Chemical Peels and Retinoids
There is a theory among some unenlightened rosacea specialists who think that if the upper layer of skin is red, just remove it and you’ll solve the rosacea problem. It is an interesting theory but the wrong solution. The chemicals, acids and retinols required to peel off and exfoliate the upper layer skin, reveal very fragile and sensitive skin. Because the skin hasn’t had time to adjust to the harsher exposed environment of the surface layer of the skin, it becomes more sensitive, more prone to redness, it may burn, sting and less able to hold moisture causing even drier skin conditions. Rosacea skin needs to be 'intact' and not to be further aggravated by any chemical or mechanical peels of the below listed means. The objective behind chemical peels and retinols is to speed up the process of removing the dead cells on the surface of the skin in the thought that this will speed up the process of the body in producing new skin cells. Younger, newer skin cells that have not yet experienced the day to day damage of pollution, dehydration, and wrinkles from the aging process which can dry the skin. There are a variety of ways this is accomplished – through natural fruit acids, Beta Hydroxy Acids, Retin-A or its generics, Alpha Hydroxy Acids, glycolic acid, benzoyl peroxide and salicylic acids.
When using fruit acids and peels, as each person’s skin is different and reacts differently based on medications currently being used or used in the recent past, environment and products or treatments regularly used, the acids are often either too weak to remove the degree of cells needed to see results or too strong causing the acid to burn through not only the dead skin cells and attacking the new cells also. This can result in increased skin redness, increased skin sensitivity, burning sensations on the skin and photo sensitivity. Another problem with using acids is that the dead cells do not come off immediately; your skin gets white, flaky, and tight as the dead cells fall off over the course of a few days. Using acids is not only uncomfortable; but it can at times do more damage than good.
Alpha hydroxy acids and beta hydroxy acids are basic fruit acids either naturally occurring or synthesized in the laboratory. Beta Hydroxy acids differ from alpha hydroxy acids in their structure and the way they work. A common beta hydroxy acid Salicylic acid is commonly used to treat acne. This is the primary purpose of beta hydroxy acids.
Alpha hydroxy acids are being used more extensively in anti-aging and anti-wrinkle products. In an effort to reduce the degree of skin irritation, beta hydroxy acids, or a combination of beta hydroxy acids and alpha hydroxy acids are being in these skin care products. The addition of beta hydroxy acids is being promoted to help minimize the appearance of fine lines and wrinkles, while improving overall skin texture.
BETA HYDROXY ACIDS
Beta Hydroxy Acid or BHA is a form of salicylic acid and a derivative of aspirin. Beta Hydroxy Acid is in skin care products to promote skin cell turnover, help clear pores and smooth skin texture. BHAs penetrate the skin layers more deeply than Alpha Hydroxy Acid, are better tolerated and gentler on the skin. Beta Hydroxy Acid is a naturally occurring substance found in the leaves of wintergreen and sweet birch. Beta Hydroxy Acid has a similar effect of the skin as Retin-A but is less irritating. BHAs can effectively exfoliate oily skin, even within oil-rich pores making it beneficial in treating acne; sun damaged skin and pigmentary disturbances.
BHA ingredients may be listed on packaging inserts as: Beta hydroxybutanoic acid, Salicylate, Salicylic acid, Sodium salicylate, Trethocanic acid, Tropic acid, or Willow extract. Occasionally, citric acid will be listed as a BHA in skin care formulations; although, citric acid is more commonly considered to be an AHA.
The FDA recommends caution when using BHAs and AHAs: applying AHAs to the skin renders the skin more susceptible to sunburn as well as the damaging effects of the sun. When using these products always apply sunscreen. Never use products containing BHA or AHA on children or infants. Due to the risk of skin irritation, always do a test patch before applying these products to a large area of skin. Discontinue and consult your physician if you experience prolonged burning, irritation or stinging. Never exceed the recommended dose.
When doing a chemical peel, several factors determine the extent of the peel: the ingredients used the strength or concentration of the ingredients, whether a pre-peel preparation was applied, the amount of the chemical and the length of time the chemical peel remains on the skin. Variations in skin thickness can also affect the outcome. The skin on the face generally heals more rapidly and is less prone to scarring, infection or skin discoloration than the areas of the neck or backs of the hands.
Chemical peels range from SUPERFICIAL using resorcinol or a natural fruit acid to DEEP using a 35% concentration of trichloroacetic acid. A superficial peel would require a series of six peels, whereas a deep peel would only require one treatment. Recovery time would certainly be more significant with a deeper peel.
THE SUPERFICIAL CHEMICAL PEELS:
A very mild superficial peel is in fact an exfoliation. The upper most layers of skin; the stratum corneum which is the visible layer of the epidermis is thinned or removed during the peeling or exfoliation process. Most chemical peels begin with a preparatory process in which an exfoliating application is applied for two to four weeks prior to the actual procedure. The exfoliating application is preformed using a strong glycolic acid cream, Tazorac , or Renova. The exfoliating process preps the skin to smooth out thickened rough areas of skin to allow the chemical peel to penetrate the skin more evenly and deeply. The vitamin A based exfoliants may also stimulate the production of collagen.
