I start the topic with a question: for whom is chemical peeling suitable? I would say for almost everyone. I exclude patients with active infection (eg fungal or bacterial, herpes) or inflammatory dermatosis of the face (dermatitis, psoriasis, lichen). The procedure is suitable for the treatment of acne (in many of its stages), scars, hyperpigmentation or as an anti-aging support to other procedures.
The depth of chemical peels is determined by many factors. In the first place is the choice of acid, its concentration and pH, as well as its method of application: how much, for how long and with what preliminary preparation of the skin. In this article I will tell you in detail about the types of acids and for what indications they are used.
Alpha-hydroxy acids:
Glycolic acid. It is the smallest of the alpha acids and is used in concentrations between 20-70%. I would call glycolic acid a universal agent because it is used in the fight against acne, pigmentation and wrinkles.
Lactic acid. I would define it as the most gentle among the acids and suitable for patients with very sensitive skin. Used in the fight against hyperpigmentation and fine wrinkles. Exfoliation is discreet and depends on the concentration of acid in the peel (5, 10, 15%).
Mandelic acid. One of the largest acids, a derivative of bitter almonds. Mandelic acid is one of the largest molecules, which determines the slow penetration and safety profile of sensitive skin. Studies with it are focused mainly on acne therapy. One * compares its effectiveness with salicylic acid and describes similar effectiveness but reduced discomfort
Beta-hydroxy acids:
Salicylic acid. I think salicylic peels are among the most popular. This β-hydroxy acid is used in concentrations of 10-30% and has a good keratolytic and comedolytic effect. It also inhibits the proliferation of C.acnes. This ranks it among the first choices for the treatment of acne, and its brightening potential allows its use in scars and pigmentation in the course of the disease.
Trichloroacetic acid
You may have come across the abbreviation (TCA), behind which lies this peeling. The acid is analogous to acetic acid and at concentrations of 10-20% has a surface effect, and at 35-70% with a medium-deep, reaching the upper layer of the dermis. At low rates it is suitable for the treatment of acne and scars, melasma and pigmentation of other origins. High concentrations are used on photo-damaged skin with fine and deep wrinkles and signs of aging.
Combinations of acids in one peel
Jessner's solution. It is a mix of 14% lactic, 14% salicylic acid, 14% resorcinol and ethanol. Can be used as a superficial to medium peel. There is no strong evidence in the literature that there are advantages over using acids as stand-alone agents. Resorcinol, on the other hand, has the potential for irritation. I personally do not use this peeling in my practice.
Peeling for melasma
Kojic acid. It is extracted from several types of mushrooms or during fermentation of some foods (soy sauce, rice vinegar). Its main effect is to inhibit the formation of tyrosine, which is necessary for the formation of melanin.
Tranexamic acid. In fact, this acid is a serious drug if used systemically and used for bleeding. In recent years, its brightening abilities in local use have gained a great advantage over well-known agents. Tranexamic acid peeling suppresses the transfer of melanin from melanocytes to keratinocytes. It is suitable for the treatment of melasma and other hyperpigmentations.
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The acids in the peels increase the photosensitivity of the skin. I advise you to use strict sun protection and choose the right season for the treatment with them. Rely on an experienced dermatologist to assess the type of acid, its concentration and frequency of manipulations to avoid side effects.
P.S. There are still many acids that are used as exfoliating agents. This article will be continued. 🤓