12 Chemical Peels

Ezra Hazan, Seaver L. Soon, and Hooman Khorasani

Summary

Chemical peels are a safe and cost-effective treatment for a variety of cosmetic and medical conditions. They work by inducing epidermal and dermal ablation at varying levels, depending on the chemical and concentration, among other factors. Superficial peels penetrate to the level of the epidermis and can treat acne, melasma, skin texture, and fine lines with little to no downtime. Medium-depth peels penetrate to the level of the papillary dermis and can be used to treat scarring, fine lines, and signs of photoaging, such as actinic keratoses and lentigines. Deep peels ablate to the level of the reticular dermis and can be used to treat focal scars or for facial resurfacing of deep wrinkles. Proper patient selection, peel and concentration selection, pre- and postpeel regimen, technique, and postprocedure care are all essential in performing an effective peel. When used in the appropriate skin type, peels are well tolerated and considered safe.

Key words

chemical peels - resurfacing - melasma - wrinkles - photoaging - TCA - Jessner’s solution

• 1 Soleymani T, Lanoue J, Rahman Z. A practical approach to chemical peels: a review of fundamentals and step-by-step algorithmic protocol for treatment.. J Clin Aesthet Dermatol 2018; 11 (8) 21-28 PubMed

• 2 Butler PE, Gonzalez S, Randolph MA, Kim J, Kollias N, Yaremchuk MJ. Quantitative and qualitative effects of chemical peeling on photo-aged skin: an experimental study.. Plast Reconstr Surg 2001; 107 (1) 222-228 PubMed

• 3 Lee KC, Wambier CG, Soon SL, et al. Basic chemical peeling: Superficial and medium-depth peels.. J Am Acad Dermatol 2019; 81 (2) 313-324 PubMed

• 4 Monheit GD, Chastain MA. Chemical and mechanical skin resurfacing. In: Bolognia JL, Schaffer JV, Lorenzo C, eds. Dermatology. 4th ed. Beijing, China: Elsevier; 2018:2593–2609

• 5 Zeichner JA. The use of lipohydroxy acid in skin care and acne treatment.. J Clin Aesthet Dermatol 2016; 9 (11) 40-43 PubMed

• 6 Bridenstine JB, Dolezal JF. Standardizing chemical peel solution formulations to avoid mishaps. Great fluctuations in actual concentrations of trichloroacetic acid.. J Dermatol Surg Oncol 1994; 20 (12) 813-816 PubMed

• 7 Cox SE, Butterwick KJ. Chemical peels. In: Robinson JK, eds. Surgery of the Skin: Procedural Dermatology. Philadelphia, PA: Elsevier; 2005:463–482

• 8 Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A study comparing chemical peeling using modified Jessner’s solution and 15% trichloroacetic acid versus 15% trichloroacetic acid in the treatment of melasma.. Indian J Dermatol 2009; 54 (1) 41-45 PubMed

• 9 Puri N. Efficacy of modified Jessner’s peel and 20% TCA versus 20% TCA peel alone for the treatment of acne scars.. J Cutan Aesthet Surg 2015; 8 (1) 42-45 PubMed

• 10 Castillo DE, Keri JE. Chemical peels in the treatment of acne: patient selection and perspectives.. Clin Cosmet Investig Dermatol 2018; 11: 365-372 PubMed

• 11 Hetter GP. An examination of the phenol-croton oil peel: part IV. Face peel results with different concentrations of phenol and croton oil.. Plast Reconstr Surg 2000; 105 (3) 1061-1083, discussion 1084–1087 PubMed

• 12 Lee KC, Sterling JB, Wambier CG, et al. Segmental phenol-Croton oil chemical peels for treatment of periorbital or perioral rhytides.. J Am Acad Dermatol 2019; 81 (6) e165-e166 PubMed

• 13 Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B. Evidence and considerations in the application of chemical peels in skin disorders and aesthetic resurfacing.. J Clin Aesthet Dermatol 2010; 3 (7) 32-43 PubMed

• 14 Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris.. Dermatol Surg 2008; 34 (1) 45-50, discussion 51 PubMed

