Name: CHEMICAL PEELS
Uploaded: 2023-09-05
Duration: 34 min
Description: Good morning, everyone. In this presentation, I will be discussing the topic of chemical peels. We will explore the history of the procedure, its mechanisms and classification, its pros and cons, and its current status in the Indian scenario. Finally, we will consider the areas where further research is necessary. I look forward to taking you through this journey. Let's begin..

[Audio] Good morning, everyone. In this presentation, I will be discussing the topic of chemical peels. We will explore the history of the procedure, its mechanisms and classification, its pros and cons, and its current status in the Indian scenario. Finally, we will consider the areas where further research is necessary. I look forward to taking you through this journey. Let's begin.. 

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[Audio] Chemical peels are a widely utilized method of skin rejuvenation meant to enhance its aesthetic. This text will cover the definition, history, chemistry, concept, mechanism, classification, indications, contraindications, pre-operative and post-operative procedures, commonly used peels, complications, special types, advantages and disadvantages, combinations with other procedures, Indian perspective, special populations, and the future of chemical peels. To sum up, a synopsis of the subject will be provided.. 

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Definition History Skin chemistry Concept  Mechanism of action Classification Indications Contraindications Evaluation  Pre-op-> Procedure -> Post-op Commonly used Peels Complications Special types Advantages & Disadvantages Combination with other procedures Chemical peels- Indian scenario Special Populations Future of chemical peels Conclusion

[Audio] Chemical peels, referred to as chemo-exfoliation, involve the ablation of the skin by using specific chemical agents to carefully and uniformly remove a layer of skin. This process aims to improve the skin’s appearance by revealing a healthier layer beneath it. Depending on the type, concentration and depth of the peel, the effects of this procedure can vary.. 

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Chemical peels  or  Chemo-exfoliation is 
 A method of targeted cutaneous ablation induced by specific chemical agents that allows for a rapid, predictable, and uniform thickness of chemo-ablation to a given desired cutaneous depth, ultimately resulting in improvement in the clinical appearance of skin.

[Audio] Chemical peels have a history that dates back to ancient times. Egyptians employed a number of substances, such as alabaster, animal oils, salt, honey and sour milk, to improve the appearance of their skin. French women used old wine, containing tartaric acid, for the same purpose. In 1874, German physician Friedrich von Hebra pioneered the use of tinctures and croton oil for lightening pigmentation issues. In 1882, Unna went further by introducing salicylic acid (SA), trichloroacetic acid (TCA), phenol and resorcinol, which formed the foundation of modern chemical peels.. 

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Present in various forms through time immemorial 1500 BC Ancient Egyptians used alabaster, animal oils, salt, honey & sour milk for cutaneous aesthetic enhancement  French women used old wine (Tartaric acid) for skin improvement  Von Hebra 1874 – used tinctures and croton oil for lightening disorders of pigmentation Unna 1882- use of Salicylic acid (SA), Trichloro acetic acid (TCA), Phenol & Resorcinol - first iteration of chemical peel

[Audio] Chemical peels have been used for many years. In 1940, researchers created a mixture of resorcinol and salicylic acid which made the treatment more effective and less harmful. Fifty years of research was published by Mackee and Karp, which provided guidelines for modern peels. Mackee also proposed phenol as an acne scar treatment in 1952. Later, between 1965 and 1970, Baker and Gordon modified the phenol peel. In 1980, Stegman compared the depth of dermabrasion with chemical peels, which helped to develop more controlled and scientific procedures. Chemical peels have been successful and are becoming increasingly popular.. 

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Max Jessner 1940 combined resorcinol and SA – increased efficacy and decreased toxicity of both Mackee & Karp- published 50 y of research and provided guidelines for modern peels Mackee 1952- Phenol for acne scars Baker and Gordon 1965-70 modifications of the phenol peel Stegman 1980 compared the histological depth with dermabrasion and paved way for scientific and controlled chemical peel procedure

[Audio] Chemical peels are a procedure that involves the use of acids to create a controlled burning of the surface layer of the skin. The result of this is a resurfacing and remodelling of the area, with the aim of reducing pigmentation, wrinkles and scars. Our objective is to attain a level of damage that is sufficient to exfoliate the layers of skin, without causing injury or loss of tissue from the structures underlying the dermis.. 

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Chemicals -> controlled burns-> destruction of skin layers-> repair by resurfacing & remodelling

 Goal: To wound the skin to a desired level deep enough to cause exfoliation of layers, while being superficial enough to allow regeneration from the appendageal structures and dermis through wound healing, and reducing pigmentation, scars & wrinkles

[Audio] The pH of skin is "mildly acidic" and the pKa value is a measure of the pH at which an acid and its salt exist in equal proportions. Making chemical peels with a lower pH and thus more acidic solution can lead to efficient peels, but it can also result in more irritation. To avoid this, buffering the solution increases the proportion of salt and lowers the irritation, while not reducing the efficacy.. 

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pH of skin is ~4.7-5.7 (mildly acidic) pH measures the ability of substance to donate proton pKa is pH at which acid and salt exist in equal proportions ~50% each When pH is less than pKa value of chemical, acid form- the active agent responsible for exfoliation, dominates Important to have proper balance to have efficacious peel with minimal irritation Lower the pH, more acidic  more efficient but more irritation Buffering the solution increases the salt form thereby reducing irritation (and efficacy)

[Audio] Chemical peels are common in dermatology for skin rejuvenation, resurfacing, and facial rejuvenation. They can use different types and strengths of chemicals, depending on the desired effect. Metabolic action peels, such as AHAs, retinoic acid, and azelaic acid, alter enzyme function and affect cell structure and function without damage. Caustic action peels, such as TCA peels, cause keratocoagulation of protein in the area of application. Toxins action peels, such as phenol, resorcinol, and SA, disable enzymes and denature proteins, resulting in cell death. These peels are systemically absorbed and can affect other areas away from the application.. 

