Chemical peeling

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

chemical peels; Peeling; Peeling treatment; Peel process

Definition
This section has been translated automatically.

Chemoexfoliation of the skin, in which controlled use of chemical noxious agents, e.g. trichloroacetic acid (TCA 10-35%), alpha-hydroxy acids such as glycolic acid (20-70%), lactic acid, malic acid, citric acid, tretinoin (usually used as an additive), salicylic acid (up to 50% when used extrafacially) causes epithelial ablation without scarring.

Indication
This section has been translated automatically.

Aging skin; actinically damaged skin; hyperpigmentation; lentigines; milia; acne comedonica.

You might also be interested in

Dermatology

Vitiligo. Sharply defined, map-like white patches on the forearm.

Vitiligo (overview)

Chronic, localized or generalized skin disease in which intrinsic or extrinsic factors lead to the destruct...

Advertisment

Implementation
This section has been translated automatically.

Preparation (e.g. for glycolic acid peeling): 1 week before the peeling, no external application of vitamin A acid, depilatory products, face masks, exfoliative sponges, wax treatment or electrolysis.

On the day of the treatment: no make-up/no cosmetics, no shaving/no aftershave!

Practicalities: Cleaning of the skin, for deep wrinkles/erosions: Application of Vaseline. Begin with 20% glycolic acid and neutralize with sodium bicarbonate or water (in the periorbital region: water) for 1-2 minutes. After tolerance by patients (stinging, itching, burning) and the appearance of a typical erythema. Repeat the treatment after 2-4 weeks, increasing the duration of action (max. 5 minutes) and concentration (20%, 35%, 50%, 70%). Duration of treatment: Approx. 6-8 peeling treatments.

Contraindication
This section has been translated automatically.

History of hypertrophic scars or keloid formation, hypo-/hyperpigmentation (post-inflammatory), recurrent herpes simplex infections (if necessary, aiclovir prophylaxis for 7 days, start 3 days before peeling treatment with 400 mg p.o. 5 times/day)), previously performed surgical procedures (6-month interval), radiotherapy and dermabrasion (3-6-month interval), isotretinoin intake in the last 6 months, collagenosis, photosensitivity and allergy to peeling substance; skin type IV: risk of hypo- or hyperpigmentation.

Complication(s)
This section has been translated automatically.

Persistent erythema, persistent hyper-/hypopigmentation, hypertrophic scar and scar contractions, erosions and excoriations, herpes simplex exacerbations (acyclovir prophylaxis)

Remember! Consistent sun protection until 6 weeks after peeling!

Literature
This section has been translated automatically.

Coleman WP 3rd (2001) Dermal peels. Dermatol Clin 19: 405-411
Fulton JE, Porumb S (2004) Chemical peels: their place within the range of resurfacing techniques. At J Clin Dermatol 5: 179-187
Mendelsohn JE (2002) Update on chemical peels. Otolaryngol Clin North Am 35: 55-72
Monheit GD (2004) Chemical peels. Skin Therapy Lett 9: 6-11
Roberts WE (2004) Chemical peeling in ethnic/dark skin. Dermatol Ther 17: 196-205
Schurer NY (2003) Anti-aging. Facts and visions. dermatologist 54: 833-888
Wiest L (2004) Chemical peels in aesthetic dermatology. dermatologist 55: 611-620

Tables
This section has been translated automatically.

Peeling substances/recipes	Concentration/content	Localization of the effect	Penetration
Baker Gordon formulation I (contains phenol, not approved in Germany (negative monograph); only stationary use due to toxicity and increased risk of cardiac arrhythmia)	Phenol. liquefact. 3,0	predominantly dermal	deep ***
	Croton oil 3 trp.
	Aqua distilled 2,0
	TCA 50% ad 100,0

Baker Gordon formulation II (contains phenol, not approved in Germany (negative monograph); only stationary use due to toxicity and increased risk of cardiac arrhythmia)	3 g Phenol 88%	predominantly dermal	deep ***
	2 g distilled water
	8 trp. Hexachlorophen 0.23% in propylene glycol
	Three trips. Croton Oil
	TCA 50% ad 100,0

Jessner solution recipe	resorcinol 4,2 g	predominantly epidermal	superficially *
	Acid. salicyl. 4.2 g
	Acid. lact. 4.2 ml
	ethanol 96% 30,0 ml

5-fluorouracil	0,5-5%	predominantly epidermal	superficially *
Glycolic acid	8%	predominantly epidermal	superficially *
	15%	predominantly epidermal	superficially *
	20, 35, 50%	predominantly epidermal	superficially *
	70%	dermoepidermal	average depth **
Isotretinoin	0,1%	predominantly epidermal	superficially *
Lactic acid	10-20%	dermoepidermal	average depth **
Resorcin	20-30%	predominantly epidermal	superficially *
Salicylic acid	5-10%	predominantly epidermal	superficially *
Tretinoin	0,01-0,1%	predominantly epidermal	superficially *
Trichloroacetic acid solution (TCA)	10-25%	predominantly epidermal	superficially *
	35%	dermoepidermal	average depth **
	35% + Jessner solution	dermoepidermal	average depth **
	35% + dry ice	dermoepidermal	average depth **
	50-70% several times	dermoepidermal	average depth **
* = surface penetration (penetration depth: 0.06 mm); = medium depth penetration (penetration depth: 0.45 mm); * = deep penetration (penetration depth: 0.6 mm)