Diseases

As a general rule, so called over-the-counter peels do not damage the skin and therefore cannot produce the same sort of results that a peel performed by a physician is likely to achieve. On the other hand, they are safe products and are unlikely to produce any skin damage. The so-called "microdermabrasion" is similarly non-invasive.

Superficial peels rarely require anesthesia but are accompanied by a burning sensation when the solution is applied. This can be relieved by the application of cool compresses and fan-aided evaporation. Deeper peels often require extensive local anesthesia, systemic sedation, and rarely, general anesthesia. The peeling process begins with the application of a defatting solvent (acetone or alcohol), which is wiped uniformly over the area to be treated. The peeling solution is then applied for the appropriate time period and then halted by the application of a neutralizing solution. Bandages are applied to the treated area, and the patient is sent home to convalesce.

Often it is suggested to pretreat patients with tretinoin cream for a period of time prior to the peel. People who get cold sores (herpes simplex infections) should start on antiviral medications like acyclovir (Zovirax) one week prior to treatment and continue taking these for two weeks after therapy to prevent reactivation of cold sores. All patients should be encouraged to use high SPF sunscreens prior to and after peeling. Those with darker skin may also require pretreatment with hydroquinone preparations.

The risks, side effects, and complications of chemical peels include scarring, infection, reactivation of herpes simplex infections, and a substantial contrast in coloration of the treated skin. All patients will have a recuperation period, the length of which depends upon the depth of the peel. Deep peels can result in substantial periods of healing on the order of weeks. Deep peels generally require extensive local anesthesia, conscious sedation, and occasionally general anesthesia, which carries its own risks.

If performed correctly in appropriate patients, the appearance of the treated skin will have a more youthful texture with a uniform coloration that will blend with their untreated skin.

Chemical peels are broadly defined by the depth of damage in the skin that they produce. They are categorized as superficial, medium, and deep. Superficial peels do not damage skin below the epidermis, the most superficial skin layer. Medium peels may reach to the superficial layer of the dermis, the deeper layer of the skin. Deep peels generally reach the deeper layers of the dermis. The depth of damage depends on the nature and concentration of the chemicals in the peeling solution and the length of time they are permitted to interact with the skin. Popular chemicals in peeling solutions include retinoids (tretinoin dissolved in propylene glycol), alpha-hydroxy acids (lactic acid and glycolic acid), beta-hydroxy acids (salicylic acid), trichloroacetic acid, and phenol (carbolic acid). Jessner's solution, a combination of resorcinol (14 g), salicylic acid (14 g), and lactic acid (85%) in ethanol (95%), is also an excellent peeling agent.

A chemical peel involves the application of toxic chemical solutions to the skin in a controlled manner, producing controlled tissue death. The desired depth of the wound is dependent upon the condition to be treated. After the peel, the skin regenerates. The damaged skin likely regenerates through the growth of cells from deeper layers of the epidermis or from undamaged hair follicles.

The skin is especially sensitive after a chemical peel. It is essential to practice strict sun avoidance during and after the healing process. The skin may remain sun sensitive for some time after the peel. The frequency of post-op physician visits will depend upon the depth of the peel and the preferences of the physician.

The most common candidate for a chemical peel is a person with sun-damaged skin, uneven pigmentation, and/or actinic keratoses. Sun damage results in fine wrinkling, skin thinning, sun spots (liver spots or solar lentigines), and very early precursor to skin cancers called actinic keratoses. Skin peels may also be used to treat acne scarring.

Individuals with darkly pigmented skin should be very cautious about having chemical peels. This is because there is a significant chance that the pigmentation of the newly healed skin will be substantially different from their current skin color.