Superficial or Refreshing Chemical Peel:
Superficial chemical peels are a slightly deeper process which removes a thicker portion or even the entire epidermal layer. The superficial peels extend up to 0.06mm to the papillary dermis. This refreshing process helps to even out or reduce the appearance of very mild skin discolorations or blotchy skin areas, helps to cleanse the pores, and reduce any remnants of skin discoloration due to acne. This is the type of chemical peel normally performed by an aesthetician or in a spa location. The superficial or refreshing peel is often done using Resorcinol which results in a deeper peel similar to a sunburn.
Superficial peels do not cause a disruption in your daily routine. This is a series of weekly peels performed over the course of several months. The usual protocol is for 6 consecutive treatments and then a refresher peel every two to three months. Each treatment is cumulative and the previous peel enhances the effect of the next. This peel contains a higher concentration of chemicals than would be available over the counter. Within a few days of each chemical application, one would notice a slight flaking or peeling of the skin. Based on your response to the peel, the next treatment application is adjusted in strength and duration of application. Based on your individual response, it may be necessary to follow up with a daily application of a soothing cream
The active ingredients used to perform the mild to moderate superficial chemical peels include Lactic Acid, Glycolic Acid (AHA), Resorcinol, Salicylic Acid (BHA), Jessner's Peel which is a combination of salicyclic acid, resorcinol and lactic acid mixed in an ethanol base, Trichloracetic Acid or TCA which is also known as AccuPeel and the Obaji Blue Peel. Chemical peels performed by physicians use higher levels of glycolic acid and would be classified as more of a Medium peel.
THE MEDIUM CHEMICAL PEELS
Medium Chemical peels extend through the epidermis, down into the next layer of skin called the papillary dermis which is the upper most portion of the dermis. Medium chemical peels are the level at which the risk of complications are more prone to occur. The preparatory process for a Medium chemical peel involves the use of a broad-spectrum sunscreen for at least a month prior to the actual peel, a bleaching agent usually hydroquinone in a 4% concentration as well as a pre-exfoliation process using a strong glycolic acid cream, Tazorac , or Renova for up to four weeks prior to the peel . The bleaching agent and pre-exfoliation help smooth rough patches of skin and balance the skin tone for a more even peel. Due to the risk of irregular pigmentation, medium peels are not recommended for people with darker skin tones.
The important factor for a successful medium peel is addressing the risk of infection before it occurs. When receiving a TCA peel or non-buffered 70% + glycolic acid peel, an anti-viral medication to prevent herpes is started before the peel is performed. A course of prescription antibiotics may also be prescribed. Buffered peels containing 70 to 99% glycolic acid do not produce the significant type of peeling that you would experience with AccuPeel. Chemicals utilized in a Medium peel include TCA 35-70%, non-buffered Glycolic Acid 70 to 99%, glycolic acid followed by TCA, Baker’s Phenol either alone or under occlusion by tape, or a combination peel incorporating solid CO2 followed by medium strength TCA.
THE DEEP CHEMICAL PEELS:
The deep chemical peels extend 0.45 mm to the upper reticular dermis. This type of chemical peel results in extensive shedding of the upper layers of skin. Your skin appears as if it has suffered a very severe sunburn. For this reason many patients choose to remain at home recovering for up two to three weeks post treatment. During this recovery time, you must avoid the sun completely, avoid any activity or situation that would result in excessive sweating, and limit facial muscle movement as these may result in premature peeling and scarring of the skin. As with a medium peel, it is necessary to pre-treat the skin for at least two prior to treatment with a combination of hydroquinone cream and Retin-A. This procedure is done in an operating in order, control pain and to address any adverse complications. A deep chemical peel consists of a high concentration of trichloroacetic acid or TCA. The acid burns off the skin when applied. The skin will whiten or blanche from the acid, then turn pink or red in color then over the next couple of days the skin begins to peel and shed extensively. You will need to avoid using makeup until all the scabbing has healed.
There is a risk of substantial complications with a deep chemical peel. There is a risk of infection from the open wounds, one may experience uneven skin tone, Hyperpigmentation or darkening of the skin color, Hypopigmentation or lightening of the skin color, excessive skin redness, scarring, peeling of the skin and increased sun sensitivity.
Retin-A or Tretinoin
Retin-A or Tretinoin is used to treat acne. It reduces the formation of pimples and promotes quick healing of pimples that do develop. Use only as directed to minimize side effects which include skin redness, stinging of the skin, skin peeling and sun sensitivity. It may take three to six weeks to see results and during that time, acne may worsen before it improves. Do not apply near the eyes, mouth, or open cuts since this Retin-A can irritate sensitive skin.
RETINOL composed of retinyl acetate and retinyl alcohol , also known as AFRIM is a naturally occurring form of vitamin A found in orange, yellow, or red colored fruits and vegetables. Its effects are similar in nature to Retin-A reported to aid in forming new collagen to help accelerate cell renewal and improve the appearance of fine lines but with much less irritation than Retin-A.
DIFFERIN® also known as adapalene gel is used to treat acne vulgaris. Side effects include dryness of the skin, skin redness, burning, and irritation, itching and peeling.