Chemical Peels: What's New and What Isn't New but Still Works Well

Abstract

Chemical peeling is becoming increasingly popular for the treatment of skin rejuvenation where it can improve damaged skin and fine wrinkles. The basic procedure aims at obtaining a controlled chemical burn of the epidermis and/or dermis. This results in epidermal regeneration and postinflammatory collagen neoformation with remodeling of collagen and elastic fibers and deposition of glycosaminoglycans in the dermis. Various chemicals have been used as peeling agents, of which the most used are the alpha-hydroxy acids, such as glycolic acid, or beta-hydroxy acids, such as salicylic acid. The choice of the compound is linked to the different indications and to the depth of the desired peeling. Phenol is still the best agent for deep peeling but requires specific indications, prescription, and post-peeling care. Combination of different compounds is one innovation in the field of chemical peelings. Further controlled studies are necessary to set up specific guidelines.

Chemical peels: A review of current practice

“…This is achieved with water, sodium bicarbonate, sodium hydroxide or ammonium salt solutions. 30,41 AHA do not induce a frosting pattern. Glycolic acid is the most common AHA peeling agent.…”

“…28 Other important considerations include cutaneous priming, application technique, occlusion and contact time. 1,28,30 Superficial peels target the epidermis and the epidermal-dermal interface causing partial or complete necrosis. 28,31,32 They exfoliate the skin from the stratum corneum down to the papillary dermis at a depth of 60 lm.…”

“…26 They are derived from fruit such as apples (malic acid), grapes (tartaric acid), lemons and oranges (citric acid), sugar cane (glycolic acid) and milk (lactic acid). 30 At lower concentrations, AHA causes decreased corneocyte adhesion. 33,40 At higher concentrations it promotes epidermolysis.…”

“…5,30 It has a pKa of 2.97 and is poorly soluble in water. 28,43 Salicylic acid differs from AHA by the presence of a hydroxyl group at the second carbon atom position.…”

Is chemical peeling becoming outdated?

“…French women used aged wine, which contains tartaric acid, to have a fine and smooth skin. Similarly, substances such as sour milk, animal fats and limestone were used in various periods to rejuvenate the skin [1][2][3] . The popularity of alpha hydroxy acids (AHA) have increased in the 20 th century due to their positive effects on keratinization disorders and chemical peeling has become today one of the most frequently used, simply and easily applied procedures not only in dermatocosmetology but also in the treatment of many dermatologic diseases.…”