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Metabolic action: interfere with enzyme function and affect cell structure & function without destruction- stimulation/modification action only Eg: AHA, retinoic, azelaic acid peel Caustic action: Coagulating cellular proteins of the area of application – localised keratocoagulation Eg: TCA peel Toxic action: enzyme inactivation and protein denaturation -> cell death. Not only at local site but also distant site- systemically absorbed Eg: Phenol, Resorcinol, SA

[Audio] Chemical peels are a type of procedure used to improve the appearance of the skin by exfoliating the top layers of skin, called the epidermis. Depending on their chemical composition and the degree of cell death they cause, chemical peels can be categorized into two categories. These peels can be used to reduce wrinkles, age spots, acne, and other skin related issues, and often require a series of treatments for best results.. 

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Based on Chemical Composition




 Based on Histological depth of Necrosis

[Audio] Chemical Peels are a form of skin resurfacing treatment that consists of applying a special form of acid to the skin in order to resurface it. This slide will discuss the different types of acids used for these treatments, divided into four groups: Alpha Hydroxy Acids, Beta Hydroxy Acids, Alpha Keto Acids, Tri Chloro Acetic Acids, Retinoic Acids, Resorcinol and Phenol. Each of these is derived from a natural source, such as milk, apples, grapes, citrus fruits and willow bark. Together, these acids help to remove the top layer of the skin in order to improve texture, clarity, and other skin issues.. 

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Group of acids found in food Natural source Alpha Hydroxy Acids 2-hydroxypropionic acid- Lactic acid (LA) Monohydroxysuccinic acid-Malic acid Dihydroxysuccinic acid- tartaric acid Citric acid and Glycolic acid (GA) Sour milk Apples Grapes Citrus fruits and sugarcane Beta Hydroxy Acids Salicylic acid (SA) Willow bark, sweet birch Alpha keto Acids Pyruvic acid
 Tri Chloro Acetic Acid

 Retinoic Acids

 Resorcinol

 Phenol

[Audio] Chemical peels are an effective way to reduce wrinkles, improve skin texture and even out skin discolorations. Different types of peels are determined by the depth of peeling required, ranging from very superficial to medium. Generally, a TCA peel with a 10-15% concentration of acid is used for a very superficial peel, while a TCA with a 35-50% concentration is used for a medium peel. Combinations of peels, like Jessner and TCA or GA and TCA, can also be used. To ensure proper healing, proper care must be taken after the treatment.. 

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Ruben’s classification  -Small et al. modification

Type Histological Level Agents Very superficial (Stratum corneum) Penetrate s. corneum and upper layers of s. spinosum (usually up to s. granulosum). Exfoliate the s. corneum only TCA 10-15% one coat GA 20-35% (buffered) LA 50%, tretinoin SA 20%, Jessners 1-3 coats,  Resorcinol paste 20-30% Superficial (epidermis) Penetrate entire epidermis upto basal layer and upto upper p. dermis . Can cause necrosis of all layers upto basal layer. TCA 20-30% one coat GA 50-70% buffered 3-5 min Jessners 4-7 coats,  resorcinol paste 40-50% Medium  (papillary dermis) Penetrate through epidermis upto upper reticular dermis. Cause necrosis through part or full papillary dermis TCA 35-50% one coat GA 70% unbuffered 5-10 min Phenol-88%, SA 30-50% Combinations- Jessner + TCA, GA + TCA Deep (Upper Ret. Dermis) Penetrate and cause necrosis upto mid-reticular dermis. Baker-Gordon Phenol formula, modified Baker’s peel

[Audio] Chemical peels are a type of skin treatment meant to improve the general appearance of skin. The depth of the chemical peel depends on multiple elements, such as the chemical being used, its concentration, the number of coats applied, the technique of application, the pre-peel cleansing, the kind of skin surface, the body area it is being used on, and the time of contact. To achieve a pleasing result, all of those factors must be taken into account and adjusted accordingly.. 

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Agent Concentration No. of coats Technique (painted or rubbed in) Priming of skin How skin was cleaned pre-peel Type of skin surface Anatomical location Duration of contact

Superficial Peels
Medium Depth Peels
Deep Peels
Stratum
Basal
cell

[Audio] Without greetings, without beginning with Today, and without thanks:
Chemical Peels is the topic of discussion. It is essential to choose the appropriate formulation for these peels as the vehicle plays an essential role in influencing concentration and efficacy. Free acid, a non-neutralised acidic solution with high bioavailability, can cause more stinging and side effects. Ammonium hydroxide is used for partially neutralised solutions resulting in less skin irritation. Buffered peels, partially neutralised, are more secure. Glycocitrate is used to form estrified peels which also lead to reduced irritation. Glycolic acid with purified water and strontium nitrate can reduce skin irritation by suppressing type C neurons. Gel based peels with low concentration of free acid and slower release are ideal for sensitive skin but are less potent.. 

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Should be chosen with care as vehicle has key role in concentration & efficacy Free acid: aq non-neutralised acidic solution with great bioavailability more effective but higher stinging & side effects Partially neutralised: added base, eg. Ammonium hydroxide- less irritant Buffered: partially neutralised stable form Esterified: solution forming glycocitrate- less irritant GA + purified water + strontium nitrate: SN reduces irritation by inhibiting type C neurons Gel based: less free acid available; slower release- suitable for sensitive skin; less irritable but less efficacious

Common Indications. Pigmentary disorders Melasma Post-inflammatory hyperpigmentation Freckles Lentigines Facial melanoses Acne Superficial acne scars Postacne pigmentation Comedonal acne Acne excoriιe Acne vulgaris-mild to moderately severe acne Aesthetic Photoaging Fine superficial wrinkling Dilated pores Superficial scars Epidermal growths Seborrheic keratoses Actinic keratoses Warts Milia Sebaceous hyperplasia Dermatoses papulosa nigra. 

