A chemical skin peel is a popular procedure used to treat various skin problems and conditions from acne, age spots, wrinkles and even some cancerous and precancerous growths. A caustic acid or substance is applied to the skin to burn and usually slough off or remove the outer layers of the skin (epidermis) and allow new skin to grow. Some chemical peels may go deeper into the dermis (next layer of skin). The purpose of this chemical peeling is to remove damaged, blemished, sun-damaged, freckled skin and replace it with younger, healthier skin.
After healing the skin will be tighter, thicker (due to increased collagen production – an added benefit of the stronger peels). Upon healing the skin may appear fuller, smoother with smaller pores and with less wrinkles and fine lines. Basically ones skin will look rejuvenated and more youthful following a chemical peel.
There are many types and varieties of these chemical peels. They are usually grouped and defined by their relative strength and depth of the peel that is achieved. There are basically four groups, the light peels (AHA), light oil-based peels (BHA), medium peels (TCA), and deep peels (Phenol). AHA (Alpha Hydroxy Acids) – These are the mildest of the peels. They are usually sugar derived hence their names, glycolic, malic, lactic and other fruit acids. These peels are usually performed by a dermatologist or esthetician and have minimal healing or downtime. Downtime is referred to as the time when the skin is healing and may be uncomfortable to be viewed in public due to peeling and possibly discolored dead skin that is usually associated with a deeper peel.
These lighter peels are usually done on an outpatient basis and are commonly referred to as a ‘lunch time’ peel. An occlusive dressing similar to plastic wrap or layering (more than one application at one time) may be used to drive the acid in further and result in a deeper peel. They are effective for light skin pigmentation problems, reduction of oil produced by overactive sebaceous glands, sun spots, light sun damage and other minor skin problems. Usually multiple treatments are required to have the desired effect as it is not a deep peel. AHA’s are easily dissolved in water and are prepared either as a liquid or a cream. Glycolic acid is the most popular and extensively used of these peels.
BHA (Beta Hydroxy Acids) – The main difference between these acids and alpha hydroxyl acids (AHA) is that BHA’s are only oil soluble. There is basically only one BHA, salicylic acid. This unique feature of being oil soluble makes this acid very effective in cleaning and removing bacteria, dead skin cells and sebum oil from deep inside the pores. Because of this solubility difference, salicylic acid is better suited for use on oily, irritated skin with postules, blackheads and whiteheads. It is available in numerous forms, cream, gel, lotions, shampoo and topical solutions. The latter two forms are primarily for treating the scalp as salicylic acid has also been found effective in the treatment of dandruff, psoriasis, and dermatitis of the skin and scalp. Same as with AHA peels, occlusive dressings and/or layering may be used to drive the acid in farther.
TCA (Trichloroacetic Acid) – TCA or trichloroacetic acid peels are deeper medium depth peels. TCA is a more effective and longer lasting peel than the sugar and citric peels as it goes deeper into the dermis and can therefore treat more skin ailments, conditions and problems. A TCA peel does not require layering or occlusive dressings (methods used to drive AHA and BHA peels deeper). TCA, being a deeper peel, is effective on more skin conditions and problems. Basically a TCA peel has the benefits of both AHA and BHA peels along with deeper penetration and longer lasting effects. Healing or downtime tends to be longer as much as several weeks or more depending on the depth achieved. Peeling is more severe and the results more dramatic. TCA peels are routinely used by dermatologist and plastic surgeons in office as recommended treatments for all stages of acne including acne vulgaris.
Numerous clinical studies have found to be every bit as effective as Accutane without any of the side effects (Accutane has been in the news lately for some rather severe potential side effects). TCA peels have also been proven to remove and treat freckles, years of sun damage, bad pigmentation, scars, loose skin and wrinkles and fine lines. TCA has recently even been used by doctors to treat, remove and lighten tattoos. Phenol Peels. Phenol peels are the deepest chemical skin peels. They commonly result in a permanent bleaching pigmentation effect as they reach deeply through the dermis. Phenol is toxic when absorbed through the skin and can effect heart rate, function and cause arrythmias, so a phenol peel is always done in a doctors care and with anesthesia as it is the deepest and most painful of the peels. It is a last resort peel due to its harshness and bleaching properties. Phenol is rarely performed nowadays due to its toxicity and the advent of safer medium depth peels like the TCA peel. Phenol peels have a long healing process and can require extensive care.
There are various derivatives of each of these 4 groups, but basically these are the various chemical skin peelsl. Clinical studies published in the Annals of Plastic Surgery and elsewhere show the TCA peels are the most effective of the peels on the most skin conditions and problems. Regardless of the peel used, maximum sun protection must be used to protect the new skin from harmful UV rays that can cause cancer in unprotected skin. A high SPF (sun protection factor) sun block and protective attire (hats) are recommended.
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