Introduction to chemical peels

Chemical peel is an aesthetic method of skin regeneration and rejuvenation. The actual peeling procedure involves the application of a caustic chemical substance to destroy layers of the skin which induces epidermal and Dermal skin repair mechanisms. This action causes skin peeling that is able to stimulate regeneration process. During a chemical peel application, one size does not fit all. The depth of destruction would depend on the choice of substance used and its concentration. When making this choice, the depth of targeted structure and the skin condition of the patient is being considered. Other factors to be considered includes; -Chemical class of the peeling agent, -Chemical concentration, -Frequency of application -Pressure of the application. The major classification of chemical peels includes superficial, medium and deep peels, superficial peels alpha‐hydroxy‐acids and most recently lipo‐hydroxy acid are used to induce an exfoliation of the epidermis. Medium‐depth agents, e.g. trichloroacetic acid (< 50%) cause an epidermal to papillary dermal peel and regeneration. Deep peels using trichloroacetic acid (> 50%) or phenol based formulations reach the reticular dermis to induce dermal regeneration. Based on mode of action, chemical peels can be made of Keratolytic agents, keratocoagulant agents or/and proteolytic agents. Keratolytic agents, such as hydroxy acids, work by breaking apart the bonds that hold skin cells together or by dissolving cellular glue. E.g.l, glycolic, lactic, or salicylic acid. Keratocoagulant agents work by coagulating skin proteins. Mostly used for treating dermal skin problems as they stimulate collagen and tissue regeneration, e.g, TCA peel which is applied in layers and can penetrate deep into the dermis. Proteolytic agents include enzymes that dissolve cellular tissue and are a gentle and effective method to rejuvenate the skin. Enzymes such as papaya, pineapple, and pumpkin are ideal to exfoliate sensitive skin types. The success of any peel is crucially dependent on the physicians understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedures. Chemical Peels are effective on skin problems which includes fine lines, wrinkles, brown spots, sun damage, clogged pores, skin discolouration, dull complexion, acne scarring, rough skin, skin blemishes, blotchy skin, hyperpigmentation, age spots, freckles.etc. Best candidate for chemical peels are people with fair/light skin as they respond best to Chemical Peel. People with darker skin types may also achieve excellent results but with a carefully and skillful application process and the after care will also determine the result of the peel. Chemical Peels can be performed on the face, neck, chest, arms, hands and legs as far as the skin area needs to be improved. For application process, Skin needs to be cleansed so as to remove excess oil and dirt then the peel solution is applied in layers depending on depth of penetration. While doing so, skin is to be monitored to study the reaction of which it is washed out after few mins. After peel is washed off, a moisturising cream and sunscreen is applied to avoid skin dryness and reduce sun contact. Proper aftercare to maximise the result of the peel is then prescribed to prevent any possible complication, like PIH, scarring, etc. These could include; -avoiding sun exposure and protection against harmful effect of the sun with use of sunscreen, -moisturisers to increase flexibility of skin so it can peel faster , -skin healing ointment to improve skin healing, -depigmenting cream to control pigment production that could cause PIH. After a Chemical Peel, patient may experience redness and sometimes swelling which will only last for few days but this depends on the kind of peel used. Also after few days of peel application, patient will experience mild flaking of the skin which last for about 5-7 days or within 14days if doing harder regions like legs. Afterwards, expect a smoother and more evenly toned skin with a firmer, fresher and more youthful appearance.