Possibilities of chemical peeling

Igor Kirikevich, dermatologist, Cayetana company

So, let us remember that peeling (from English to peel - to cleanse, remove the peel) is the process of removing epidermal cells, if necessary, penetrating to the dermis, using various methods, to solve any cosmetic problems.

Types of peeling

Chemical peeling is an acceleration, activation of natural exfoliation and chemical resurfacing of the skin using special substances.

Peels are differentiated by the depth of their impact.

Superficial peeling acts at the level of the stratum corneum of the epidermis (glycolic, lactic, azelaic, salicylic, phytic, mandelic acids, trichloroacetic (TCA) in a concentration of 1-15%), retinoids, Jessner's solutions. It is the most gentle and popular type of chemical peeling. After it, you can continue your normal lifestyle, side effects are statistically insignificant. There are practically no contraindications, or they are exaggeratedly emphasized in the literature. Later in the article we will focus specifically on superficial chemical peeling, and why will be immediately clear.

Important: peels with AHA acids, especially glycolic, are the deepest among superficial ones. Further it will also be clear why we focus on this fact.

Medium peeling reaches the basal layer of the epidermis and acts at the level of the dermo-epidermal barrier (TCA, phenol, microcrystalline dermabrasion, laser correction, salicylic acid 30%). The number of side effects and contraindications for this type of peeling is quite large.

Deep peeling reaches the level of the reticular dermis (phenolic, for example). The procedure is responsible, medical, performed under anesthesia, since it is nothing more than a chemical burn of the facial skin followed by regeneration of the epidermis. It is performed in a hospital and is aimed at removing deep wrinkles and scars. The effect lasts for a very long time, up to several years, but can be done only once; the rehabilitation period lasts about 5 months. The procedure is traumatic, has many contraindications, restrictions and side effects. In many developed countries, both Western and Eastern, the question has been repeatedly raised at the state level to ban such procedures due to their extreme health hazard. In a number of countries, “deep peeling”, for example phenol peeling, is prohibited. We will not consider it in this article.

general information

AHAs (alpha hydroxy acids, or fruit acids) are a group of natural organic acids found in fruits, sugar cane, sour milk and wine. They have been used by dermatocosmetologists for over 50 years. It is one of the most popular ingredients in cosmetic products. ANAs are able to affect the condition of the skin at the molecular, cellular and tissue level. Safe. The most common AHAs are glycolic, lactic, lemon, apple, and wine. When applied to the skin, fruit acids have exfoliating, moisturizing, anti-inflammatory, brightening and antioxidant effects, and also stimulate the synthesis of collagen and glycosaminoglycans in the skin.

The exfoliating effect of AHAs is due to their ability to weaken the adhesion (cohesion) of corneocyte cells in the stratum corneum. In response to increased desquamation, cell division in the basal layer is activated. In the lowest part of the epidermis, adjacent to the dermis, there is the so-called germinal layer, also known as the basal layer. It is here that the birth of new cells occurs, ensuring the processes of regeneration of the epidermis.

AHAs have a moisturizing effect on the skin by accelerating the renewal of the epidermis. It is known that on the surface of keratinocytes there is a complex of water-retaining molecules, or natural moistening factor - NMF (from the English Natural moistening factor). NMF is most pronounced in young cells, and in old horny scales it degrades. Accelerated cell division of the basal layer and rapid desquamation of horny scales leads to an increase in the content of functionally active NMF in the skin.

Strengthening the synthesis of glycosaminoglycans and collagen occurs due to the stimulating effect of AHA on skin fibroblasts. Another explanation for the effect of AHA on the synthesis of the intercellular substance of the dermis is provided by the theory of stress. A chemical burn to the skin is a severe stressor, in response to which the skin’s protective systems are activated. This leads to the mobilization of internal resources, increased reparative activity of skin cells, and increased synthesis of vital molecules. The many people who have safely survived burns (including thermal burns) are the best confirmation of this theory. Thus, under the influence of AHA, the epidermis becomes thinner and the dermis thickens. The stratum corneum becomes firmer and more elastic, and small and medium-sized wrinkles are smoothed out on the skin.

AHA acids also contribute to the destruction of melanin, which causes a lightening effect and reduces hyperpigmentation.

One of the main advantages of peeling with AHAs is safety and harmlessness, due to which they allow you to adhere to the most important principle of healing: “Do no harm.” AHA preparations are developed taking into account different skin types and contain various organic acids. Let's take a closer look at them.

Action of AHA acids

Glycolic acid is found in sugar cane and green grapes. Among the AHAs, it has the smallest molecule, so it easily penetrates the epidermal barrier and has the most pronounced effect. It has the ability to reduce hyperpigmentation, reduce hyperkeratinization, smooth out fine wrinkles, improve complexion, normalize the metabolism of epidermal and dermal cells, rejuvenate the skin, restore the structure of collagen and elastin in the dermis, which makes the skin tighten.

Lactic acid is found in sour milk and grapes. It has the most pronounced hydrating (moisturizing) and keratolytic (exfoliating) effect among other AHA acids.