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Pigmentary disorders

Melasma   Post-inflammatory hyperpigmentation Freckles Lentigines Facial melanoses 
Acne

Superficial acne scars Postacne pigmentation Comedonal acne Acne excoriιe Acne vulgaris-mild to moderately severe acne
 Aesthetic

      Photoaging Fine superficial wrinkling Dilated pores Superficial scars
 Epidermal growths

      Seborrheic keratoses Actinic keratoses Warts Milia Sebaceous hyperplasia Dermatoses papulosa nigra

[Audio] Chemical Peels are aesthetic procedures employed to improve the look of the skin. However, certain pre-existing conditions can make them not suitable for some patients. These include active bacterial infection, active herpes infection, open wounds, active inflammatory dermatoses, photosensitive drugs, unfounded desires from the procedure, and non-compliant patients. For deep or medium chemical peels, persons with dark skin types and history of keloid tendency should be avoided as well.. 

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Active bacterial infection Active Herpes infection Open wounds Active inflammatory dermatoses Patients on oral Iso-tretinoin therapy* Pt on photosensitive drugs Unrealistic expectation and non compliant patient For medium/deep peels : dark skin type and history of keloid tendency

A picture containing drawing

Description automatically generated

Gerber PA, Kukova G, Bölke E, Homey B, Diedrichson E. Severe hyperpigmentation and scarring following glycolic acid peel treatment in combination with low-dose isotretinoin. Eur J Med Res. 2014;19(1):60. Published 2014 Nov 7. doi:10.1186/s40001-014-0060-x

[Audio] Chemical peels are gaining traction as a solution for various skin issues. Before undergoing one, it is imperative that patients have knowledge of the procedure and its subsequent effects. The process consists of exfoliating a section of skin using a chemical solution that is later neutralized. Afterwards, the area is allowed to heal and its surface is expected to be smoother. Following treatment, the patient can experience various levels of discomfort, inflammation and redness but these should subside as the skin heals, leaving it looking rejuvenated and healthier.. 

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[Audio] Prior to chemical peeling, it is of utmost importance to perform a patient evaluation. This should include obtaining a patient's past history, including length of sun exposure and lifestyle, any scarring post-peel, recent waxing, scrubs, facials, or home remedies like lemon. Furthermore, determine if the patient is currently pregnant or lactating, a smoker, and have a comprehensive drug history of photosensitive agents, blood anticoagulants, or isotretinoin.. 

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History : Recurrent herpes simplex, procedures done in past, duration of sun exposure & lifestyle, history of scarring post peel, recent waxing, scrubs or facials, home remedies (caustic substances like lemon), pregnant or lactating, smoking h/o, detailed drug h/o (photosensitive agents, blood anticoag, isotretinoin)

[Audio] Chemical peels can be a great way to reduce signs of skin damage, pigmentation, scarring, and photo damage. A thorough skin evaluation, using a lens and wood’s lamp must be done before deciding to proceed with a peel in order to determine the best type of peel and to give the patient realistic expectations about the results. Education about possible risks of an untrained professional or self-application must be provided to the patient for them to make an informed decision on whether to go ahead with a chemical peel.. 

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Examination: Skin/ lesion examination with lens and wood’s lamp for skin type and texture, pigmentation, scarring, photo-damage
 Based on the above data, appropriate peel selected and patient given clear information regarding procedure with realistic expectations; explained about safety and efficacy
 Patient has to make the final informed decision on whether to proceed; also necessary to educate patient regarding perils of getting peels from untrained/self application

[Audio] When preparing the skin for a chemical peel, there are certain steps you should take to ensure the best results. The use of topical retinoids can be applied daily at night for two weeks before the peel. This helps to speed up the process of re-epithelialization and wound healing, while also aiding better penetration of the skin. Additionally, tyrosinase-blocking agents such as hydroquinone, kojic acid and GA 6-12% can help to reduce the skins ability to synthesise melanin, reducing the chance of post-peel issues. All of these agents should be stopped three to five days before the peel and shaving should be avoided on the day before as well as the day of. This advice is based on the findings of Anitha B. in 2010.. 

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-Preparing skin for peel -> enhanced results Topical retinoids daily night application for 2 weeks prior peel Speeds re-epithelialization and wound healing Aids better penetration by keratolytic action on s.corneum Tyrosinase blocking agents hydroquinone, Kojic acid GA 6-12% -Some of these agents reduce skins ability to synthesise melanin thereby reducing chance of post peel PIH -All these agents are stopped 3-5 d before peel* -shaving avoided on day before and day of peel
 *Anitha B. (2010). Prevention of complications in chemical peeling. Journal of cutaneous and aesthetic surgery, 3(3), 186–188. https://doi.org/10.4103/0974-2077.74500

g)
Hydroquinone USP, 4%
Skin Bleaching Cream
Rx Only

[Audio] In order to protect our skin from the sun, we should limit sun exposure and use a cap, scarf, or umbrella to cover any exposed skin. Additionally, it is important to apply a broad-spectrum sunscreen generously for optimal protection from UV radiation.. 

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-Sun Protection: Restricted exposure;  Advocate use of cap, scarf, umbrella etc Broad-spectrum sunscreens must be used

[Audio] A small test peel on the area behind the ear two weeks prior to the full face peel is a good way to ensure that no unfavorable reactions occur, and to inform the patient of potential side effects. It is also beneficial to apply topical treatments to the face during this time, and if the patient has a busy working schedule, it may be best to plan the peel for a weekend in order to allow any peeling skin to heal for two to three days.. 

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Test Peel A small 1 inch area in post-auricular region is subjected to the peel agent 2 weeks prior to full face peel  To detect adverse reactions To make patient aware of the sequelae Using this visit to prime the pt with topicals -Plan procedure towards weekend for working patients as skin peels for 2-3 days

[Audio] Chemical peels are a go-to for improving the tone and texture of the skin. A few pieces of specialized equipment are necessary to do this procedure: a glass cup or beaker to hold the necessary chemical agent; a head band or cap to protect the patient's hair; spirit and acetone; gloves; petrolatum; cotton-tipped applicators or swabsticks; 2x2 cotton gauze pieces; a fan for cool down; a timer; and a syringe filled with normal saline in case of accidental spillage into the eyes.. 

