Peeling: conditions for effectiveness

Patients often ignore purchasing cosmetic products for home peeling recommended by a cosmetologist. They explain this by saying that they can see good results even without additional funds. Thus, in some cases, pre- and post-peel care is absent or carried out inappropriately, which leads to an increasing number of dissatisfied patients, complications and adverse reactions that discredit the technique.

The timing of the start and volume of pre-peel preparation and post-peel care depends on many factors. Prescriptions are influenced by the characteristics of the patient’s skin - its type, phototype and concomitant skin pathology, as well as peeling parameters - the depth of its effect, the concentration of acids, the pH of the drug, the characteristics of the active components.

The directions for which pre-peeling preparation is carried out include the following purposes:

• photoprotective agents;
• products that inhibit melanogenesis;
• products that level the relief and adapt to alpha hydroxy acids (AHA);
• means for the prevention of recurrence of herpetic eruptions.

Step-by-step post-peeling care always depends on the characteristics of the peels being performed, so in this review we will consider the main universal points: features of photoprotection and prevention of post-inflammatory pigmentation.

An important pre-peeling preparation measure is sun protection, which is recommended to start at least 2-3 weeks before the first peel. It includes the use of external cosmetics and compliance with regimen recommendations. Sun protection is prescribed to shield melanocytes from exposure to UV rays, which leads to a decrease in the level of melanin synthesis. These measures significantly prevent the appearance of post-peeling hyperpigmentation.

Any peeling, even superficial, is accompanied by a thinning of the stratum corneum, which protects the skin from penetration of sunlight. This leads to a decrease in the scattering and reflectivity of the skin, which causes an increase in solar penetration. As a result, cells that are usually hidden under the thickness of the epidermis are subject to photodamage. On melanocytes, this is reflected in the form of stimulation of melanogenesis, and also increases the likelihood of mutations. Taking this into account, the use of photoprotective agents is mandatory in the post-peeling period.

As the depth of peeling increases, the duration of use of the photoprotective agent and the SPF value increase:

• after superficial peeling, it is recommended to use a cream with SPF of 25 or higher for 2-3 weeks;
• after medium and deep - with SPF 50+ for 6-12 weeks (during the rehabilitation process, the cream can be replaced with SPF 30).

Photoprotective cream should be applied immediately after cleansing the skin in the morning. Application is repeated every 3 hours, regardless of weather conditions (fog or cloudiness) and even when indoors, since the glazing of the premises blocks predominantly UV-B rays, while UV-A rays penetrate almost completely. Halogen lamps, headlights and cathode tubes are also sources of radiation that can induce hyperpigmentation. It is also necessary to take into account the ability of infrared and x-ray radiation to have a similar effect.

Considering that the use of photoprotective agents in practice does not provide complete protection from ultraviolet radiation, it is advisable to formulate regimen recommendations for the patient: avoid direct sunlight, stay in shady areas (if impossible, position your back to the sun).

In some cases, the pre-peeling preparation must include cosmetics containing melanogenesis inhibitors, which include kojic acid, arbutin, azelaic acid, licorice extract, mulberry extract, vitamin C. This group of substances helps to change the metabolism of melanocytes, reduces the level of melanin synthesis and changes its quality, and also has a comprehensive effect on the skin.

• Kojic acid, included in preparations in pure form or as part of an Aspergillus extract, exhibits antityrosinase and antioxidant activity, potentiates leukocyte phagocytosis.
• Glabridin (the main constituent of licorice root) prevents the appearance of pigmentation and erythema that can occur as a result of exposure to UV-B rays, and exhibits antityrosinase and anti-inflammatory activity.
• Glycyrrhizin and glycyrrhizic acid prevent the development of erythema by inhibiting the degradation of endogenous cortisol.
• Mulberry extract contains arbutin and malberoside F, which are active tyrosinase inhibitors, and the latter of them is also an antioxidant.
• Vitamins A, C, E, as a rule, are also included in such products - they have anti-inflammatory and antioxidant activity, protect against UV damage and stimulate epidermal renewal.

These drugs in pre-peel therapy protocols are prescribed in cases of pre-existing hyperpigmentation and a history of pigmentation, with phototypes IV-VI, when planning medium and deep peels, in cases where a history of risks of hyperpigmentation has been identified.

Products of this group (often presented in the form of an emulsion, but for oily skin a gel form can be used) are prescribed 2-4 weeks before the first peeling (the more aggressive the peeling and the darker the skin, the earlier this recommendation must be made). This preparation tactic ensures reliable prevention of the appearance of pigmentation after peeling and improves its therapeutic effectiveness in the treatment of existing pigmentation.

The use of products with tyrosinase inhibitors is also relevant in the post-peeling period in the treatment of pigmentation. It is also necessary to prescribe them to prevent post-inflammatory pigmentation during medium and deep peels. It is recommended to apply cosmetics containing tyrosinase inhibitors 2-3 times a day directly to areas of hyperpigmentation and once a day to the entire face.

One of the common recommendations for pre-peeling skin preparation is the use of home care products containing AHAs. As a rule, products with an acid concentration of 8-15% are recommended. These products are prescribed 2-4 weeks before the first peeling; they are recommended to be used daily in the evening. ANAs in pre-peeling preparation have a number of positive effects: they reduce the thickness of the stratum corneum due to the destruction of connections between keratinocytes; smooth out the skin texture in the presence of areas of hyperkeratosis. This promotes deep and uniform penetration of peeling acids.

Regarding the positive effects of long-term use of low concentrations of ANA, it is necessary to note their stimulating effect on the synthesis of epidermal lipids, an increase in the rate of epidermal renewal, as well as an increase in the thickness of the stratum spinosum.

But, on the other hand, it is important to consider that preparing the skin for peelings using AHA is not always relevant. This largely depends on the composition of the peeling preparations. When working with peeling solutions with high concentrations of acids, low pH, containing conductor molecules, thinning of the stratum corneum and increased skin permeability can lead to excessive penetration of acids and cause undesirable post-peeling phenomena. Also, special caution in prescribing products with AHA must be exercised in cases of initially thinned epidermis, which also leads to excessive penetration of the solution.

These phenomena can be avoided by in-depth study and evaluation by a cosmetologist of the products chosen for work. As a rule, peeling manufacturing companies take into account the nuances of the “work” of their products and provide not only appropriate recommendations for their use, but also produce cosmeceutical products that must be prescribed for pre-peel preparation and post-peel care. Therefore, home appointments and professional peeling should be carried out within the same cosmetic brand, when you need to strictly follow the manufacturer’s recommendations and instructions for peeling. This helps to avoid errors in working with each specific product and reduce the number of adverse events.

Prevention of herpetic eruptions in the general plan of pre-peeling preparation is relevant in patients who have a history of them (in this case, only a manifestation of the disease is sufficient). Prescription of prophylactic doses of antiviral drugs is necessary for peels that affect the papillary dermis, or peels that cause a pronounced inflammatory reaction.

Prescribing pre-peeling care in some cases can help the cosmetologist establish contact with the patient and assess his readiness to follow the doctor’s recommendations. This is a very important point when planning medium and deep peels, the rehabilitation of which takes place mainly at home, and for a successful result the patient must strictly follow the doctor’s instructions. Not only the risk of side effects, but also the final effect of the procedure will depend on this.

First published: Cosmetologist No. 1, 2017