Malic acid is found in many fruits, especially apples and tomatoes. In addition to its exfoliating effect, it stimulates cells, enhancing cellular metabolism.

Tartaric acid, in free or esterified form, is found in ripe grapes and old wine. Has exfoliating, whitening and moisturizing effects. Has a pleasant smell of old wine.

Citric acid is found in citrus fruits. It has the highest molecular weight of all the listed AHA acids. It has a whitening effect on the skin, which is enhanced in the presence of tartaric acid. Has antioxidant and bactericidal properties.

Salicylic acid is a beta acid containing a phenolic group. Not an AHA, but often used in combination with fruit acids to enhance exfoliation. Contained in the form of esters in birch bark and wintergreen leaves. It has pronounced antiseptic, antifungal and keratolytic properties.

Components of drug effects

The strength of the skin irritant effect of cosmetic preparations containing AHAs does not depend directly on the concentration of the acid, but depends on its acidity (pH) and can be fundamentally changed by changing their pH. Thus, a product containing only 2% AHA with a pH of 1.4 is more active than a product with 30% AHA and a pH of 4.0.

For example, many brands offer products with 80 and even 90% acid content! I urge you to treat such information competently and carefully. If such preparations really contained “90% acids,” they would immediately cause a severe chemical burn! But this doesn't happen. And all because such products actually contain not acids in their pure form, but their buffer solutions. Thus, a product with 80% AHA and a pH of 4.5 is “weaker” than a product with 8% AHA and a pH of 1.3. So such drugs have only a minimal and short-term aesthetic effect. But the information that “the product contains 80-90% acids” is only marketing and is aimed at the person’s subconscious: a potential client should be tempted by a “large percentage” of the active ingredient and, accordingly, make their choice in favor of this product.

What is pH? This is the hydrogen potential, which indicates the level of acidity (alkalinity) of substances and is indicated by numbers from 0 to 14. The lower the pH value, the higher the acidity:

• a substance with a pH of 7.1 and above is an alkali;
• a substance with a pH of 7.0 is neutral;
• a substance with a pH of 7.0 down the scale to “0” is an acid.

The natural acidity of normal healthy skin ranges from 4.1-6.1.

It has been scientifically proven that there is a very close connection between the pH of glycolic acid, its effect on the rate of epidermal renewal and the degree of skin irritation. At a pH below 3.0, the acid has a more noticeable stimulating effect, but at the same time a fairly high degree of skin irritation. The latter can be easily eliminated with a properly selected post-peeling preparation.

Indications for all forms of chemical peels

Youth age:

• oily problem skin (seborrhea);
• acne (hyperkeratinization, clogged pores);
• hyperpigmentation, including freckles;
• prevention and care for molluscum contagiosum.

Young age group (25-35 years):

• prevention of photoaging;
• prevention and treatment of human papillomavirus infection;
• very dry skin (feeling of tightness, redness, roughness and/or flaking);
• post-acne. This is a collective concept that unites a complex of persistent skin changes resulting from long-term acne and seborrhea, as well as manipulations carried out to treat these diseases. Post-acne includes: enlarged pores; uneven skin texture; scarring; stagnant spots; post-inflammatory hyper- and depigmentation; persistent erythema and dilation of capillaries.

Middle and older age group (40 years or more):

• preparation for deep dermabrasion and skin plastic surgery;
• stretch marks, scars, scars;
• calluses, ichthyosis;
• hyperpigmentation (chloasma and age spots);
• prevention and correction of cosmetic skin defects (wrinkles, folds, aging skin).

Contraindications for all forms of chemical peels

Contraindications are:

• injuries in the area of peeling;
• previous laser or mechanical peelings (chemical peeling is carried out if at least six months have passed);
• pregnancy (late stages);
• severe and very severe degree of acne - papulopustular stage;
• herpes in the active phase;
• atopic dermatitis;
• demodicosis - acute stage;
• chronic urticaria;
• tall phototypes (IV-VI; i.e., from dark-skinned people of the Mediterranean type - Greece, Turkey, to very dark and dark - Africans);
• rosacea and a large number of inflamed blood vessels;
• warts;
• taking medications containing roacutane (discontinuation of such medications should occur 6 months before the peeling procedure);
• atrophic skin, thinned as a result of age-related changes (chronoaging);
• recent completion of a course of chemotherapy, a course of hormonal therapy for the treatment of acne;
• skin cancer, nevi.

Glycolic peeling

Glycolic peeling is the most popular and widespread type of superficial peeling today. It is the deepest among superficial peels and the most superficial among deep ones.

Action. The use of glycolic acid in the preparation, which has the lowest molecular weight and size, allows you to solve problems associated with hyperkeratosis, dry skin, the formation of fine wrinkles, acne and post-acne. Glycolic acid improves skin hydration and has antioxidant properties. Its mechanism of action is still a matter of debate, but there is evidence that it may act not only as an exfoliant, but also as a direct stimulator of skin renewal. Glycolic peeling is extremely popular among patients, since this acid, even in high concentrations, does not cause such a strong inflammatory reaction and such prolonged redness of the skin as THA or phenol. The face takes on a normal appearance so quickly that glycolic peeling in the West is called lunch-time peel (“lunch break peeling”).