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Glass cup or beaker in which the required agent is poured Head band or cap for patient Spirit & acetone Gloves Petrolatum Cotton-tipped applicators or swab sticks 2" x 2" cotton gauze pieces Fan for cooling Timer Syringe filled with normal saline for irrigation of the eyes, in case of accidental spillage

[Audio] Chemical peels are a popular treatment to improve the appearance of the skin. Prior to any chemical peel, the immediate and post effects must be explained to the patient. Pictures should be taken before and after each session. The patient should be informed that if the solution contacts the eyes or a severe burning sensation occurs, the healthcare provider should be notified immediately. To obtain the best results, the patient should wash their face with soap and water twice.. 

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Full informed consent and explanation of the immediate and post peel effects  and care to be taken is explained.  Pre-op and post picture for each session should be mandatory Pt advised to immediately tell if solution enters eye or severe burning sensation develops Patient advised to wash with soap and dry face twice- recommended

[image] A close up of a sign Description automatically generated

[Audio] When preparing for a chemical peel, the patient should lie supine with their head at an approximate 45 degree incline, eyes closed and ears plugged with cotton. A hairband should be used along with thin layers of petrolatum on lip margins, nasal crease, and canthi of eyes. A spirit gauze scrub should be done one or twice followed by a single cleansing with an acetone-soaked gauze to ensure the skin is defatted. Lastly, always check the peel bottle to confirm the chemical agent to be used.. 

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Lies supine with head ideally at 45 incline.  Eyes closed and ears cotton plugged.  Hairband in place.  Thin layer of petrolatum used in sensitive areas- lip margins, nasal crease and canthi of eyes esp for periorbital peels Spirit gauze scrub of face once/twice ->  single cleansing with acetone-soaked guaze to ensure defatting of skin.  Check peel bottle to confirm agent.

[Audio] For a chemical peel, begin by pouring a peel of the desired concentration into a beaker. Dip a gauze sponge or applicator into the peel, making sure there is no dripping. Apply the peel with smooth strokes to the forehead, right cheek, chin, left cheek, glabella, nose and peri-oral area, as well as the upper and lower eyelids. Finally, with feathering, apply the peel into the borders of eyebrows, the hairline, the vermilion border and the submandibular region.. 

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Pour peel of desired conc. in beaker Gauze sponge or applicator is immersed into it. It is then elevated and pressed against wall of beaker to drain out excess and ensure no dripping Apply with smooth strokes sequentially – forehead, r. cheek, chin, l. cheek, glabella , nose , peri-oral area, upper and lower eye-lids. Apply gently into the borders of eyebrows, hairline, vermilion border and submandibular region : Feathering

[Audio] Chemical peels are a form of exfoliation that can help improve the tone, texture and overall appearance of the skin. During the procedure, the skin typically goes through stages of erythema, blanching and white frosting appearance, which is produced by denatured proteins - a sign of good take. The degree of frosting varies based on the type of agent being used, with stronger agents leading to deeper penetration and a more effective peel. If a patient experiences an intense burning sensation, the reaction can be stopped early in order to allow the skin to rest and heal.. 

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Varies for each agent Takes several min – erythema, blanching and white frosting  Frosting is light, medium and lastly deep white : caused by denatured proteins; not every agent produces frosting Stronger white  deeper penetration & peel Appearance of uniform white coat- sign of good take Usually reaction can be terminated once frosting occurs Reaction can be terminated earlier if pt has intense burning sensation

[Audio] Switch on the fan to begin the chemical peeling procedure. Start with the eyelids, then move to the forehead, as it has thicker skin. When the burning sensation subsides, wipe off any water from the eyelids and ask the patient to open their eyes. Dab cold water until the burning sensation is gone, avoiding rubbing. Frosting should disappear within half an hour and the patient should stay onsite during this time. Finish the procedure with a cold water or an ice gauze sponge.. 

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Switch on fan and terminate with cold water/ice gauze sponge. Start with eyelids (last site of application) and go on to the rest of face, lastly on forehead –thicker skin till burning sensation reduces Wipe water off eyelids and pt asked to open eyes Patient is asked to dab cold water till burning subsides. Rubbing is avoided. Frosting disappears within half hour and pt is asked to wait in the premises during this period

[Audio] After the peel, proper care is vital to obtain the best results. In the first 24 to 48 hours, cold water compresses and calamine lotion can help ease the skin. Five to ten days later, the face will darken to brown or black, eventually completely peeling off. Do not pull or tug at the peeling skin as this can cause serious damage.. 

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Critical to follow for optimum results Cold water/ ice compresses , calamine lotion given for soothing. First 24 -48 hours promote dessication and separation and restrict emollients Day 1 & 2 : skin dark brown black and desquamates completely by 5-10 days (variation early and late peelers); Never pull at the peeling skin

[Audio] After the chemical peel, it is important to take steps to protect the newly exfoliated skin. Apply an emollient to keep your skin moisturized and to prevent tightness and cracking. The underlying fresh skin may be erythematous, so it is important to use sun protection and night emollients during the first two weeks. Use a very mild soap for your face and avoid scrubbing or steaming. After two weeks from the peel, you can resume using topical products.. 

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Once skin peels, tightness and cracking occurs, apply emollients and keep skin moist Underlying fresh skin is erythematous. Sun protection and night emollients for 2 weeks. Pt is followed up on weekly basis to tackle any post-peel consequences if they arise Very mild soap for face during this period ; no scrubbing,steaming Topicals can be resumed within 2 weeks after peel

[Audio] Chemical peels can be a good way to improve the look of the skin. There is no definitive guideline for how light the peel should be. The doctor will need to check in with the patient during their follow-up sessions to ensure the treatment is going as planned, usually every two to three weeks for the first three months, then every three months afterward if the patient still needs maintenance. It should be noted that the strength of the chemicals used and the length of the sessions can be adjusted until the desired results are achieved.. 

