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Chemical peels are the minimally invasive cosmetic treatment that utilises the skin’s natural regenerative potential. Therefore, they work similarly to other popular aesthetic procedures, such as laser skin resurfacing and RF microneedling.

Safe application in primary care requires an understanding of the wound healing process.

Adequate training in this technique enables the practitioners to recognise and manage potential complications. It also provides necessary knowledge about various exfoliating agents.

What are chemical peels?

A chemical peeling procedure uses chemical agents to remove the epidermis and sometimes the dermis as well. The technique helps the skin’s natural regenerative cycle and provokes a healing response. Newly-formed tissue layers usually show improvements in superficial scars, lesions, pigmentary changes, fine lines, wrinkles, and so on.

The procedure

The practitioner applies the appropriate exfoliating agent on clean skin, waits the necessary amount of time and then removes the agent with water or a neutraliser, depending on the acid used.

Post-procedure, the treated skin is temporarily sensitive. However, once the healing process is over, the “new” skin is smoother and tighter. The pores and signs of damage are less prominent too.

Side effects are rare, although harsher chemical agents can cause permanent skin discolouration, scarring, and reactivation of cold sores.

Types of chemical peels

Chemical agents of different strengths exfoliate the skin at different depths. According to this, we differentiate three types of chemical peels:

1. Superficial peels – Alpha-hydroxy acid (AHA) and salicylic acid gently exfoliate the skin. Such peeling agents do not penetrate deep into the skin. They remove dead skin cells from the surface (stratum corneum) and slightly improve discolouration and skin texture.
2. Medium peels – Glycolic or Trichloroacetic (<50%) acid exfoliants can improve moderate skin issues, such as age spots, fine lines, freckles, and actinic keratosis. Medium peels affect the epidermis and, rarely, the papillary dermis.
3. Deep peels – Aggressive peeling agents, such as phenol and Trichloroacetic acid (>50%), reach into the dermis and remove damaged skin cells, improving the appearance of deep scars. Deep peels are done on the face and only once. One session is enough to remove age spots, freckles, and some wrinkles.

Indications

The indications for chemical peels include skin issues commonly treated in both aesthetic medicine and dermatology. These include, but are not limited to:

• Acne and acne scars
• Post-inflammatory hyperpigmentation
• Wrinkles
• Enlarged pores
• Surgical scars
• Melasma
• Ephelides
• Solar lentigines
• Milium
• Lichen planus
• Ichthyosis
• Seborrheic and actinic (solar) keratosis

Pre-treatment assessment

Quality management of patient’s expectations in the best possible way before the procedure is essential. Also, physicians should do a general skin check-up and go through medical history. The no-go signs are too much sun damage, keloid scars, and infections.

Pre-treatment and post-treatment photographs are a must, and getting a signed consent is highly recommended.

Contraindications

Chemical peels are not advisable for pregnant and breastfeeding women and patients with a compromised immune system function. History of keloid scars and radiation therapy is also a contraindication.

Potential side effects

Side effects related to this procedure are rare, but the probability increases with deeper peels. The most common side effects include redness, irritation, and sensitivity.

Other, less common, side effects include:

• Infections
• Oedema
• Erosions
• Ulcers
• Pigmentation issues
• Vesicles
• Capillary dilation

Scar formation and allergic reactions are also possible.

Recommended aftercare

Quality sun protection is an absolute must, regardless of the peeling type.

A follow-up appointment can help determine if recovery is moving in the right direction. Deeper peels require substantial recovery time and, occasionally, medical attention.

Learn more with the Certificate Courses in Aesthetic Medicine

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References

• Samargandy S, Raggio BS. Skin Resurfacing Chemical Peels. 2021 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31613532.
• Truchuelo M, Cerdá P, Fernández LF. Chemical Peeling: A Useful Tool in the Office. Actas Dermosifiliogr. 2017 May;108(4):315-322. English, Spanish. doi: 10.1016/j.ad.2016.09.014. Epub 2016 Dec 5. PMID: 27931952.
• Al-Talib H, Al-Khateeb A, Hameed A, Murugaiah C. Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris. A Bras Dermatol. 2017 Mar-Apr;92(2):212-216. DOI: 10.1590/abd1806-4841.20175273. PMID: 28538881; PMCID: PMC5429107.