Chemical peels and oxidative stress. Prevention of complications

Patients have a lot of questions and the level of trust in cosmetologists decreases when, after chemical depigmenting peeling, instead of whitened, radiant skin, hyperpigmentation appears. The same complication can occur after any other chemical peeling to correct aesthetic imperfections: wrinkles, uneven skin texture, scars, post-acne, etc. Thus, the main task of a cosmetologist is to protect his patient from possible complications.

Excessive melanin formation occurs mainly under the influence of UV rays. But there are many other reasons for the occurrence of this skin color defect: hormonal changes (pregnancy, menopause, taking COCs), injuries, chronic inflammation, some fungal skin diseases (for example, pityriasis versicolor).

No less problematic is the opposite situation - hypopigmentation, which at this stage of study is almost impossible to correct. Its pathogenesis is based on inhibition of melanin production by melanocytes or destruction of the cells themselves. Triggers for a decrease in pigmentation of the skin and its structures can be a supra-threshold emotional shock (against the background of severe stress, patients often complain of cases of sudden appearance of gray hair), long-term dermatological diseases - vitiligo, chronic pityriasis versicolor.

Against the background of internal and external stress factors, the level of antioxidant protection decreases, tissues become more sensitive to active free radicals. This process is called oxidative, or oxidative stress. Under the influence of these substances, the production of melanin is stimulated, and with a long duration or super-intensity of this process, the reserves of melanocytes are depleted and the cells themselves die.

Under the influence of chemical peeling, the activity of free radicals in tissues similarly increases, so if the procedure technology is violated or the antioxidant mechanisms of the skin are depleted, oxidative stress can be provoked. As a result, there is a risk of worsening defects (increased dullness of color, dry skin, severity of wrinkles, irritation) or provoking new complications. Also, the paradox is that all these phenomena are possible when carrying out procedures aimed specifically at their correction.

To minimize possible undesirable effects, it is important to correctly and timely assess the resource capacity of tissues - the ability to withstand short-term stress. First of all, you need to study the level of antioxidant protection and choose a peeling composition based on the existing skin indicators.

All acids can be divided into metabolic (ANA up to 70%), caustic (concentrated ANA, BHA, TCA) and toxic (phenol, as well as kojic, azelaic and ascorbic acids in high concentrations). Thus, fruit acids in low concentrations have a low risk of complications compared to caustic and toxic ones. The more aggressive the impact, the more pronounced tissue inflammation will be (the physiological response of the adaptive systems to any severe irritation and damage).

The pathophysiology of inflammatory processes involves increased production of free radicals. This process is necessary for tissue healing and desired results after a chemical peel procedure. But, on the other hand, the patient’s antioxidant system may not withstand the extreme action of free radicals.

With the naked eye it is impossible to determine the free radical balance in the blood and skin, as well as its resistance to aggressive factors without the risk of complications. Additional research methods can be used to suggest the patient undergo the following examinations for a comprehensive assessment of oxidative stress:

• Determination of levels of biological substances in the blood:
  • ascorbic acid;
  • tocopherol;
  • coenzyme-Q;
  • reduced glutathione;
  • malondialdehyde;
  • 8-OH-deoxyguanosine;
  • β-carotene.
• A smear of sebum to determine the level of non-enzymatic antioxidants in it:
  • ascorbic acid;
  • glutathione;
  • vitamin E;
  • coenzyme Q10

In 2-4 weeks, a general assessment of the patient’s health should be carried out, his psycho-emotional and somatic status, as well as the condition of his skin, should be assessed. The skin of a person with somatic diseases, under chronic stress, with bad habits, disturbed sleep patterns and imbalanced eating habits needs preventive antioxidant protection at least 2 weeks before peeling and 2-4 weeks post-procedure. In such cases, it is advisable to administer vitamin E, coenzyme Q, N-acetylcysteine, zinc and selenium orally, as well as the external use of cosmetics with antioxidant protection.

It is important to remember that you should avoid the use of antioxidants with photosensitizing activity (β-carotene, phytocyanins, etc.) and do not apply products with antioxidant properties (especially ascorbic acid and flavonoids) within 2-4 hours after the procedure, as this may disrupt the chains chemical reactions triggered by chemical peeling and will lead to unpredictable results.

It is important for a cosmetologist to convey to the patient the need to strengthen antioxidant protection long before the proposed procedure, since this is a cumulative process and its duration depends on the initial ratio of free radicals and pro-oxidant factors. In turn, this indicator correlates with the age, general condition, lifestyle and other individual characteristics of the patient’s body preparing for the chemical peeling procedure. A specialist working with acids must be well versed in the mechanisms of their effect on the skin, understand the points of application of specific solutions and the goals of the chosen procedures, since it is necessary to correctly compare the peeling technique with the features of the clinical picture. No less important is the appointment of a general pre-peeling course of oral and external agents.

Correct educational work with the patient in a specialist’s office makes cosmetology more effective and predictable!