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Physician - active role in creating an environment conducive  rapid healing  no set rules; no limit to superficial peels if indicated Recommended once/2-3 weeks x 3 m and followed by once in 3 months Maintenance if required Conc of agent and duration are variables which should be increased till desired results achieved

[Audio] Chemical peels have grown in popularity in recent years due to their ability to improve skin texture and remove imperfections. However, with any potential treatment, it is important to weigh the pros and cons. Common complications associated with chemical peels include persistent erythema, premature peeling, secondary infection, and allergic reaction (which is rare). Post-inflammatory hyperpigmentation can also occur, however it is usually reversible within six months, leaving a line of demarcation. Scarring, including atrophic, hypertrophic, or keloidal can also occur with chemical peels. In some cases, an isotretinoin therapy may be prescribed and phenol peels can cause cardiotoxicity. It is important to bear these risks in mind when deciding whether a chemical peel is right for you.. 

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Persistent erythema  Premature peeling Secondary infection Allergic reaction (rare) PIH –usually reversible within 6 m, line of demarcation Scarring- atrophic, hypertrophic or keloidal - ? Role of isotretinoin therapy Phenol peels- cardiotoxicity

[Audio] Good afternoon students. Chemical peels are a powerful skin treatment that can be used to improve many skin issues. However, it is important to properly select and evaluate patients to minimize any potential complications. Generally speaking, deeper peels are associated with more adverse events and require strict monitoring. In the event of persistent erythema, topical steroids or pulse dye laser therapy may be used. Persistent pigmentary alterations can be minimized through pre and post-care regimens that include tretinoin, hydroquinone, and topical steroids. Deep peels can cause permanent destruction of melanocytes, however, camouflage cosmetics can be used to effectively mask any skin discoloration. Milia can be treated through lancing or electrosurgical methods. In the event of infection, it is important to recognize the signs and symptoms early on and treat appropriately with antibiotics. Finally, cardiotoxicity is a rare complication that can be minimized through hydration, ventilation, and prophylactic use of propranolol.. 

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Proper pt selection and evaluation of risk : benefit, greatly minimize complications In general, Deep peels  more AE and require strict monitoring; avoided in IV-VI types Persistent erythema – topical steroid, pulse dye laser Persistent PIH – proper pre &post care regimen; Combination of tretinoin, hydroquinoine and also topical steroid Permanent destruction of melanocytes- deep peels: camouflage cosmetics Milia- lancing, electrosurgical  Infection- early recognition and appropriate antibiotic therapy Cardiotoxicity- hydration, ventilation and prophylactic propanolol

[Audio] Chemical peels are one of the most popular treatments to improve skin texture and tone. They involve the application of a chemical solution to the face. The solution works to speed up the renewal of the epidermis. The most commonly used peels are Tri Chloro Acetic Acid (TCA), Glycolic Acid (GA), Salicylic Acid (SA), Retinoic Acid Peel, and Jessner’s Peel. Each of these peels have unique properties and varied strengths. Depending on the condition of the patient's skin, the appropriate peel can be determined and discussed with a skin specialist.. 

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Tri Chloro Acetic Acid (TCA) Glycolic Acid (GA) Salicylic Acid (SA) Retinoic acid peel Jessner’s Peel

[Audio] Today’s presentation is about chemical peels. I will focus on TCA Peel. TCA stands for trichloroacetic acid and is a type of chemical peel. It can range from 10 to 35% in concentration and has a low pKa 0.6. It is used to treat photodamaged skin, seborrheic keratosis, keratosis pilaris, warts, superficial scars, xanthelasma palpebmin, melasma, and PIH. As for the pre-procedure, there are some steps to follow that can be used with TCA Peel. After the application of TCA, frosting may appear. If the patient experiences severe discomfort, the process can be terminated immediately. Prep products like Obagi Blue Peel, Easy TCA, and Accupeel are commercially available.. 

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TCA-10,15,20,25,30,35% Distillation product of Nitric acid –low pKa~0.6 Indication: Photodamaged skin, seb keratosis, keratosis pilaris, warts, superficial scars, xanthelasma palpebrum, melasma and PIH The pre-procedure-post outlined earlier fits with TCA peel Reaction: Frosting Can terminate earlier if pt experiences severe discomfort Commercial prep: Obagi Blue peel, Easy TCA, Accupeel

[Audio] Chemical peels have become popular for skin rejuvenation and treating certain skin conditions. Glycolic acid is one of the common chemical peels used in aesthetic practice. It is an alpha-hydroxy acid derived from sugar cane and is compounded in concentrations of 20 to 70%. It works by decreasing the cohesion of keratinocyte cells, stimulating the basal keratinocytes and the fibroblasts, and inhibiting tyrosinase which is essential in the production of melanin. Glycolic acid chemical peels are used to treat acne, post inflammatory hyperpigmentation, dyschromias, dilated pores, fine wrinkles and photo-aging. The test peel, pre-operative and post-peel care is similar to the one used for Trichloroacetic acid peels. Knowing this information should give you a better understanding of this method and its indications.. 

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GA-20,25,30 upto 70%; prepared by CO+HCHO Test peel, pre-op, procedure, post-peel care remains same as TCA Mechanism:  decrease keratinocyte cohesion, stimulation of basal keratinocytes, inhibit tyrosinase, fibroblast modulation, antioxidant and moisturising action Indications: acne PIH & superficial scarring, dyschromias like melasma, dilated pores, fine wrinkles, photo-aging

[Audio] Chemical peels offer a great solution to reduce the signs of aging and improve skin texture. A chemical solution is applied to the skin that causes the upper layers to be exfoliated, revealing a smoother and brighter layer. It's important to be aware of the risks associated with this process, such as prolonged erythema and discoloration. To avoid these issues it is important to stop the peel when the desired end-point of moderate erythema is reached, and use general anaesthetic for extreme discomfort.. 

