Dermatology and aesthetics
PeelingWhat is peeling Preliminary treatment Peeling with TCA Indications for peeling with TCA Post-peeling treatment
- What is peeling
- Classification of the various types of peeling
- Preliminary treatment
- Peeling with TCA
- Indications for peeling with TCA
- Post-peeling treatment
The term peeling means a treatment that has the aim of smoothing and improving the appearance of the skin.
It is a very ancient technique, of which numerous witnesses have reached us, in particular from Egypt, Greece, Turkey, India and Babylon.
In the past, different types of substances were used, including sulfur, pumice, powders derived from minerals and plants, as well as shredded flowers and subsequently mixed with other substances of vegetable origin.
Starting from 1882, the German dermatologist Paul Gerson Unna was involved in the study of numerous substances and peeling methods, then publishing the results obtained by experimenting with some substances such as salicylic acid, resorcinol, phenol and trichloracetic acid. In England, however, the dermatologist George Miller Mackee published in 1952 the result of an experiment on the use of phenol in the treatment of post-acne scars. During the First World War, the post-peeling phenol occlusive technique was experimented in France, which was subsequently imported to the United States in the 1930s and 1940s and used for the treatment of wrinkles and post-acne scars.
The use of trichloracetic, salicylic acid and lactic acid became increasingly popular between the seventies and eighties, the period in which the results obtained in the treatment of numerous imperfections and skin pathologies were disclosed with the use of glycolic acid.
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What is peeling
The skin is a dynamic organ that every day eliminates, through a physiological mechanism, an infinite number of keratinized cells.
Chemical peeling is an accelerated form of exfoliation that occurs through the use of a chemical. If it is very superficial, it accelerates the natural exfoliation of the stratum corneum, while if it acts at a deeper level it creates necrosis and inflammation of the epidermis, papillary dermis or reticular dermis.
Chemical peeling creates obvious changes in the skin through three mechanisms of action:
- stimulation of cell turnover through the removal of dead cells of the stratum corneum;
- elimination of damaged and degenerated epidermal cells, which are replaced by normal cells (with a particularly evident result in the treatment of actinic keratoses and abnormal pigmentations);
- introduction of an inflammatory reaction and activation of inflammation mediators (a mechanism still little known), with the consequent production of new collagen and glycosaminoglycan fibers (revitalizing mechanisms of the dermis).
Peels that act at a deep epidermal level carry risks of complications and unwanted outcomes; it is therefore of fundamental importance to follow treatments and therapies that obtain the desired results with the least possible risk.
By performing several superficial or medium depth peeling sessions, a satisfactory and lasting aesthetic result can be obtained through a cumulative result, without the risk of undesirable effects
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Classification of the various types of peeling
- Very superficial peeling: removes only the superficial horny layer.
- Surface peeling: creates necrosis of part or all of the epidermal layer reaching the basal layer of the epidermis.
- Medium depth peeling: creates necrosis of the epidermis and part of the papillary dermis.
- Deep peeling: produces necrosis of the epidermis, papillary dermis and can extend to the reticular dermis; the chemicals used are: retnoic acid, 5-Fluorouracil (5-Fu), Jessner's solution, resorcinol, salicylic acid, trichloracetic acid, a-hydroxy-acids, a-keto-acids (pyruvic acid), phenol.
The depth of the peeling depends on numerous factors, such as:
- the type of substance used;
- the concentration of the substance used;
- the number of passes with the chosen substance on the same area of skin;
- the application technique;
- the preparation of the skin in the phase preceding the treatment;
- the type of skin treatment in the period preceding the peeling;
- the type of skin of the patient;
- the area of skin treated;
- the exposure time of the chosen chemical agent on the skin.
Considering all these variables, it is natural to understand that any classification relating to the various types of peeling cannot be classified mathematically, since, with the same substance, it is possible to obtain a superficial result on a certain type of skin, and on a another subject a deeper peeling.
Of course, the experience, competence and sensitivity of the doctor are indispensable conditions for the success of the therapy.
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