Chemical Peel

There are three types of chemical peels:

• Light or superficial chemical peels: Mild chemicals like alpha-hydroxy acid are used in light chemical peels. This peel gently removes only the outermost layer of the skin (epidermis). It does not penetrate to the deeper skin layers.
• Medium chemical peels: A medium chemical peel penetrates the outer layer of skin completely and the middle layer of the skin partially (epidermis and some varying extent of dermis) with the use of stronger chemicals like trichloroacetic acid or glycolic acid. It’s more effective than a light chemical peel in removing damaged skin cells.
• Deep chemical peels: With the use of relatively strong chemicals like trichloroacetic acid and phenol, deep chemical peels penetrate the outer and the middle layers of skin entirely (epidermis and dermis). This removes all damaged skin cells. However, chemicals like phenol can have complications in patients with some risk factors.

The dead or damaged skin cells of the face can be removed by exfoliation. Exfoliation can be of two types – physical or chemical. While face scrubs used at home fall under the former category, the use of acids and other chemicals to remove damaged skin cells comes under the latter. The skin consists of three layers – outermost epidermis, middle dermis and innermost hypodermis. Chemical peels, depending on the strength of the chemicals used, penetrate different depths of the skin (ranging from only the outermost layer to both outer and middle layers). Chemical peels are cosmetic dermatological procedures performed in clinics. These treatments have strict contraindications and require serious patient motivation for adherence to precautions for optimum results.

(Read more: How to remove dark spots on the face)

Following are some of the reasons why chemical peels may be recommended:

• Wrinkles and fine lines (Read more: Home remedies for wrinkles)
• Sun damage (Read more: How to treat sunburn)
• Scars, especially acne scars
• Hyperpigmentation (Read more: Pigmentation)
• Uneven skin tone or redness
• Melasma, also known as chloasma: Greyish brown patches on the skin of forehead, cheeks, nose and chin that appears during hormonal changes during pregnancy or with the use of oral contraceptive pills (OCPs) in women. While it usually resolves on its own after completion of pregnancy or stoppage of OCPs, in some cases it can persist.

Before a chemical peel treatment, a consultation with the dermatologist performing the procedure is done. They will take a thorough medical history, including that of other skin conditions, medication intake and a propensity to scar. A physical examination may be done to rule out preexisting risk factors and a dermatological assessment will be made. Some laboratory investigations might be advised at this time. Testing for HIV will also be recommended as a positive status is an absolute contraindication to skin chemical peel treatment. After the patient receives the go-ahead for chemical peel treatment, the doctor will explain the treatment options best suited for the patient as well as the expected outcomes, risks and complications. Following this, the patient will be asked to prepare for the procedure by:

• Ensuring they haven’t been using retinol drugs for at least 48 hours previous to the chemical peel treatment.
• Ensuring they haven’t been on accutane treatment for a minimum of 6 months.
• The patient should not shave, wax, epilate or use any other means of hair removal on the area to be treated for at least a week prior to chemical peel treatment.
• Hair bleaching creams should not be used over the area of treatment either.
• Facial scrubs and other home exfoliants should not be used for at least one week leading up to the chemical peel treatment.
• In patients who suffer from fever blisters or cold sores due to a herpes simplex infection, an antiviral medication may be prescribed for use before the procedure.
• The patient, in some instances, may be asked to apply a special lotion, like glycolic acid lotion, to help improve treatment outcomes by the dermatologist.
• In some cases, the dermatologist might recommend retinoid ointment prior to chemical peel treatment to prevent darkening of the skin. It should be used only if advised by the doctor.
• A sedative or analgesic may be prescribed by the doctor to be taken before the procedure. The patient should follow the doctor’s advice and take the medication only if specified.

Chemical peel treatments are done in the dermatologist’s clinic or office and do not usually require hospital admission. However, deep chemical peels are done in an outpatient surgical facility. Before the procedure, the hair is tied back away from the face, the face is cleansed and eyes are protected with goggles or gauze. A local anaesthetic injection can be given to numb the face before giving the chemical peel treatment to reduce the burning sensation. However, with deep chemical peels, a regional anaesthetic may be preferred to numb larger portions for deeper treatment; this may especially be necessary if deep chemical peel treatment is being carried out in the face and neck regions. Additionally, while receiving deep chemical peel treatment, a heart monitor is hooked on to monitor cardiac activity during the procedure.

Light chemical peel: Using a cotton ball, gauze or special brush, a mild chemical like salicylic acid is applied onto the area being treated. The skin begins to whiten and the patient may feel a burning or stinging sensation. Once the treatment is complete, the remaining solution is wiped clean with a neutralising solution.

