Skin is a constantly regenerating organ; everyday, cells divide at the basal layer of the epidermis and move upwards to the top-most layer of stratum corneum from where they are shed. As they move upwards, they undergo lot of changes and this process is called keratinization.
Chemical peeling is a procedure wherein the exfoliation is accelerated and organised by application of exfoliating agents to the skin. The use of exfoliating agents to peel the epidermis dates back to ancient Egypt. Sour milk baths (containing lactic acid) were used by ancient Egyptian women to soothe the skin. The main purpose of peeling is for rejuvenation and to erase the marks of photo-damage and ageing.
The chemical peel creates changes in the skin by three mechanisms:
- Stimulation of epidermal growth through removal of stratum corneum
- Destruction of the specific layers of the damaged skin and replacement with normal tissue.
- Induction of inflammatory reaction deeper in the tissue, leading to activation of mediators of inflammation, resulting in the production of new collagen and ground substance in the dermis.
The agent, usually a solution, removes varying amounts of epidermis and depending on the strength, affects the dermal collagen. Wound repair consists of epidermal regeneration by migration from surrounding structures and replacement of new dermal connective tissue resulting in rejuvenation of the skin. In addition to improving the texture of the skin, peeling is also useful in the treatment of acne, acne scars, pigmentation caused by acne and other conditions like lentigines, melasma etc.
The choice of the agent depends upon the depth of the peel required. Broadly, peeling is classified into:
- Superficial – Stimulates epidermal growth; agents used are CO2 slush, liquid nitrogen spray, glycolic acid (30-50%), Trichloroacetic acid (TCA, 10%)
- Medium – Glycolic acid (70%), TCA (20-30%), combination of TCA and CO2 snow
- Deep – Phenol.
Superficial and medium depth peeling are most often used in our set-up. Superficial peels are usually used for rejuvenation, comedonal acne and epidermal pigmentation. Medium depth peeling is used for acne scars and fine wrinkling due to ageing.
Chemical Peeling: Pre and Post Treatment
