As previously mentioned, the ancient Egyptians used salt, animal oils and alabaster to improve skin appearance. Sulphur, mustard and limestone were also used in olden days. Early in the 1900’s, MacKee administered phenol for treatment of acne scars. Gross practised phenol peeling in Los Angeles in the 1930’s. In 1941, Eller and Wolff reviewed various exfoliation regimes. These included the use of pumice on the skin as well as sulphur and resorcinol pastes.
In 1966, Urkov described methods using phenol. In the 1960’s, Ayres compared his results with those of Morash, citing histologies of trichloracetic acid (TCA) and phenol. Brown et al reported phenol formula, the histological changes it produced and its potential toxicity. In 1962, Litton and Baker published their respective nonsaponized and saponized formulas. The 1970’s and 1980’s saw further advancements in full-face phenol application or TCA peels in combination with dermabrasion.
The common underlying concept is to wound the skin for the exfoliation of damaged epidermis and dermis with remodelling of the tissue with new collagen and new epidermis. Materials used for chemical peeling are keratolytic or and coagulant agents. TCA (trichloracetic acid) and phenol in high concentrations promote lys of skin layers. Together with scab formation, exfoliation and parallel epidermis regeneration, reorganization, proliferation of collagen and elastin bundles take place, clinically translated into a newly restored skin with a younger appearance. The surface becomes smoother without fine wrinkles, with significant improvement of deep wrinkles and pigmentation. (Fig. 18 – 21)
Chemical peels can be divided into superficial, medium and deep peels. By altering the type of chemical, the constituents of the chemical solution, the concentration of the solution or the technique, various degrees of exfoliation can be achieved. Superficial peels are used to treat superficial keratosis or dyschromia. These various chemical modalities include 10% to 20% trichloracetic acid (TCA), 70% glycolic acid and Jessner’s solution. Medium depth peels are used to treat deeper pigmentation problems, deeper keratosis and fine wrinkling. These agents include full strength phenol and 35% TCA. The TCA peel can be potentiated with the addition of Jessner’s solution, carbon dioxide or glycolic acid. These potentiating agents act as additional irritants that increase the permeability of the epidermis and allow increased penetration of the peeling agent. Deep peels are indicated to treat deep wrinkles associated with photoaging and deep pigmentation problems.
Common Indications for Chemical Peel:
- Wrinkle / aging
- Scarring: post acne
- Actinic keratosis
- Large pores – Hamartomatous skin
Prepeel skin conditioning: Preparation of the skin with Retin-A (0.025%-0.05%) AHA (10-20%), Hydroquinone 4%, Kojic Acid 2%, vitamin C, topical antibiotics and accutane (10-20mg) have been fully explained in the chapter on laser resurfacing.
Fig. 18 – 21. The factors that effects the depth of the peel are the number of passes and duration of peeling, concentration and chemical characteristic of solution that has been used and the skin preconditioning program. Deep peel is not recommended for skin type IV, V and VI (People from the Middle East, Asian and African).
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Materials for Chemical Peel