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Reaction: NO frosting.  Desirable end-point is mild-to moderate erythema; difficult to appreciate in Indian skin types Undesirable: grayish white discoloration due to epidermolysis or vesiculation. Peel should be terminated immediately Keep GA on till time reached or pt complains of severe discomfort

[Audio] Chemical peels provide an effective way to improve skin care. This treatment involves applying a chemical solution to the skin, which makes the skin slough off. To stop this process and prevent it from getting worse, ice-cold water or 10-15% NaHCO3 should be applied. People may feel a fizzing sensation when NaHCO3 is used, which is an indication that the solution has been neutralised. It is normal for people to experience a feeling of warmth during this process. Generally, the treatment should start with a two-to-three minute duration, and then increase by 30 seconds up to a maximum of five minutes per visit. Concentration should start at 20%, and then go up by 10% each week. To ensure the best results, it is important to only adjust one parameter at a time, so first increase time and then move on to increasing the concentration.. 

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Terminated with ice-cold water or 10-15% NaHCO3 (neutralise and prevent further penetr) When NaHCO3 used, fizzing indicates neutralisation and pt may feel heat from the process, reassure Start with 2-3 min increase by 30s-1 min every visit to max of 5 min; conc  start with 20 and increase by 10 each week Modify ONE parameter per visit; first increase time; after limit reached; keep it constant and inc concentration

[Audio] Chemical peels are a great way to address a variety of skin concerns, from signs of aging to skin conditions. Salicylic acid and trichloroacetic acid (TCA) are the most commonly used chemicals for these peels. Salicylic acid can be used in concentrations of SA-10, 15, up to 30%, and Salipeel, a gel form of the acid, has a pKa of 2.98. Pre-operative procedures, test peels, and post-peel care are similar for TCA and salicylic acid peels. Indications for salicylic acid peels may include acne vulgaris, acne post-inflammatory hyperpigmentation and scars, as well as rosacea, freckles, and other skin discolorations.. 

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SA-10,15 upto 30% and Salipeel(gel); pKa 2.98 Test peel, pre-op, procedure, post-peel care remains same as TCA Indications: acne vulgaris, rosacea, acne PIH and scars, freckles, etc

[Audio] Before starting to discuss chemical peels and their use in skin treatments, it is important to understand the pre-peeling process. It is recommended to drink one to two glasses of water prior to application and also to shake the SA solution to ensure an even concentration and distribution. After application, one may expect a whitening effect due to the precipitation of SA crystals, commonly referred to as a pseudo-frost. This is typically accompanied by a stinging sensation that usually lasts two to three minutes. If there are any areas not showing a pseudo-frost, spot-peeling should be performed. Afterwards, two to three coats should be applied to achieve a uniform effect. After fifteen to thirty minutes, the frost should be wiped off with cold water or washed away.. 

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Pre-peel: pt advised to drink 1-2 glasses of water Prior to application, shake container to ensure conc and distribution of SA solution Reaction: immediate whitening seen (~30s): precipitation of SA crystals: PSEUDO-FROST Stinging sensation for 2-3 min and then subsides- endpoint Any skip areas showing no pseudofrost should be spot-peeled Usually 2-3 coats applied to get uniform effect Wipe frost with cold water or wash off after 15-30 min

[Audio] Chemical peels have different advantages and disadvantages, and gel-peel, or Salipeel, is one type that does not cause stinging or pseudo-frost. However, it can be difficult to gauge the endpoint, so it's advised to ask the patient to wash the area after 6 - 8 hours. High concentrations of gel-peel (over 30%) should be avoided on large areas as it can be absorbed into the body and lead to salicylism, which can have serious symptoms, such as tinnitus, dizziness, headache, nausea, hyperventilation, delirium, coma and even death. On the other hand, gel-peel is preferable for active inflammatory conditions, such as acne, rosacea, Fox Fordyce's disease, or keratosis pilaris, due to its lipophilic, anti-inflammatory and self-neutralizing nature.. 

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Gel-peel(Salipeel): no stinging or pseufo-frost; difficult to gauge endpoint; ask pt to wash after 6-8 h
 Large areas high conc (30%) is avoided as absorption possible  Salicylism: Tinnitus, dizziness, headache, nausea, hyperventilation, delirium, coma, death Preferred in active inflammatory conditions like acne, rosacea, Fox Fordyce’s disease, Keratosis pilaris –lipophilic, anti-inflammatory &self-neutralising nature

[Audio] Retinoic acid, often called a yellow peel, is an effective solution for improving the firmness and elasticity of the skin. It is the active form of retinol and is known to stimulate cell differentiation, cell growth, and the formation of GAGs and polysaccharides which assist in retaining water and bring youthfulness to the skin. Additionally, the yellow peel has cleansing and anti-inflammatory effects that can enhance the texture and structure of the skin, making it appear more vibrant and younger. It is usually applied two days consecutively, once or twice a month, and should be rinsed off after seven to eight hours.. 

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Active form of retinol –vit A Regulate differentiation, proliferation and increase GAGs and polysaccharides which are responsible for water retention  firm and tight skin Cleansing, anti-inflammatory effects- improves structure and texture- rejuvenating and whitening effect Classic yellow peel, often applied 2 days in a row once in 1 or 2 months  Washed after 7-8 hrs

[Audio] Chemical peels are a type of exfoliation treatment that involves the removal of the upper layers of skin. Jessner's Peel is a combination device that uses a mix of resorcinol, salicylic acid, and lactic acid to treat irregularities in the skin. The original formula of Jessner's Peel is composed of 14g of resorcinol, 14g of salicylic acid, and 15% of lactic acid in 95% ethanol 100ml, but a modified form omits the resorcinol to reduce toxicity; instead, it uses 17% of lactic acid, 17% of salicylic acid, and 8% of citric acid in 95% ethanol 100ml. In addition, other combinations, like those featuring kojic acid and hydroquinone, are also available.. 

