Chemical Peels

Chemical peeling involves the application of chemical agents that act to accelerate the normal process of exfoliation. A variety of chemical agents are used to produce varying effects to the skin. Sloughing of the stratum corneum, produced by superficial chemical peeling, improves skin texture by stimulating the growth of a thicker epidermal layer. These peels are also effective for the treatment of superficial skin lesions. Medium-depth peeling agents produce injury to the papillary and upper reticular dermal layers by their chemical cauterant effect. This helps reverse the effects of photoaging, including the treatment of mild to moderate facial rhytids and pigmentary dyschromias. They are also performed for the removal of actinic keratoses. Deeper escharotic peeling agents act by destroying specific layers of skin, creating necrosis and inflammation in the epidermis, papillary dermis, and reticular dermis. The deeper peeling agents are indicated for the treatment of patients with significantly photoaged skin. Some chemicals may be used as superficial, medium, or deep peeling agents. A number of factors, including the concentration, the number of layers applied to the skin, and the duration of contact of the peeling agent with the skin, may affect the depth of the peel. Understanding the properties of these chemical agents is key to their successful use (Table 30-3).

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