CHEMICAL PEELING

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CHEMICAL PEELING

• Dr. Bindu.R.S
• Dpt of D V
• Medical College
• Trivandrum

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Chemical Peeling/ Chemoexfoliation

• Definition
• Application of one or more chemical agents to
  the skin to cause controlled chemical burns
  resulting in destruction of a portion of
  epidermis / or dermis through dry desquamation
  or moist maceration followed by exfoliation
  subsequent resurfacing of epidermis with
  remodelling of collagen elastic tissue the
  deposition of glycosaminoglycans during the
  repair process in the dermis.

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History

• Ancient Egypt
• Cleopatra Sour milk ( lactic acid)
• French Women Old wine ( tartaric acid)
• Last decade Many agents

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Classification
Depth Injury Agent
Superficial Papillary dermis TCA 10-30 GA, SA
Medium depth Upper reticular dermis 45 TCA 70 GA 35 TCA, 89 Phenol
Deep peeling Midreticular dermis TCAgt 50 Bakers formula peel
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Common peeling agents

• TCA Trichloro Acetic Acid
• GA Glycolic Acid
• SA Salicylic Acid

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TCA

• Crystals
• MOA Precipitate epidermal proteins,
  dermal inflammation, sloughing.
• White frosting
• Superficial 10- 30
• Medium depth 45
• Deep peeling- gt 50
• Complications- Hyperpigmentation, prolonged wound
  healing, scarring.

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Glycolic Acid

• Alpha hydroxy acid
• Sugar cane
• 70 stock solution
• Diluted- 20, 25, 30
• Readymade patented prepn Neostrata
• Neutrogena, Gorgeous peel

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Salicylic Acid

• Beta hydroxy acid
• Willow bark, wintergreen, sweet birch
• Superficial peeling
• Powder
• Dissolved in ethanol / methanol
• 10, 15, 20
• Pseudo frost

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Mechanism of Action

• Controlled chemical burns
• Destruction of upper layers of skin
• Partial thickness wound
• Secondary intention
• Thinning of SC, regulation of epidermal
  thickness, laying down of new collagen, ground
  substance
• More normalized tissue
• Better cosmetic appearance

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STAGES

• 1.Coagulation
• 2.Reepithelialization
• 3.Granulation tissue
• 4.Angiogenesis
• 5.Collagen matrix remodelling

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GA- Addl MOA

• Higher conc gt20 - chemical burns
• Lower conc lt 20 - Epidermal changes with
• Minimum surface destruction
• 1.Decreases keratinocyte cohesion
• 2.Epidermolysis
• 3.Epidermal growth
• 4.Decreases melanin production

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5.Fibroblast modulation 6.Antioxidant
action 7.Moisturizing action
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INDICATIONS

• Acne
• Postacne hyperpigmentation
• Superficial scarring
• Acne excoriata
• Comedolytic acne

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2. Dyschromias Melasma FDE Melanosis
(Photo,Diffuse/ Localized) Freckles Lentigines
Post inflammatory hyperpigmentation (PIH)
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3. Aesthetic Dilated pores Fine
wrinkles Moderate actinic damage
aging Superficial scars
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Contraindications

• Active infections bacterial, viral (herpetic)
• Open cuts
• Facial dermatitis
• Tendency to keloid formation
• Photosensitizing medicines
• Unrealistic expectations
• Non cooperative patients

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PREPROCEDURE

• Colour complexion
• Fair, Wheatish, Semidark, Dark
• Fair ideal for superficial medium depth peels
• Other types- PIH more chance
• Depth of the lesion
• Woods lamp
• Epidermal deep
• Dermal - less obvious

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PRIMING

• Prepare the skin 2 weeks prior
• Topical retinoids Tretinoin 0.025
• Adapalene 0.1 Tazarotene 0.1
• Reepithelialization
• Uniform penetration
• Skin lightening

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Tyrosinase Blocking Agents Hydroquinone
2-4 Kojic Acid 2 Azelaic acid 20 Decreases
melanin synthesis PIH less
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TEST PEEL

• 2 weeks prior
• 1-11/2 inch circular/ square
• Post auricular
• Detect adverse reaction
• Patient familiar

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FULL FACE PEEL

• Weekend
• SAFETY PRECAUTIONS
• 1. Check the labels
• 2. Never pass open container over the patient
• 3. Never perform with the patient lying
  completely flat
• 4. Keep water filled syringes ready

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FULL FACE GA PEELING

• Materials 1.GA 20, 25, 30
• 2. 5 Na bicarbonate
• 3. Cotton buds/ 2 X 2gauze pads
• 4. Spirit, Acetone, Cold water
• 5. Syringe filled with water
• 6. Soap, towels, plastic sheets, glass
  beakers

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PROCEDURE

• PREPEEL
• Consent
• Preparation
• Repeatedly wash face
• Lie supine- 45degrees, eyes closed, ear plugged,
  hair pulled back, lips protected with petrolatum

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• 2. PEEL
• GA into glass beaker, gauze sponge immersed in it
• Apply with smooth strokes sequentially and
  unitwise-
• forehead, right cheek, chin, left cheek,
  glabella,
• nose, perioral area,upper lower eyelids,
  margins
• of eyebrows, hairline,vermillion border
• submandibular region.
• Feathering
• Repeated coat

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• C. REACTION
• No frosting
• Instant erythema / stinging / burning
• Time factor - start with ½ a minute, increase by
  ½ a minute on subsequent visit to a maximum of 5
  minutes. 1-3 minutes dry desquamation, 3-5
  minutes moist maceration
• Concentration of GA- higher the , deeper the
  penetration

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Start with 20 Increase the concentration by 5
during each visit Gradually go upto 70 d.
TERMINATION OF PEEL Bedside fan Ice cold water/
5 Na bicarbonate Sponge the eyelids first, last
forehead
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• Wipe the water off the eyelids
• Open the eyes
• Dab cold water till burning sensation subsides
• Pat dry the face
• Avoid rubbing the face
• 3. POSTPEEL
• At home cold water/ ice compresses
• Calamine lotion for 24- 48 hours

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Day 1 2 skin dark brown black 5- 10 days
desquamates completely C. Once peeling apply
emollients d. On completion- underlying skin
erythematous Sunscreens moisturizers for 1- 2
weeks Follow up weekly e. Very mild soap for
cleansing the face f. Topical tretinoin at
night, hydroquinone in the morning
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SCHEDULE

• No set rules, no limit to the number
• Once in 3 weeks for 3 months
• Once in 3 months
• Maintenance as and when required
• Partial recurrence additional light peels

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SPOT PEEL/FOCAL PEEL

• Localized lesion
• Eg Melasma, PIH, Freckles
• Peeling done in the affected area only
• Procedure the same

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COMPLICATIONS

1. Infections herpes, bacterial
2. Milia formation
3. Premature peeling
4. Persistent erythema
5. Allergic reactions
6. Post inflammatory hyperpigmentation
7. scarring