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Combination peel; Multiple coats used Increased efficacy while maintaining safety Standard: Resorcinol 14g +SA 14 g+ LA 15% 14 ml in ethanol 95% 100ml Modified: LA 17%+ SA 17% + Citric Acid 8% in ethanol 95% 100ml. Resorcinol eliminated to reduce toxicity Other combinations with KA, Hydroquinone etc exist

[Audio] Phenol USP 88% 3ml, Tap water 2ml, Septisol liq soap 8 drops and Croton oil 3 drops constitute Baker’s/Gordon’s formula for deep peel. Exploring the rise of technology and its potential for replacing human workers, as well as the drawbacks of technological advancement, is something worth noting.. 

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Deep peel Phenol USP 88% 3ml Tap water 2ml Septisol (liq soap) 8 drops Croton oil 3 drops

[Audio] Chemical peels are a popular form of skin treatment and involve the application of a chemical substance to the skin, which causes the top layer to peel off. This reveals a fresh layer of skin which is generally smoother and brighter in comparison. There are various kinds of chemical peels, such as combination, sequential, spot, peri-orbital and non-facial peels, all of which may be tailored in order to accomplish the desired outcome. For instance, combination peels are more effective on areas that require more intensive treatment, while non-facial peels may be used on other body parts, such as the hands, neck and chest. All-in-all, chemical peels are a safe and cost-efficient method for improving the look of the skin.. 

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Combination Peels Sequential Peels Spot/Focal Peels Peri-orbital peels Non-facial peels

[Audio] Chemical peels are an effective skin care treatment. A combination peel is a medium depth peel that can be used to treat a range of skin issues, from superficial acne scars to discoloration and photodamage. This procedure should occur every three months and typically takes 10 to 12 days to heal. Two examples of combination peels are the Monheit Peel, which involves applying Jessner Solution and then Trichloroacetic Acid, and the Coleman/Frutell Peel, which involves applying Glycolic Acid followed by Trichloroacetic Acid. For Indian resistant melasma and Lichen Planus Pigmentosus, it has been found that applying Glycolic Acid followed by Trichloroacetic Acid in varying strengths (20%, 35-70%) for up to two minutes before washing off can be an effective treatment. However, it is important to note that this treatment carries a risk of Post Inflammatory Hyperpigmentation and scarring.. 

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Medium depth peels useful for treating superficial acne scars, resistant dyschromias, photodamage etc Healing 10-12 d; once in 3 m Eg: Monheit Peel: JS followed by 35% TCA  Coleman Frutell Peel: GA 70% (kept 2 min and washed off) followed by 35% TCA
 Cases of Indian resistant Melasma and LPP : treated with GA 35-70% (2 min and  wash) followed by  20% TCA  found effective. Chances of PIH & scarring is significant

[Audio] Chemical Peels are a type of professional skin treatment which can help to improve texture and tone. This involves applying solutions containing acids that remove the damaged outer layers of the skin, revealing clearer and brighter skin beneath. Concentrations of the solution typically range from 20% to 30%, applied in two coats until a faint frosting is visible. After a five minute wait, the solution should be wiped and rinsed off, and the face blotted dry. For resistant areas or a full face with damage, 10-15% TCA should be applied with a swab, until a minimal frosting is visible. Chemical Peels offer higher efficacy and lower complications than alternative treatments, and are particularly efficient in darker skin types, especially for cases of melasma and PIH when used in combination with topical treatments.. 

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SA 20-30% full face – 2 coats till pseudofrost visible

 Wait 5 min wipe and rinse face and blot dry

 Apply 10-15% TCA over affected areas (or full face if generalized) with swab 2-3min till minimal frosting

Increased efficacy with lowered complications Useful in darker skin types esp in recalcitrant case of melasma, PIH in addition to topicals

[Audio] We are going to discuss Chemical Peels today. This type of treatment uses mild to stronger acids to address a range of skin problems, such as freckles, melasma, acne, and superficial scars. For Spot/Focal Peels, which are used to take care of a few, single lesions, a toothpick, needle, or swab is required to administer a more superficial peeling. The application process involves lightly applying the acid from the centre to the edge of the area. To treat atrophic scars, TCA or phenol should be used with a toothpick or wooden applicator. This treatment technique is known as Chemical Reconstruction of Skin Scars or CROSS. That wraps up our overview of Chemical Peels.. 

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Limited, affected area; small or large but localised Indications:  Few and well-localised lesions eg. Freckles, melasma, acne, SK, AK More superficial peeling required eg. Freckles with GA Toothpick, 26g needle or swab can be used. Centre to periphery feathering strokes Atrophic scars: edge of  toothpick/wooden applicator dipped in 50-100 % TCA or 88% Phenol and pressed against depressed base and inner walls of scar till lesion frosts white. Then washed with ice cold water Chemical reconstruction of skin scars (CROSS)

[Audio] When treating the periorbital region, certain precautions must be taken due to the laxity, thin nature and proximity to the eye. Common agents for this area include glycolic acid 20%, lactic acid 30%, salicylic acid 20-70%, and trichloroacetic acid 10-15%, with retinol sometimes used. Pre-peel cleansing should be done before beginning the peel. Petroleum jelly should be applied around the canthi. A dual end applicator with one end used for application and the other a dry end for soaking up any excess acid pooled at the medial canthus is ideal. It is important to stretch the folds adequately to prevent any pooling in the creases. Eyes should be kept shut for the entire procedure. The peel should start with 20% glycolic acid for 1 minute, then alternate visits to increase time or concentration.. 

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-Emphasis on certain precautions to be taken due to laxity, thin nature and proximity to eye -GA 20% - agent of choice; LA 30%, CA 20-70% TCA 10-15% retinol also used  Gentle pre-peel cleansing Use of petroleum jelly at canthi Dual end applicator- one end for application and other dry end for soaking excess acid pooled at medial canthus; cotton ear bud- ideal Stretch folds adequately to prevent pooling in creases Eyes should be shut entire procedure Peel to be started at 20% GA for 1 min and alternate visit increase time/conc

[Audio] Chemical peels are a popular skin treatment designed to reduce the appearance of wrinkles, blemishes, uneven skin tone, and discoloration. In the West, non-facial peels are commonly used on the neck and arms. In India, peels may be employed to reduce acne post-inflammatory hyperpigmentation or axillary hyperpigmentation. Trichloroacetic acid (TCA) in concentrations ranging from 20 to 35%, glycolic acid (GA) from 50 to 70%, and salicylic acid (SA) from 20 to 30% are the most common agents used for peels. Since the reaction to these agents, including erythema and frosting, may take some extra time due to anatomical differences, it is important for anyone considering a chemical peel to be aware of the potential risks and ensure that they are working with a qualified provider.. 

