Chemical Peels and RetinoidsThe ingredients and concentration obviously play a very big role in determining the ultimate depth of the chemical peel. However, other variables can make a difference such as whether a pre-peel de-fatting preparation was performed, the amount of chemical applied, and the length of time the chemical was allowed to stay on the skin. Another important factor is which area will be treated. The variations in skin thickness can affect the ultimate peel outcome. For instance, the face usually heals far more rapidly and typically experiences far fewer complications (such as discoloration, scar formation and infection) than areas such as the backs of the hands or neck. Chemical peels are classified as being SUPERFICIAL or DEEP. The superficial peels include the naturally occurring fruit acid peels, or the chemical resorcinol. These peels need to be performed about six times. The deep peels include the TCA (or trichloroacetic acid 35%) peels, which only need to be performed once.
THE SUPERFICIAL CHEMICAL PEELS: Very Superficial: This really isn’t a true peel, more of an exfoliation. The most superficial layers of the stratum corneum (at the top of the epidermis) is removed or thinned during exfoliation. Most chemical peels have a preoperative regimen of using exfoliating agents such as Renova, Tazorac or a strong glycolic acid cream for 2-4 weeks prior to the actual procedure. This helps the chemical peeling agents penetrate more deeply and evenly. The use of these exfoliants also have the obvious beneficial properties of smoothing out thickened rough areas, helping self tanners go on more evenly and helping other skin rejuvenation products reach deeper tissues. Additionally, there has been good evidence that vitamin A exfoliants can help stimulate collagen deposition. Superficial: Superficial chemical peels remove skin through a portion or the entire epidermal layer. These are the “refreshing” forms of skin peels. They can also help with reducing the appearance of very mild blotchy skin discoloration, remnant acne discoloration and help cleanse the pores. This is the most common form of peel that you would find performed in a spa or by an aesthetician. Higher levels of glycolic acid are typically used by physicians falling toward the Medium range. Resorcinol peels can cause a slightly deeper peel much like sunburn. Superficial peels do not interfere with your normal everyday activities, so you need not take time off work or stay at home out of the public eye. In other words, these peels are a full treatment program over several months. The peels should be performed weekly, as they contain a concentration of ingredients which are far higher than those sold over the counter or applied by beauty therapists. It is also important not to abandon this treatment prior to having had the full course, because the treatments are cumulative and the previous one enhances each subsequent treatment. The ideal number of treatments is six. Several days after each of the peels, flaking or light peeling of the skin will occur. Subsequent weekly peels have their strength and length of application adjusted according to your individual previous response. It may be important to combine the regular applications at the clinic with an ongoing treatment, which you perform yourself, using special creams, on a daily basis. After your treatment, it is recommended that you have a peel done every 2 to 3 months as on-going maintenance. Active ingredients used in mild to moderate chemical peels: Glycolic Acid (AHA), Salicylic Acid (BHA), Lactic Acid, Jessner’s Peel (a combination of salicyclic acid, resorcinol and lactic acid mixed in ethanol), Resorcinol, TCA (Trichloracetic Acid) TCA is used in a variety of peeling regimens such as AccuPeel and the Obaji Blue Peel.
THE DEEP CHEMICAL PEELS: The superficial peels extend 0.06mm to the papillary dermis, while the deep chemical peels extend 0.45 mm to the upper reticular dermis, causing extensive shedding of the upper skin layers. Your skin will look as if it has had a very severe sunburn, so most patients choose to remain at home and out of the public eye for 5-7 days. However you are welcome to leave the house, as long as you don't go out in the sun at all, exercise heavily causing excessive sweating, or move your facial muscles more than absolutely necessary, as this may cause premature peeling of the skin resulting in scarring. Your skin needs to be pre-treated for two weeks prior to the procedure, with Retin-A cream and hydroquinone cream. These creams prime the skin, and prevent hyperchromasia (darkening) occurring after the peel. The peel consists of a high concentration of trichloroacetic acid (TCA), which burns, when applied. For this reason, it must be applied in an operating room under very controlled conditions, so that treatment can be given to help prevent any pain. During the peel, your skin will blanche (whiten) and then turn pinkish in color. Over the next few days, the skin will peel extensively. It is important not to pick at it. You will be given clear instructions on your follow-up skin care program at home. Seven to ten days after the procedure, you will be advised to continue using hydroquinone cream, and permit the use of makeup once all the scabs have healed. These complications can occur with the application of chemical peels:
Active ingredients used in deep chemical peels: Baker’s Phenol. Medium: Dealing with infection preventatively is important here. For non-buffered glycolic acid and more commonly TCA peels, the use of antiviral medication (herpes prevention) started before the peel is performed is very helpful. The use of antibiotics is sometimes also used. It is absolutely CRUCIAL that you not pick at the peeling skin during the healing phase. This is a sure way to end up with an infection and long lasting problems such as scarring or skin discoloration. Often the use of emollients during the first few days is incorporated in addition to the continued use of sunscreen, and a very mild cleansing agent. Make-up is often avoided until the skin has fully peeled away. Buffered peels such as the M.D. Forte Glycolic Acid peels that range from 70-99% do not cause the type of significant noticeable peeling that you can see with peels such as AccuPeel. However, a series ranging from 6-12 Forte peels compared to usually 1 of the AccuPeel are utilized. Skin sensitivity, degree of skin concerns, time down, and cost will determine the selection. Examples of chemicals used for a medium peel include: Glycolic Acid 70%+ (non-buffered), TCA 35-70%, combination peels such as solid CO2 followed by medium strength TCA, and glycolic acid followed by TCA. Deep: This peel goes through the epidermis, papillary dermis and into the deeper portion of the dermis known as the reticular dermis. These peels are not a simple procedure. Absorption of the active ingredient, phenol, has been known to cause cardiac arrest and even death. Patients who undergo phenol peels should be placed under general anesthesia and on full cardiac and pulmonary monitoring. This is one of those procedures that emergency back-up is going to determine the outcome if something goes wrong. An anesthesiologist should be present, and preferably have this procedure done in a surgical setting, not just a room adjacent to the doctor’s office. The down time from this procedure is obviously the longest, 2-3 weeks is generally required before you want to be seen in public. Due to the depth of the peel leaving deeper tissue exposed, there is an increase in photosensitivity to the sun. Examples of ingredients used in deep peels include: Baker’s phenol alone or under occlusion by tape.
