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Chemical peeling

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

chemical peels; Peeling; Peeling treatment; Peel process

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DefinitionThis section has been translated automatically.

Chemoexfoliation of the skin, in which controlled use of chemical noxious agents, e.g. trichloroacetic acid (TCA 10-35%), alpha-hydroxy acids such as glycolic acid (20-70%), lactic acid, malic acid, citric acid, tretinoin (usually used as an additive), salicylic acid (up to 50% when used extrafacially) causes epithelial ablation without scarring.

IndicationThis section has been translated automatically.

Aging skin; actinically damaged skin; hyperpigmentation; lentigines; milia; acne comedonica.

ImplementationThis section has been translated automatically.

Preparation (e.g. for glycolic acid peeling): 1 week before the peeling, no external application of vitamin A acid, depilatory products, face masks, exfoliative sponges, wax treatment or electrolysis.

On the day of the treatment: no make-up/no cosmetics, no shaving/no aftershave!

Practicalities: Cleaning of the skin, for deep wrinkles/erosions: Application of Vaseline. Begin with 20% glycolic acid and neutralize with sodium bicarbonate or water (in the periorbital region: water) for 1-2 minutes. After tolerance by patients (stinging, itching, burning) and the appearance of a typical erythema. Repeat the treatment after 2-4 weeks, increasing the duration of action (max. 5 minutes) and concentration (20%, 35%, 50%, 70%). Duration of treatment: Approx. 6-8 peeling treatments.

ContraindicationThis section has been translated automatically.

History of hypertrophic scars or keloid formation, hypo-/hyperpigmentation (post-inflammatory), recurrent herpes simplex infections (if necessary, aiclovir prophylaxis for 7 days, start 3 days before peeling treatment with 400 mg p.o. 5 times/day)), previously performed surgical procedures (6-month interval), radiotherapy and dermabrasion (3-6-month interval), isotretinoin intake in the last 6 months, collagenosis, photosensitivity and allergy to peeling substance; skin type IV: risk of hypo- or hyperpigmentation.

Complication(s)This section has been translated automatically.

Persistent erythema, persistent hyper-/hypopigmentation, hypertrophic scar and scar contractions, erosions and excoriations, herpes simplex exacerbations (acyclovir prophylaxis)

Remember! Consistent sun protection until 6 weeks after peeling!

LiteratureThis section has been translated automatically.

Coleman WP 3rd (2001) Dermal peels. Dermatol Clin 19: 405-411
Fulton JE, Porumb S (2004) Chemical peels: their place within the range of resurfacing techniques. At J Clin Dermatol 5: 179-187
Mendelsohn JE (2002) Update on chemical peels. Otolaryngol Clin North Am 35: 55-72
Monheit GD (2004) Chemical peels. Skin Therapy Lett 9: 6-11
Roberts WE (2004) Chemical peeling in ethnic/dark skin. Dermatol Ther 17: 196-205
Schurer NY (2003) Anti-aging. Facts and visions. dermatologist 54: 833-888
Wiest L (2004) Chemical peels in aesthetic dermatology. dermatologist 55: 611-620

TablesThis section has been translated automatically.

Peeling substances/recipes	Concentration/content	Localization of the effect	Penetration
Baker Gordon formulation I (contains phenol, not approved in Germany (negative monograph); only stationary use due to toxicity and increased risk of cardiac arrhythmia)	Phenol. liquefact. 3,0	predominantly dermal	deep ***
	Croton oil 3 trp.
	Aqua distilled 2,0
	TCA 50% ad 100,0

Baker Gordon formulation II (contains phenol, not approved in Germany (negative monograph); only stationary use due to toxicity and increased risk of cardiac arrhythmia)	3 g Phenol 88%	predominantly dermal	deep ***
	2 g distilled water
	8 trp. Hexachlorophen 0.23% in propylene glycol
	Three trips. Croton Oil
	TCA 50% ad 100,0

Jessner solution recipe	resorcinol 4,2 g	predominantly epidermal	superficially *
	Acid. salicyl. 4.2 g
	Acid. lact. 4.2 ml
	ethanol 96% 30,0 ml

5-fluorouracil	0,5-5%	predominantly epidermal	superficially *
Glycolic acid	8%	predominantly epidermal	superficially *
	15%	predominantly epidermal	superficially *
	20, 35, 50%	predominantly epidermal	superficially *
	70%	dermoepidermal	average depth **
Isotretinoin	0,1%	predominantly epidermal	superficially *
Lactic acid	10-20%	dermoepidermal	average depth **
Resorcin	20-30%	predominantly epidermal	superficially *
Salicylic acid	5-10%	predominantly epidermal	superficially *
Tretinoin	0,01-0,1%	predominantly epidermal	superficially *
Trichloroacetic acid solution (TCA)	10-25%	predominantly epidermal	superficially *
	35%	dermoepidermal	average depth **
	35% + Jessner solution	dermoepidermal	average depth **
	35% + dry ice	dermoepidermal	average depth **
	50-70% several times	dermoepidermal	average depth **
* = surface penetration (penetration depth: 0.06 mm); = medium depth penetration (penetration depth: 0.45 mm); * = deep penetration (penetration depth: 0.6 mm)

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer