Chemical peels

Chemical peels are a type of non-surgical skin rejuvenation.  Three categories of chemical peels include superficial, medium-depth, and deep peels. Skin disorders that may benefit from treatment with peels include:
Acne
Scarring
Photodamage
Actinic keratoses (precancerous skin growth usually caused by sun exposure)
Pigmentary disorders

Patients should consult a physician (typically a dermatologist) who is experienced in the use of chemical peels. Skin priming and peel selection are essential for optimum results with minimum side effects. Pre-treatment preparation for two to four weeks before the peel ensures an even take of the peeling agent. A broad spectrum UVA/UVB sunblock with minimum of SPF 30 should be utilized with all peels.

Medium-depth chemical peeling is defined as controlled damage from a chemical agent, and can be performed in an office visit. Agents currently used include combinations such as Jessner's topical solution (14% salicylic acid, 14% resorcinol, 14% lactic acid in ethanol) and 35% trichloroacetic acid, or 70% glycolic acid with 35% trichloroacetic acid (TCA). Use of Jessner's solution or 70% glycolic acid will destroy the epidermal barrier by breaking up individual epidermal cells prior to the application of 35% TCA which allows a deeper penetration of TCA and a more even application of the peeling solution. The application of acid and resultant frosting are better controlled with the combination which creates an even peel with a low incidence of pigmentation problems and scarring. 

Jessner's solution with 35% TCA peel is used for mild-to-moderate photoaging including pigmentary changes, and epidermal growths. It is a single procedure with a healing time of 7-10 days. It is useful also to remove diffuse actinic keratoses as an alternative to chemical exfoliation with topical 5-fluorouracil chemotherapy, due to a significantly shorter treatment and healing period. Vigorous cleaning and degreasing is necessary for even penetration of the solution. The procedure is usually performed with mild preoperative sedation and pain is typically relieved with nonsteroidal anti-inflammatory agents.

US Dermatology Review 2006, pages 88-91, by Helen M. Torok, MD
Skin Therapy Lett 9(2):6-11, 2004  (http://www.medscape.com/viewarticle/469514_3)

Copyright 2006, Storey Marketing - Monthly Website Updates. All rights reserved. Questions regarding this article should be directed to the staff at Pharmacy Innovations.