International Academy of Cosmetic Dermatology
Chemical peels are used to address the aging process, pigmentary concerns, and scars. They are usually differentiated by the depth of penetration of the peeling agent and are usually classified into 1) superficial, 2) medium, and 3) deep chemical peels
- Superficial chemical peeling agents include:
- glycolic acids (alpha hydroxyl acids and a variety of other fruit acids)
- tricholoroacetic acid (TCA) in low concentrations (up to 20%)
- Jessner’s solution
- lactic acid
- salicylic acid (also known as beta peels).
Superficial chemical peels are used to remove the top layers of the skin and as such are commonly used to exfoliate these top layers of the skin, giving the skin an overall refreshed look. In series, these peels are commonly used to treat mild acne vulgaris, rosacea changes, and a variety of pigmentary concerns. Mild redness, followed by superficial desquamation, is common. Most patients see improvement in their skin following a series of these peels.
- Medium depth chemical peels are usually performed with TCA, in concentrations up to 35%. On occasion, another agent, such as glycolic acid or Jessner’s solution is used in combination with TCA to enhance the effects of the TCA peels. Medium depth chemical peels are commonly used to treat photodamaged skin, including the effects of aging and pigmentary concerns, fine lines and wrinkles, and acne scars.
For the majority of patients receiving these peels, there will be a period of skin desquamation which can last from several days up to one week and require patients to avoid excess sun exposure during the healing time. Adverse events include pigment changes and scarring, if not performed correctly or by skilled physicians.
- Deep chemical peels can be performed with 50% TCA or more commonly with the use of phenol. The majority of dermatologists do not perform phenol peels which require appropriate monitoring during and after the procedure. Intense peeling is common after phenol peels, but in skilled hands, it can produce an outstanding photorejuvenation effect and minimize most acne scars. Side effects, however, are common when not performed by skilled surgeons and include pigmentary changes and even scarring.
Michael H. Gold, MD
Nashville, TN, USA