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

Definition
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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.

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

Implementation
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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.

Contraindication
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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)
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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!

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

Tables
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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)

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Last updated on: 29.10.2020