Application of the Wounding Agent

Prior to the application of all peeling solutions, cutaneous lipids, debris, and excess stratum corneum are removed by vigorously cleansing the skin with alcohol or acetone-soaked sponges [19]. Then the area is rinsed with water and dried. Prior to applying the peeling agent, the cleansed skin should be checked for the presence of residual oil and, if needed, the cleansing process repeated. The wounding agent is then applied. Depending on the agent used and the concentration, the amount of time the agent is left on the skin varies, generally between 2–4 min. Frosting with different wounding agents is variable in rate and appearance and depends on the preexisting degree of photodamage, the choice of applicator used, and the adequacy of defatting [7]. Neutralization of the agent is used with either water or sodium bicarbonate. Of note, the effect of AHAs and glycolic acid depends on the contact time on the skin and therefore must be washed off with water or neutralized with 5% sodium bicarbonate after 2–4 min. During this time, patients may experience mild stinging and burning with minimal discomfort; the patient undergoing a superficial peel does not require sedation or general anesthesia. Finally, an emollient is applied to the treated area of skin postprocedure.

The amount of peeling agent applied, the degree of rubbing, and the duration of skin contact must be carefully monitored. The effect of a chemical peel is dependent upon the chemical agent, its concentration, and the techniques employed before and during the application. Each wounding agent has individual chemical properties and causes a specific pattern of injury to the skin. All superficial wounding agents will be discussed individually.