Medium chemical peel: A special applicator with cotton, gauze or a sponge is dipped in a solution of trichloroacetic acid (which is dyed blue) or glycolic acid and applied on the area to be treated. The skin will begin to whiten and a cold compress is held to the area. Blue discolouration can occur with trichloroacetic acid peels. The burning sensation can last up to thirty minutes but does not require a neutralising solution.

Deep chemical peel: The patient will be put under sedation and the dermatologist will apply phenol with a special applicator to the areas being treated. The skin whitens or greys temporarily. The entire procedure is wrapped up in under fifteen minutes to reduce exposure to phenol and limit its potential side effects.

Normal activity can be resumed after a chemical peel treatment. However, keep the following things in mind:

• Avoid sun exposure while the skin is peeling.
• Use of a gentle cleanser, moisturiser and sunscreen are recommended to aid the healing process.
• Avoid sweating too much or strenuous exercise for the first few days after a chemical peel treatment.

Chemical peels can be beneficial in reducing scarring in individuals, boosting their self-confidence and improving their mental health. However, in certain cases, chemical peels should be avoided altogether. Following are the people who should not get chemical peels:

• Those who have unrealistic expectations
• Those who have an unstable emotional or mental state
• Women who are or might be pregnant
• Women who are lactating
• HIV positive patients
• Those who are significantly immunosuppressive due to:
  • Diabetes mellitus
  • Corticosteroid therapy (within the last month)
  • Cancer treatment
  • Immunotherapy for autoimmune diseases or inflammatory bowel disease
• Those who are suffering from severe hepatorenal disease (kidney and liver dysfunction) 
• Those with cardiac abnormalities
• Those allergic to chemical peel constituents (aspirin allergy is an indication to avoid salicylic acid chemical peels)
• Those who have open wounds in the area that is to be peeled
• Those who have infections of the area of treatment like:
  • Herpes simplex
  • Impetigo
  • Cellulitis
• Those with a history or propensity of keloid formation
• Those with a history of hypertrophic scarring
• Those who have been diagnosed with or suspected of having skin cancer in the area to be treated. This included:
  • Melanoma
  • Basal cell carcinoma
  • Squamous cell carcinoma
• Those who have dermatitis or skin diseases in the area to be treated. This could include:
  • Vitiligo
  • Atopic dermatitis
  • Psoriasis, etc.
• Those who have an autoimmune disease affecting the skin like:
  • Psoriasis
  • Scleroderma
• Those who have skin telangiectasias
• Those who have genetic diseases like Ehlers-Danlos syndrome, which typically presents with paper thin friable skin
• Those who have been recently treated with the following drugs in the last 6 to 12 months:
  • Isotretinoin
  • Accutane
  • Corticosteroids (should have been off steroids for at least a month prior to the chemical peel procedure)
• Patients with skin types that always burn and never tan in the sun, clinically described as Fitzpatrick grade IV (olive skin tone), V (brown skin tone) and VI (black skin tone), are not recommended to undergo a chemical peel.

Some mild side effects following a chemical peel are common and expected. These are temporary and resolve shortly. They include:

• Redness of the skin
• Dryness of the skin
• Stinging or burning of the skin
• Slight swelling in the area of treatment
• With deep peels, the ability to tan might be permanently lost

However, some more serious side effects, including severe complications, can arise in some patients after a chemical peel. These can be:

• Darkening or lightening of the skin colour: Lightening of the skin occurs in individuals with darker skin tones as well as the skin looking patchy. Therefore, chemical peel treatments are not recommended in those skin types that always tan and never burn in sunlight (Fitzpatrick grade IV to VI).
• Infections: People with herpes simplex may experience flares following a treatment. Very rarely, chemical peels can cause fungal or bacterial infections.
• Heart, liver or kidney damage: Phenol, a chemical constituent of chemical peel treatments, can damage the liver and kidney tissues. It can also damage the heart muscle and produce irregular heartbeats. Presence of hepatorenal disease (liver and kidney dysfunction) and cardiac abnormalities are both contraindications for chemical peel treatments.
• Scarring: Permanent scarring can sometimes appear in the chemically treated area.

Following are the expected outcome of the different types of chemical peels:

• Light chemical peel outcome: Recovery usually occurs in 4-7 days and the skin can look unusually lighter or darker temporarily.
• Medium chemical peel outcome: While the skin recovers within 5-7 days, redness can sometimes persist for several months. At first, the skin swells, blotches, crusts and finally, it peels off to reveal the underlying skin which looks revitalised.
• Deep chemical peel outcome: These peels are associated with severe swelling (eyelids may be forced shut due to facial swelling), redness, burning and a throbbing sensation. It takes roughly two weeks or longer for the new skin to form. White patches and cysts can form and last for weeks. Redness can last for months.