1 Types of Chemical Peels

(1)

Types of Chemical Peels

Antonella Tosti, Maria Pia De Padova, Matilde Iorizzo

The author has no financial interest in any of the products or equipment mentioned in this chapter.

1

Contents

1.1 Advantages/Disadvantages . . . . 4

1.1.1 Glycolic Acid . . . . 4

1.1.1.1 Advantages . . . . 4

1.1.1.2 Disadvantages . . . . 4

1.1.2 Jessner’s Solution . . . . 4

1.1.2.1 Advantages . . . . 4

1.1.3 Pyruvic Acid . . . . 5

1.1.3.1 Advantages . . . . 5

1.1.4 Resorcinol . . . . 5

1.1.4.1 Advantages . . . . 5

1.1.5 Salicylic Acid . . . . 5

1.1.5.1 Advantages . . . . 5

1.1.6 Trichloracetic Acid . . . . 5

1.1.6.1 Advantages . . . . 5

1.1.7 Deep Chemical Peels . . . . 6

1.1.7.1 Advantages . . . . 6

1.1.8 Combination Peels: Salicylic Acid + TCA . . . . 6

1.1.8.1 Advantages . . . . 6

1.2 How to Choose the Best Peeling for the Patient . . . . 6

1.2.1 Acne . . . . 6

1.2.2 Actinic Keratosis . . . . 7

1.2.3 Dark Skin . . . . 8

1.2.4 Melasma . . . . 8

1.2.5 Photoaging . . . . 9

1.2.6 Post-inflammatory Hyperpigmentation 9 1.2.7 Rosacea . . . . 9

1.2.8 Solar Lentigo . . . . 10

(2)

1 1.1 Advantages/Disadvantages Summary

쐽 Glycolic acid 쐽 Jessner’s solution 쐽 Pyruvic acid 쐽 Resorcinol 쐽 Salicylic acid 쐽 Trichloracetic acid 쐽 Deep chemical peels

쐽 Combinations peels: salicylic acid + trichloracetic acid

1.1.1 Glycolic Acid 1.1.1.1 Advantages

쐽 Very mild erythema 쐽 Mild desquamation 쐽 Short post-operative period 쐽 Useful in photodamage

1.1.1.2 Disadvantages

쐽 Burning sensation and erythema during application

쐽 No uniformity of application 쐽 Neutralization is mandatory

쐽 Necrotic ulcerations if time of application is too long and/or skin pH is reduced 쐽 Cautious application in patients with

active acne

1.1.2 Jessner’s Solution 1.1.2.1 Advantages

쐽 Excellent safety profile 쐽 Can be used in all skin types

쐽 Substantial efficacy with minimal “down time”

쐽 Enhances the penetration of TCA

쐽 Concerns regarding resorcinol toxicity, including thyroid dysfunction

쐽 Manufacturing variations

쐽 Instability with exposure to light and air 쐽 Increased exfoliation in some patients

(3)

1.1.3 Pyruvic Acid 1.1.3.1 Advantages

쐽 Very mild erythema 쐽 Mild desquamation 쐽 Short post-operative period 쐽 Can be used in skin types III and IV

쐽 Intense stinging and burning sensation during the application

쐽 Neutralization is mandatory

쐽 Pungent and irritating vapors for the upper respiratory mucosa

1.1.4 Resorcinol 1.1.4.1 Advantages

쐽 Easy to perform

쐽 Uniformity of application and penetration 쐽 Useful in acne, post-inflammatory

hyperpigmentation and melasma 쐽 Not painful (the burning sensation during

the peeling is usually mild)

쐽 Desquamative effect aesthetically unacceptable

쐽 Unsafe in Fitzpatrick skin type higher than V

쐽 Cannot be used in summer

쐽 Resorcinol may be a sensitizing and toxic agent

1.1.5 Salicylic Acid 1.1.5.1 Advantages

쐽 An established safety profile in patients with skin types I–VI

쐽 Excellent in patients with acne

쐽 Given the appearance of the white preci- pitate, uniformity of application is easily achieved

쐽 After several minutes the peel can induce an anesthetic effect whereby increasing patient tolerance

쐽 Limited depth of peeling

쐽 Minimal efficacy in patients with signifi- cant photodamage

1.1.6 Trichloracetic Acid 1.1.6.1 Advantages

쐽 Low-cost procedure

쐽 Uniformity of application and penetration 쐽 Depending on frost, it is easily modulable

with different concentrations

쐽 Stinging and burning sensation during the application

쐽 High concentrations are not recommen- ded in skin types V and VI

쐽 Hypo/hyperpigmentation can occur

(4)

