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

2. 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.

3. Introduction

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

5. How can we Affect Desquamation?
Mechanical Peeling
Chemical Peeling

6. 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.

7. 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.

8. 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.

10. Chemical Peeling Agents

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

12. Superficial Peeling Agents
Jessner solution?

13. 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%.

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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.

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

21. 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%

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

23. 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

24. Indications of chemical peeling
Acne
Actinic keratoses

25. Indications of chemical peeling
Melasma
Photoaging

26. Indications of chemical peeling
Post-inflammatory Hyperpigmentation

27. Indications of chemical peeling
Rosacea
Solar lentigos

28. 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.

32. 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

33. 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.

34. 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%,

35. 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

36. Complications
dermatitis
hyperpigmentation
Infections
Scarring

37. Thank You