What is chemical peeling?
The use of exfoliating agents to remove portions of epidermis and/or dermis, which results in the growth of new epidermal tissue and the alignment and deposit of new collagen in the dermis.
What are the indications for chemical peeling?
Rhytides, actinic keratoses, lentigines, melasma, acne vulgaris, rosacea, milia, superficial scarring from acne, and photodamaged skin.
What effect does chemical peeling have on the dermis?
Decrease of nonlamellar collagen.
How are the exfoliants categorized? Provide examples.
According to the depth of the wounding they produce:
1. Superficial—involves the papillary dermis (trichloroacetic acid [TCA] 10% to 20%, Jessner’s solution, salicylic acid, alpha-hydroxy acids, tretinoin).
2. Medium depth—to upper reticular dermis (TCA 35% to 50% + Jessner’s solution, pyruvic acid).
3. Deep depth—to mid-layers of reticular dermis (Baker’s phenol peel, Hetter phenol–croton oil peel).
Name the most common agents used for chemical peeling and their mechanism of action.
1. Phenol: a keratocoagulant, which denatures and coagulates surface keratin.
2. TCA: trichloroacetic acid.
3. Croton oil: native ingredient causing deep layers of injury in the phenol–croton oil peel.
4. Soap: this acts as a surfactant action, which enhances penetration.
5. Water: slows down keratocoagulation and improves absorption.
6. Salicylic acid: this denatures and coagulates surface keratin.
What is the Baker’s formula?Phenol (3 mL of 88% USP), croton oil (three drops), liquid soap (eight drops), and water (2 mL).
What is the Hetter phenol–croton oil peel?
It is a refinement of the Baker’s formula that recognizes croton oil as the active ingredient in the phenol–croton oil peel and allows titration of the degree of injury to the skin in a measured manner by accurately identifying the amount of croton oil in a given solution used on the peel.
What is another name for phenol?
Phenol is also known as carbolic acid and is an aromatic derived from coal tar.
What is Jessner’s solution?
Resorcinol (14 g), salicylic acid (14 g), lactic acid (14 mL), and ethanol (100 mL).
What are the factors that determine the depth of the peel?
An important factor is the concentration of these solutions being applied. Also important is the mechanism by which they are applied, the cleanliness of the skin, and the pressure and the number of strokes applied with the applicator.
What is the advantage of using Jessner’s solution before application of TCA?
The primary advantage is that Jessner’s solution removes the superficial layers of keratin, thereby allowing lower concentrations of TCA to be applied to reach the desired dermal depth.
What is salicylic acid (SA)?
Salicylic acid (30%) is a beta-hydroxy acid and was the original peeling agent. It is used for single or multiple resurfacing of moderately photodamaged facial skin.
What is the role of tyrosinase in skin pigmentation?
Tyrosinase is an enzyme which catalyzes production of melanin from tyrosine. Hydroquinone and kojic acid are skin lighteners that work by inhibition of tyrosinase.
When does clinical evidence of peeling begin?
It usually begins on the second post-peel day and can extend up to 12 days, depending on the depth of penetration and the drugs used.
What is the clinical course of a chemical peel?
Within the first few days there is a desquamation of the superficial layers of the epidermis. Then, depending on the solution applied, there is an injury to the epidermis and layers of the dermis. Over a 3- to 13-day period, there is reepithelialization of the wound. The skin initially can have a distinct red hue, which changes, over the ensuing time, to pink and finally having a normal appearance. This redness could be present for a number of weeks in a deep croton oil peel.
What interval between treatments is recommended for salicylic acid peels?
An interval of 4 weeks for total epidermal regeneration.
What are the advantages of salicylic acid peels?
Uniformity of application, producing a white frost visible to the naked eye, no risk of overpeeling because the vehicle volitizes in less than 4 minutes and it may also be useful for treatment of comedones and inflammatory acne.
What is the Fitzpatrick classification of sun-reactive skin types and how can it be used?
It is a classification system based on color and response to sunlight. Types I to III are usually good candidates for chemical peeling, with the exception of red-haired, freckled persons. Types IV to VI are at risk for unwanted pigmentation changes, particularly hypopigmentation.
What is the gauge by which the end point of chemical application is determined?
There is typically a frost that occurs.
What role does taping have for phenol and TCA peels?
Taping increases the depth of treatment by its occlusive action.
What are the methods used to enhance the effect of a peel?
Taping and repeated applications with a 2 × 2 sponge.
What peel should not be used in people of African-American descent?
Phenol peel and 35% TCA or higher has a significant negative effect on melanocytes.
Describe the histologic changes associated with photoaged skin.
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