• 15 Oresajo C, Yatskayer M, Hansenne I. Clinical tolerance and efficacy of capryloyl salicylic acid peel compared to a glycolic acid peel in subjects with fine lines/wrinkles and hyperpigmented skin.. J Cosmet Dermatol 2008; 7 (4) 259-262 PubMed

• 16 Chew J, Gin I, Rau KA, Amos DB, Bridenstine JB. Treatment of upper lip wrinkles: a comparison of 950 microsec dwell time carbon dioxide laser with unoccluded Baker’s phenol chemical peel.. Dermatol Surg 1999; 25 (4) 262-266 PubMed

• 17 Burns RL, Prevost-Blank PL, Lawry MA, Lawry TB, Faria DT, Fivenson DP. Glycolic acid peels for postinflammatory hyperpigmentation in black patients. A comparative study.. Dermatol Surg 1997; 23 (3) 171-174, discussion 175 PubMed

• 18 Ahn HH, Kim IH. Whitening effect of salicylic acid peels in Asian patients.. Dermatol Surg 2006; 32 (3) 372-375, discussion 375 PubMed

• 19 Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner’s solution chemical peels.. Dermatol Surg 2006; 32 (12) 1429-1436 PubMed

• 20 Khunger N, Sarkar R, Jain RK. Tretinoin peels versus glycolic acid peels in the treatment of Melasma in dark-skinned patients.. Dermatol Surg 2004; 30 (5) 756-760, discussion 760 PubMed

• 21 Al-Waiz MM, Al-Sharqi AI. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals.. Dermatol Surg 2002; 28 (5) 383-387 PubMed

• 22 Lee JB, Chung WG, Kwahck H, Lee KH. Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method.. Dermatol Surg 2002; 28 (11) 1017-1021, discussion 1021 PubMed

• 23 Bhardwaj D, Khunger N. An assessment of the efficacy and safety of CROSS technique with 100% TCA in the management of ice pick acne scars.. J Cutan Aesthet Surg 2010; 3 (2) 93-96 PubMed

• 24 Witheiler DD, Lawrence N, Cox SE, Cruz C, Cockerell CJ, Freemen RG. Long-term efficacy and safety of Jessner’s solution and 35% trichloroacetic acid vs 5% fluorouracil in the treatment of widespread facial actinic keratoses.. Dermatol Surg 1997; 23 (3) 191-196 PubMed

• 25 Tse Y, Ostad A, Lee HS et al. A clinical and histologic evaluation of two medium-depth peels. Glycolic acid versus Jessner’s trichloroacetic acid.. Dermatol Surg 1996; 22 (9) 781-786 PubMed

• 26 Waldman A, Bolotin D, Arndt KA et al. ASDS guidelines task force: consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, energy devices, and skin surgery during and after isotretinoin use.. Dermatol Surg 2017; 43 (10) 1249-1262 PubMed

• 27 Glogau RG, Matarasso SL. Chemical face peeling: patient and peeling agent selection.. Facial Plast Surg 1995; 11 (1) 1-8 PubMed

• 28 Abdel-Meguid AM, Taha EA, Ismail SA. Combined Jessner solution and trichloroacetic acid versus trichloroacetic acid alone in the treatment of melasma in dark-skinned patients.. Dermatol Surg 2017; 43 (5) 651-656 PubMed

• 29 Peikert JM, Krywonis NA, Rest EB, Zachary CB. The efficacy of various degreasing agents used in trichloroacetic acid peels.. J Dermatol Surg Oncol 1994; 20 (11) 724-728 PubMed

• 30 Obagi ZE, Obagi S, Alaiti S, Stevens MB. TCA-based blue peel: a standardized procedure with depth control.. Dermatol Surg 1999; 25 (10) 773-780 PubMed

• 31 Dainichi TD, Ueda S, Imayama S, Furue M. Excellent clinical results with a new preparation for chemical peeling in acne: 30% salicylic acid in polyethylene glycol vehicle. Dermatol Surg. 2008;34:891--899

• 32 Wambier CG, Lee KC, Soon SL, et al. Advanced chemical peels: phenol-croton oil peel.. J Am Acad Dermatol 2019; 81 (2) 327-336 PubMed

• 33 Costa IMC, Damasceno PS, Costa MC, Gomes KGP. Review in peeling complications.. J Cosmet Dermatol 2017; 16 (3) 319-326 PubMed