VITAMIN C VITAMIN C is an anti-oxidant which is believed to help protect cells from the damage of free radicals, molecules resulting from environmental pollution and ultra-violet light rays. To be effective topically, the Vitamin-C-containing product must be at an acidic pH and contain at least 10% L-ascorbic acid. It has been known to cause irritation and stinging when applied to the skin. Although it may act as a mild natural sunscreen, it is not adequate protection and should be used with a high-SPF sun block.
TOPICAL RETINOIDS
Retinoids are derived from Vitamin A. Creams containing the retinoids such as retinol and retinaldehyde can be obtained over the counter at pharmacies and supermarkets. Other topical retinoids containing tretinoin or isotretinoin require a doctor's prescription in many countries. Adapalene or Differin is a related prescription medicine. Topical retinoids can be applied to any area but are most often used on the face, the neck and the back of hands. Topical retinoids are effective in the treatment of mild to moderately severe acne. In the last few years tretinoin has also been shown to reverse some of the changes due to sun damage. If used long term, it may reduce some fine wrinkles, freckles, comedones (whiteheads and blackheads), and solar keratoses (dry scaly sun-spots). Retinoids can irritate the skin and increase the chance of sunburn and are not recommended for sensitive skin. Excessive use results in redness and peeling. The trade names of the more potent topical retinoids available by prescription are:
The exfoliating agent with the longest market use is TRETINOIN, or RETIN-A. (Its patent ran out recently; thus, there are other brands of tretinoin currently on the market, such as Avita. Renova is the same as Retin-A 0.05% in a perfumed, moderately more emollient cream.) Tretinoin or trans-retinoic acid, is a naturally occurring form of vitamin A. It is applied to the skin as a cream, liquid, or gel to treat mild to moderate acne. Other uses for tretinoin are under investigation. It acts as a chemical peeling agent which helps the skin to renew itself more rapidly. By increasing the rate of turnover of the skin, it reduces pimple and blackhead formation. It is commonly used to treat acne as well as to treat fine wrinkling. Tretinoin requires a prescription and has a number of common side effects--such as burning, redness, itching, peeling, and stinging; but it is very effective at increasing the shedding of corneocytes, the cells of the topmost layer of the epidermis, contributing to smoother-feeling skin. It also reduces pigmentation and more evenly distributes pigment in the epidermis, resulting in the improvement of mottled hyperpigmentation. Over time, tretinion can normalize atypical cells in the epidermis and stimulates the formation of a band of new collagen in the upper dermis, helping to lessen fine lines, and can cause new blood vessels to develop in the upper dermis, resulting in redness (or a "rosy glow," or flush to the skin) and reduces sallow skin hues. It may prevent collagen and elastin breakdown, helping to offset further damaging effects of sunlight. However, use of tretinoin greatly increases susceptibility to sunburn--making the use of effective photoprotective measures imperative. It produces significant photosensitivity, which means that sun exposure will create a more rapid rate of sunburn than if you were not using tretinion. It also makes the skin rather red, dry and flaky. For people who already have sunburn or windburn, dry or chapped skin, it could worsen these conditions. Tretinion is also contraindicated in pregnancy because Vitamin A acids, particularly those taken orally, can cause severe birth defects. This is also true for women who breast feed. We continually update this site to keep you informed of the latest scientific findings about rosacea. Click below to access another page within the INTERNATIONAL ROSACEA FOUNDATION site, or a related website. [Symptoms of Rosacea] [Ocular Rosacea] [Acne Factor] [Dermatitis Factor] [Lifestyle Recommendations] [Oral & Topical Antibiotics] [Non-Prescription Treatments] [Prescription Treatments] [Topical Steroids] [Chemical Peels & Retinoids] [Laser Treatments] [Glossary] [Summary] [Citations] [International Rosacea Foundation Home] [Clinical Trials Resource Center] |