these for two weeks after therapy to prevent reactivation of cold sores. All patients should be encouraged to use high SPF sunscreens prior to and after peeling. Those with darker skin may also require pretreatment with hydroquinone preparations.

The skin is especially sensitive after a chemical peel. It is essential to practice strict sun avoidance during and after the healing process. The skin may remain sun sensitive for some time after the peel. The frequency of post-op physician visits will depend upon the depth of the peel and the preferences of the physician.