By: Dina Aziz B.Sc. Pharmacy M.Sc. Pharmaceutics Chemical peels By: Dina Aziz B.Sc. Pharmacy M.Sc. Pharmaceutics

Introduction Exfoliation occurs naturally as outworn stratum corneum cells detach and are removed from the skin’s surface. Replacement of stratum corneum cells occurs by a self-renewal process as epidermal cells move upward from the basal layer, the stratum basalis, and through the subsequent two layers, the stratum spinosum and stratum granulosum, to reach the stratum corneum.

Introduction

Introduction The Stratum Corneum is comprised of layers of keratin- rich corneocyte cells , which is shed naturally in a complex process called desquamation.

How can we Affect Desquamation? Mechanical Peeling Chemical Peeling

Chemical Peeling Chemical peels are substances that cause skin cells to desquamate at an increased rate Chemical peeling is a procedure used for the cosmetic improvement of the skin.

Chemical Peeling During this procedure, a chemical agent of a defined strength is applied to the skin, which causes a controlled destruction of the skin layers (epidermis and/or dermis) with subsequent regeneration of the tissues, resulting in improvement of texture and surface abnormality.

Chemical Peels Classification Chemical peels are classified into three categories, depending on the depth of the wound created by the peel: (a) superficial peels (b) medium-depth peels (c) deep peels.

Chemical Peeling Agents

Superficial Peeling Agents AHAs ( lactic acicd, Glycolic acid,..) BHAs (Salicylic acid) Pyruvic acid Resorcinol

Superficial Peeling Agents Jessner solution?

Superficial Peeling Agents AHAs causes decreased corneocyte adhesion. it promotes epidermolysis. AHA requires neutralisation to terminate its action. AHA do not induce a frosting pattern. Glycolic acid is the most common concentrations between 30-70%.

Superficial Peeling Agents AHAs Burning sensation and erythema during application Necrotic ulcerations if time of application is too long and/or skin pH is reduced

Salicylic Acid Salicylic acid has mild analgesic, antimicrobial, keratolytic and anti-inflammatory effects. For superficial chemical peeling, salicylic acid is used in concentrations of 10–30%. Given the appearance of the white precipitate, uniformity of application is easily achieved

Salicylic Acid After several minutes the peel can induce an anesthetic effect whereby increasing patient tolerance Limited depth of peeling Minimal efficacy in patients with significant photodamage

Pyruvic Acid is used in concentrations of 40–70%. resulting in decreased epidermal thickness. Over a long term it induces increased collagen, elastic fibre and glycoprotein deposition in the papillary dermis. Pyruvic acid causes intense pain on application and its vapour is pungent and irritating

Pyruvic Acid Very mild erythema Mild desquamation Short post-operative period Intense stinging and burning sensation during the application Neutralization is mandatory Pungent and irritating vapors for the upper respiratory mucosa

Resorcinol Resorcinol disrupts the hydrogen bonds of keratin. This accounts for its keratolytic and bactericidal properties. Resorcinol is used at concentrations of 10–50% for chemical peeling and induces frosting pattern.

Resorcinol Desquamative effect aesthetically unacceptable Resorcinol may be a sensitizing and toxic agent

Medium-Depth Peeling Agents Tricholoro acetic acid (TCA) precipitates epidermal proteins and causes destruction of the upper dermis Medium- depth peeling is performed with TCA 35–50%

Trichloracetic Acid Stinging and burning sensation during the application Hypo/hyperpigmentation can occur

Deep Peeling Agents Phenol The main advantage of deep chemical peel is in the treatment of photodamaged skin with wrinkles, Facial scars such as acne scars The main disadvantage of deep peel is the special set up needed for the procedure, due to the potential cardiotoxicity of phenol. In addition,special training is needed

Indications of chemical peeling Acne Actinic keratoses

Indications of chemical peeling Melasma Photoaging

Indications of chemical peeling Post-inflammatory Hyperpigmentation

Indications of chemical peeling Rosacea Solar lentigos

Pre- Peels Caution Chemical peeling is usually a safe procedure when performed by qualified and experienced professionals. However, these procedures are not recommended for everyone. Patients should visit their dermatologists and find out whether this treatment is indicated for them.

Pre-peel care Skin should be well prepared before peeling for achieving good results . Priming of the skin These activities enhance patient compliance, detect intolerances and reduce the risk of complications such as post-inflammatory hyperpigmentation and scarring. Patients should be instructed to avoid waxing, and dermabrasion for a minimum of 3–4 weeks prior to chemical peeling

Pre-peel care Patients should be instructed to limit their UV exposure and apply a broad-spectrum sunscreen with a sun protection factor of 50+. Sunscreen should ideally be instituted 3 months prior to the procedure and continued indefinitely thereafter.

Pre-peel care Pretreatment of the skin should begin at least 2–4 weeks before the chemical peel and ceased 3–5 days prior. Tretinoin 0.025–0.05% cream should be applied for a minimum of 2 weeks Hydroquinone 2–4% cream is inititated at least 2 weeks before a chemical peel and re-introduced 1–2 weeks post peel other agents include glycolic acid 5–10%, salicyclic acid 5–10%,

Post-peel care They should be instructed to wash their face with a non-soap cleanser and to avoid rubbing, scrubbing, scratching their skin. A bland emollient should be applied regularly to the skin until peeling is complete. topical antibacterial agent may be prescribed. Sun avoidance and daily application of sunscreen should also be encouraged. ensures prompt recovery of the skin and prevents unwanted complications. The patients should be given written information on what to expect over the ensuing days and instructions on how they should care for their skin

Complications dermatitis hyperpigmentation Infections Scarring

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