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Done more commonly in west for photo-damaged areas like neck, arms In India, pt request for acne PIH on back, axillary hyperpigmentation Commonly used agents : TCA 20-35%, GA 50-70%, SA 20-30% Reaction (erythema & frosting) takes longer due to anatomical difference

FOX FORDYCE'S DISEASE WITH HYPERMELANOSIS
OF AXILLA

[Audio] Chemical peels are an effective way to improve the appearance of skin. Our skin is constantly exposed to environmental factors and the natural aging process, and chemical peels can help remove damaged skin and reduce the appearance of wrinkles and other skin imperfections. There are a variety of chemical peels available, such as lactic acid, citric acid, mandelic acid, pyruvic acid , kojic acid, azelaic acid, arginine, ferulic acid, polyhydroxy peel, Melaspeel KH, Argipeel, Blackpeel, Miami and Miami-AR peel, Retises CT, and more. These peels can be tailored to treat each individual's skin condition, making it an effective treatment for a variety of skin concerns. Thank you for your attention.. 

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Lactic acid  Citric acid Mandelic acid  Pyruvic acid Kojic acid Azelaic acid Arginine  Ferulic acid Polyhydroxy peel Melaspeel KH Argipeel Blackpeel Miami and Miami-AR peel Retises CT

CHEMICAL PEELS

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In this presentation, I will be discussing the topic of chemical peels

We will explore the history of the procedure, its mechanisms and classification, its pros and cons, and its current status in the Indian scenario

Finally, we will consider the areas where further research is necessary

I look forward to taking you through this journey

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Chemical peels are a widely utilized method of skin rejuvenation meant to enhance its aesthetic

This text will cover the definition, history, chemistry, concept, mechanism, classification, indications, contraindications, pre-operative and post-operative procedures, commonly used peels, complications, special types, advantages and disadvantages, combinations with other procedures, Indian perspective, special populations, and the future of chemical peels

To sum up, a synopsis of the subject will be provided.

Chemical peels, referred to as chemo-exfoliation, involve the ablation of the skin by using specific chemical agents to carefully and uniformly remove a layer of skin

This process aims to improve the skin’s appearance by revealing a healthier layer beneath it

Depending on the type, concentration and depth of the peel, the effects of this procedure can vary.

Chemical peels have a history that dates back to ancient times

Egyptians employed a number of substances, such as alabaster, animal oils, salt, honey and sour milk, to improve the appearance of their skin

French women used old wine, containing tartaric acid, for the same purpose

In 1874, German physician Friedrich von Hebra pioneered the use of tinctures and croton oil for lightening pigmentation issues

In 1882, Unna went further by introducing salicylic acid (SA), trichloroacetic acid (TCA), phenol and resorcinol, which formed the foundation of modern chemical peels.

Chemical peels have been used for many years

In 1940, researchers created a mixture of resorcinol and salicylic acid which made the treatment more effective and less harmful

Fifty years of research was published by Mackee and Karp, which provided guidelines for modern peels

Mackee also proposed phenol as an acne scar treatment in 1952

Later, between 1965 and 1970, Baker and Gordon modified the phenol peel

In 1980, Stegman compared the depth of dermabrasion with chemical peels, which helped to develop more controlled and scientific procedures

Chemical peels have been successful and are becoming increasingly popular.

Chemical peels are a procedure that involves the use of acids to create a controlled burning of the surface layer of the skin

The result of this is a resurfacing and remodelling of the area, with the aim of reducing pigmentation, wrinkles and scars

Our objective is to attain a level of damage that is sufficient to exfoliate the layers of skin, without causing injury or loss of tissue from the structures underlying the dermis.

The pH of skin is "mildly acidic" and the pKa value is a measure of the pH at which an acid and its salt exist in equal proportions

Making chemical peels with a lower pH and thus more acidic solution can lead to efficient peels, but it can also result in more irritation

To avoid this, buffering the solution increases the proportion of salt and lowers the irritation, while not reducing the efficacy.

Chemical peels are common in dermatology for skin rejuvenation, resurfacing, and facial rejuvenation

They can use different types and strengths of chemicals, depending on the desired effect

Metabolic action peels, such as AHAs, retinoic acid, and azelaic acid, alter enzyme function and affect cell structure and function without damage

Caustic action peels, such as TCA peels, cause keratocoagulation of protein in the area of application

Toxins action peels, such as phenol, resorcinol, and SA, disable enzymes and denature proteins, resulting in cell death

These peels are systemically absorbed and can affect other areas away from the application.

Chemical peels are a type of procedure used to improve the appearance of the skin by exfoliating the top layers of skin, called the epidermis

Depending on their chemical composition and the degree of cell death they cause, chemical peels can be categorized into two categories

These peels can be used to reduce wrinkles, age spots, acne, and other skin related issues, and often require a series of treatments for best results.

Chemical Peels are a form of skin resurfacing treatment that consists of applying a special form of acid to the skin in order to resurface it

This slide will discuss the different types of acids used for these treatments, divided into four groups

Alpha Hydroxy Acids, Beta Hydroxy Acids, Alpha Keto Acids, Tri Chloro Acetic Acids, Retinoic Acids, Resorcinol and Phenol

Each of these is derived from a natural source, such as milk, apples, grapes, citrus fruits and willow bark

Together, these acids help to remove the top layer of the skin in order to improve texture, clarity, and other skin issues.