Chemical peeling / chemoexfoliation is application of a chemical to the skin resulting in destruction of a portion of epidermis and sometimes dermis followed by its exfoliation and subsequent resurfacing of epidermis along with remodeling of the dermis. It’s one of the techniques for skin resurfacing like dermabrasion and LASER resurfacing.

Cleopatra of Egypt bathed in sour milk (containing lacticacid) to beautify her skin and French women used old wine (tartaric acid) for the same. In 1882, Unna,a German doctor reported the use of salicylic acid, resorcinol for chemical peeling. Stegman in 1980 introduced Chemical peeling in a controlled and scientific fashion.

Chemical peeling (CP) may be superficial, medium or deep depending on the depth of the peel. The various chemicals used are Trichloro acetic acid (TCA), Alpha (OH) acids or fruit acids like Glycolic acid (GA), Lactic acid, Malicacid, Beta (OH) acids like Salicylic acid (SA) etc.

Indications:

• Acne – Post acne hyperpigmentation, superficial scarring, comedolytic acne.
• Dyschromias – Melasma,freckles ,lentigenes,photomelanosis,post inflammatory hyperpigmentation.
• Aesthetic –Fine wrinkling, dilated pores,superficial scars, moderate actinic damage and ageing.

Contraindications:

• Active infection
• Open wounds or cuts
• Pregnant / nursing
• Accutane treatment- in last 6 months.

Method:

• The selection of the type of chemical peel depends on the skin colour of the patient and the depth of the skin lesion.
• Priming is preparing the skin for CP by using topical retnoids,tyrosine blocking agents like Hydroquinone, Kojic acid etc.
• Procedure: The face is cleaned. The eyes, ears and sensitive areas are protected.The peeling agent is applied on the involved areas using the appropriate applicator.After the required time the action of the peel is terminated using a neutralizer.
• Post peel care: Apply calamine lotion or emollients as advised. Avoid direct sun exposure and use sunscreens for 2 – 3 weeks .Use only mild soaps on the face.
• The Peeling may have to be repeated at an interval of 2 – 3 weeks till the required results are obtained.

Complications:

Redness, post inflammatory hyperpigmentation, mild scarring, reactivation of cold sores etc.

Chemical peeling is and art and an additional tool in the armamentarium of dermatologists. If correctly performed it improves the appearance of skin by giving a youthful texture and uniform colour.