Chemical exfoliation

Chemical peel is a procedure involving application of a caustic agent to the skin in order todamage it to some extent which induces necrosis and subsequent secondary healing by epithelialisation from the epidermal appendages. In the case of superficial peels, the obtained necrosis may not involve full epidermal thickness and the subsequent regeneration is triggered mainly by the cells originating from the deeper, undamaged layers.

In terms of the exfoliation depth, peels may fall into three or four categories. Nonetheless, it is not a rigorous division, since an individual skin reaction to the exfoliant must be taken into consideration. The following table presents an extended four-category division (Table I).

Tab. I. Division of peels in terms of exfoliation depth.

Type of peel
Depth of action Relation to Glogau scale Typical examples
I Superficial peels (exfoliate stratum corneumand stratum lucidum up to stratum granulosum) Up to 0.06 mm Recommended for skin with grade II damage according to Glogau scale 0.05%-0.1% Tretinoin, 30-50% glycolic acid, Jessner's solution (1-3 layers)
II Light peels (exfoliate full depth of epidermis and papillary dermis) Up to 0.30mm -0.45mm Recommended for skin with grade II damage according to Glogau scale 50-70% glycolic acid, 10-25% trichloroacetic acid (e.g. blue peel) Jessner's solution (4-10 layers) weekend peel, mandelic acid
III Medium peels (exfoliate up to the superficial layer of reticular dermis) Up to 0.46-0.6 mm Recommended for skin with grade II – III damage according to Glogau scale
25-40% trichloroacetic acid
IV Deep peels(exfoliate up to the middle layer of reticular dermis) Over 0.61 mm Recommended for skin with grade III - IV damage according to Glogau scale 45-60% trichloroacetic acid, phenol (The Baker-Gordon peel, Exoderm)

 

Natural exfoliating agents of plant origin are used i.a. in Asian peel, African peel, Polish herbal peel and many other preparations. There have been described complex methods of exfoliation, combining chemical peels with a variety of physical methods, such as cryopeeling with dry ice supplemented by chemical exfoliation with 35% trichloroacetic acid, proposed by Coleman and Brody. Interesting methods of combining skin abrasion with peels were described by many authors, including Stagnone (50% trichloroacetic acid peel and dermabrasion), Dupont (phenol peel and dermabrasion) and Harris (trichloroacetic acid peel and manual abrasion with sandpaper (dermasanding).