Chemoexfoliation, also referred to as chemical peels or chemical peeling, is a controlled method of causing skin injury by applying caustic substances. It is a relatively inexpensive, quick, and safe therapy, making it a common facial skin resurfacing procedure, alongside laser therapy, dermabrasion, and microneedling.
Chemical peels can refresh and rejuvenate the skin, targeting various conditions based on the peeling depth. Superficial peels, which only penetrate the epidermis, can support the treatment of actinic keratoses, solar lentigines, ephelides, dyschromias, wrinkles, acne scars, and photoaging. Medium peels may be used for treatment of superficial scars, dyschromia and pigmentary disorders, and multiple solar keratoses. Deep peels, affecting the reticular dermis, are utilized for deep wrinkles and scars, heavy photoaging.
The caustic agents used in chemical peels cause controlled kerato-coagulation and denaturation of proteins in the epidermis and dermis. This leads to the release of proinflammatory cytokines and chemokines, inducing targeted inflammation resembling the process caused by microneedling. The normal healing signal cascade is activated, including stimulation, development, and deposition of new dermal collagen and elastin, as well as the regeneration of new keratinocytes. Consequently, the epidermis is rejuvenated, thickened, and dermal volume increases.
The type of chemical peeling agent is determined by several factors, such as treatment indication, desired depth of ablation, skin type, and the patient’s relevant dermatologic history. When used appropriately with the correct technique, nearly all peel solutions and depths have shown excellent clinical success in improving skin tone and texture, while remaining cost-effective compared to invasive procedures.
Superficial peels are generally safe and well-tolerated, with mild discomfort like non-permanent burning and irritation. Scarring rather is rare with superficial peels, as is infection. However, with medium and deep peels, care must be taken to dilute the peel solution at junctions with non peeled skin. There can be other side effects of deeper peels such as allergic reactions, infections, and others.
Pretreatment can enhance outcomes and is often initiated two to four weeks before the peel, stopping three to five days prior to the procedure. Following the peel, patients should apply sunscreen daily and follow a prescribed gentle cleansing regime. The use of moisturizers may also be recommended. A long-term maintenance program is crucial for sustaining the results of chemical peels in most patients. Patient participation and education are essential, with emphasis on the significance of sun protection and proper skincare routines consisting of cleansing, toning, exfoliation, and moisturizing. Realistic expectations should be set, as best results require repeated chemical peels.
For ongoing improvement, using peels less frequently but consistently is beneficial, especially for superficial peels. Medium peels and deep peels should be used judiciously over time to effectively address challenging conditions across multiple treatments.
