Chemical Peels(Table 6-20)- Application of chemical to skin to produce a controlled partial-thickness injury with subsequent epidermal and varying dermal repair; degree of clinical improvement directly proportional to depth of peel
- Antiviral prophylaxis given for medium-depth and deep peels
- Frost: intensity correlates with level of peel
- Level 1: irregular light frost (erythema w/ streaky frosting); superficial epidermis
- Level 2: uniform white frost with underlying erythema; level of upper dermis
- Level 3: solid white enamel frosting; level of reticular dermis
- Classified as superficial, medium, and deep peels (see Table 6-20)
- Superficial peels
- Injury limited to epidermis only
- Glycolic acid: needs to be neutralized with sodium bicarbonate
- Jessner’s solution, TCA, and salicylic acid do not need neutralization
- Salicylic acid: keratolytic and comedolytic
- Medium depth peels
- Injury at or through level of papillary dermis
- Indications: epidermal growths (AK, SK, lentigines), dyschromia, rhytides
- Deep peels
- Injury at depth of reticular dermis
- Phenol: keratocoagulant, only deep chemical peeling agent (must use IV sedation with full face procedure), known to be cardiotoxic (do not exceed procedure time over 60–90 min and need cardiac monitoring), hepatotoxic, nephrotoxic
- Baker formula most widely used deep peeling agent: phenol, distilled water, croton oil, liquid hexachlorophene
- Complications: prolonged erythema (most common with phenol), scarring, permanent hypopigmentation, hyperpigmentation, scarring, milia, acne
| | | | | | | Table 6-20 Chemical Peels | | | Terms | | Description | | | 1. Superficial: very light | | Tricholoroacetic acid (TCA) 10–20%
Salicylic acid
Alpha-hydroxy acids
Tretinoin solution | | | 2. Superficial: light | | Jessner’s solution: salicylic acid/lactic acid/resorcinol/ethanol
TCA 25–30%
Glycolic acid 70% | | | 2. Medium | | 35–40% TCA
70% glycolic acid + 35% TCA
Jessner’s solution + 35% TCA
88% phenol (rarely used) | | | 3. Deep | | Baker Gordon phenol
TCA > 50% | | | | | |
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