Clinic of Dermatology

Chemical peel refers to a manipulation of controlled destruction of the superficial skin layers via chosen chemical agent. Peels are classified into deep, medium and superficial. The most popular peels are those with alpha-hydroxy acids (AHAs) and trichloracetic acid (THA).

Before	Before
After	After

What is peeling?

This is a specific technique of applying high concentrations of acid in high doses on the treated areas, but for a very short period of time. Patients may feel stinging and "stretching" of their skin. The acid is neutralized at the end of the procedure. Varying degree of redness and "scaling" is observed on the skin for the next 3-7 days. Sunprotection of the treated areas is necessary.

AHAs are also called fruit acids, because they are derived from fruits.

These are glycolic, lactic, citric and tartaric acids. They are used as ingredients in a variety of cosmetic creams in concentrations ranging from 4% to 15%. Their application as peeling agents is known for a long time.

The most popular AHA is glycolic acid, usually in concentrations of 35% or greater (70%). 70% glycolic acid stimulates collagen and elastin synthesis in the skin. Glycolic peels are non-toxic for the skin cells; they are applied as superficial peeling agents and the recovery period is short.

Indications:

• Skin aging – rough and inelastic skin; dyschromia and superficial lines of the face.
• Irregular pigmentations (melasma, age spots).
• Superficial lines of the neck, chest and hand areas.
• Oily skin and acne.
• Dry skin.
• Hyperkeratoses (localized thickening of the skin).

Contraindications

• Allergies.
• Eczema.
• Rosacea.
• Seborrheic dermatitis.
• Autoimmune diseases.
• Connective tissue diseases.
• Viral infections.
• Ongoing retinoid therapy.
• Pregnancy.

What are the side effects?

• Acne-like rash, caused by the deep cleansing of the pores.
• May trigger herpes infection.
• Acne-like rash around the mouth ( perioral dermatitis).

What kind of patients are more susceptible to complications after the peel?

Patients with sensitive skin or those who apply regularly facial masks, exfoliating agents, hair dyes, depilation creams or attend the solar studio frequently.

Complications:

• Allergic reactions.
• Herpes infection.
• Persisting redness or increased photosensitivity.
• Patchy pigmentation.
• Infections.
• Scarring.

TCA is the most commonly used agent for medium and deep peel. It is applied to manage wrinkles and elevated scars (hypertrophic scars and keloids), as well as dyschromia.

Dyschromia means pigmentary disorder, most commonly associated with increased production of melanin:

• Freckles.
• Lentigo.
• Seborrheic keratoses.
• Melasma.

Other indications for peel are:

• Acne scarring.
• Plane warts.
• Chemical rejuvenation of the face.

TCA peel may be repeated every 2 weeks until the desired effect is achieved.