1 1.1.7 Deep Chemical Peels 1.1.7.1 Advantages

쐽 Useful in patients with photodamage 쐽 Useful in patients with perioral wrinkles 쐽 Useful in patients with atrophic acne scars 쐽 Useful for facial skin rejuvenation

쐽 Cardiotoxicity 쐽 Hyperpigmentation

1.1.8 Combination Peels:

Salicylic Acid + TCA 1.1.8.1 Advantages

쐽 Efficacy in all skin types

쐽 Well tolerated in darker racial/ethnic groups

쐽 Most beneficial in treating recalcitrant melasma and post-inflammatory hyperpigmentation

쐽 Increased depth of superficial peeling 쐽 Increased desquamation in some patients

lasting up to 7–10 days

쐽 Post-inflammatory hyperpigmentation more common than with salicylic acid peeling alone

1.2 How to Choose the Best Peeling for the Patient

Summary

쐽 Acne

쐽 Actinic keratoses 쐽 Dark skin 쐽 Melasma 쐽 Photoaging

쐽 Post-inflammatory Hyperpigmentation 쐽 Rosacea

쐽 Solar lentigos

1.2.1 Acne

Acute phase (Fig. 1.1)

Comedonal acne Salicylic acid 25%

Pyruvic acid 40–70%

Jessner’s solution Unna Paste Glycolic acid 70%

Mild/moderate Salicylic acid 25–30%

inflammatory acne Pyruvic acid 40–70%

Jessner’s solution Unna Paste Glycolic acid 70%

Severe nodulo-cystic Pyruvic acid 40–60%

acne

Superficial post- Pyruvic acid 40–70%

acneic scars (Fig. 1.2) Trichloracetic acid 25–50% lotion Salicylic acid 25% + trichloracetic acid 25–30% gel

Medium-deep post- Phenol 45–80%

acneic scars Trichloracetic acid >40%

lotion

Excision, elevation, subcision

(5)

1.2.2 Actinic Keratosis (Fig. 1.3)

쐽 Trichloracetic acid >30%

쐽 Pyruvic acid 50–60%

쐽 Salicylic acid 25% + trichloracetic acid 25–30% gel

Fig. 1.1.Acne. Acute phase

Fig. 1.2.Superficial post-acneic scars

Fig. 1.3.Actinic keratosis

(6)

1 1.2.4 Melasma (Fig. 1.5)

쐽 Salicylic acid 25%

쐽 Salicylic acid 25% + trichloracetic acid 10% gel

쐽 Glycolic acid 50–70%

쐽 Trichloracetic acid 15–20%

쐽 Resorcinol

Fig. 1.4.Dark skin

1.2.3 Dark Skin (Fig. 1.4)

쐽 Salicylic acid 20–30%

쐽 Jessner’s solution

쐽 Glycolic acid 20, 35, 50, 70%

쐽 Trichloracetic acid 10–30%

Fig. 1.5.Melasma

(7)

1.2.6 Post-inflammatory

Hyperpigmentation (Fig. 1.7)

쐽 Salicylic acid 20–30%

쐽 Glycolic acid 70%

쐽 Jessner’s solution 쐽 Pyruvic acid 40%

1.2.7 Rosacea

쐽 Erythrosis (Fig. 1.8): salicylic acid 15–25–30%

쐽 Papulo-pustolar rosacea (Fig. 1.9): salicylic acid 25–30%

Fig. 1.7.Post-inflammatory hyperpigmentation

Fig. 1.6.Moderate photoaging 1.2.5 Photoaging (Fig. 1.6)

Mild to moderate Glycolic acid 50–70%

Trichloracetic acid 50%

Salicylic acid 20–30%

Salicylic acid 25% + trichloracetic acid

>25% gel

Extensive Glycolic acid 70% + trichloracetic acid 35%

Jessner’s solution + trichloracetic acid 35%

Pyruvic acid 60–70%

Phenol 45–80%

(8)

1

1.2.8 Solar Lentigos (Fig. 1.10)

쐽 Trichloracetic acid >25%

쐽 Salicylic acid 25% + trichloracetic acid 25–30% gel

쐽 Phenol 45–80%

Fig. 1.8.Erythrosis Fig. 1.9.Papulo-pustular rosacea

Fig. 1.10.Solar lentigos

(9)

Modalities of Application II