Therapeutic effect:

• rebuilds skin function to a “young”, normal program;
• has a brightening effect;
• has an anti-age effect;
• has a healing effect on acne and post-acne problems.

Research shows that one of the effects of glycolic acid on the skin is to increase its resistance to UV radiation. It is possible to carry out the procedure in the summer, which has been done for a long time by successful cosmetologists in both the West and the East. Ukrainians are still afraid to carry out such peeling during solar activity. However, this is the topic of the next article...

Diagnostics:

• acne (acne disease);
• aging and photosensitized skin;
• very dry skin;
• stretch marks, scars and scars;
• hyperpigmentation;
• oily and problem skin, seborrhea.

Mode of application. We clean the skin of the face, neck and décolleté using a make-up remover that corresponds to the diagnosis. We carry out a light gommage procedure. Apply glycolic peeling (3 ml of the drug) in a thin, even layer with a special fan-shaped brush. To enhance the effect, you can lightly massage the skin with your fingertips. If exposure is prolonged and the gel product dries, you can lightly moisten the surface of the skin with water using a fan brush. Leave the product on for 5-6 minutes, then rinse with plenty of water until the tingling stops. Do not allow the product to get into your eyes or mucous membranes! If the skin is delicate, thin and sensitive, we additionally use a neutralizer for chemical peeling.

At the end of the procedure, we generously apply a soothing cream that corresponds to the diagnosis after chemical peeling and, with gentle massage movements, help the product to be absorbed.

Important! The peeling procedure begins with thorough cleansing of the skin. For this purpose, special pre-peeling products are used, for example, cleansing makeup remover gels with a slightly acidic pH. Do not treat the skin with soap, as this will lead to excessive alkalization of the skin and reduce the effectiveness of peeling.

After rinsing off the cleanser and drying thoroughly, apply the acid to the skin with quick and precise movements in an even layer. We carry out the treatment in the following sequence: forehead, temples, chin, neck. The central part of the face and eyelids are processed last. On the eyelids, the acid is applied to the border with the eyelashes. Glycolic acid is not harmful to the eyes, but during peeling you should always have a container of water nearby so that you can quickly rinse your eyes if acid gets into them.

After applying the acid, the specialist must remain with the client at all times. Accurate timing of the procedure is carried out, as well as an assessment of the patient’s sensations and skin reactions. Even in the case of normal tolerance to glycolic or tartaric acids, the patient feels an intense burning sensation in the first 2-3 minutes, but it should not be intolerable. By the third procedure, the patient, as a rule, adapts and calmly tolerates the burning sensation. However, the patient’s statement “it is very painful, it is impossible to endure” serves as an indication for immediate neutralization of the acid. The same applies to pronounced erythema.

It is advisable that the acids in the preparations are contained in a free and most active state - read the label carefully.

In the first minutes, a moderate burning sensation may be noted, to which the client quickly (1-3 minutes) gets used to it. Slight redness (hyperemia) is also a natural and completely normal skin reaction to acid peeling. The most important objective sign that determines exposure time is erythema (redness). If obvious signs of diffuse erythema appear, the acid should be neutralized immediately. If necessary, after neutralization in more problematic areas (keratomas, deep wrinkles), re-application of the drug is allowed to achieve local, more pronounced erythema.

When correcting cosmetic defects caused by photoaging or the presence of focal hyperpigmentation in a patient, the acid is neutralized immediately after the onset of diffuse erythema. With the biological type of aging, longer exposure to acid is indicated, sometimes until the onset of a targeted “frost effect”.

After the exposure time has expired, it is necessary to completely remove the acid from the surface of the skin. Simply rinsing with water does not ensure complete removal. Therefore, neutralization is an important and responsible stage of the peeling procedure. It is carried out in three stages. First, remove the main amount of the drug using a sponge soaked in water. Then a neutralizer is applied, which stops the peeling completely. Finally, the remaining glycolic acid and neutralizer are thoroughly washed off with water. The procedure ends with the application of a soothing cream after the chemical peel.

Subsequently, the client is advised to wash with cool water and a soap-free cleanser. In the next 2-3 days after the procedure in the salon/clinic, the client should not use creams containing fruit acids at home, as their use can lead to deeper undesirable skin reactions. Minor erythema may be noted immediately after the procedure. In the following days, some may experience mild flaking of the skin, especially after washing and drying the skin with a towel. The effect of the appearance of a “crust” may be observed in places where the skin is thinned or damaged, but this does not last long and goes away within 1-2 days.

Daily care during a glycolic peel consists of washing your face with dechlorinated cool water without using soap or alkaline products and using a soothing chemical peel cream daily.

Exposure time. After the diagnosis, we do a test to determine the tolerance of acid peeling: apply a small amount of acid to a sensitive area of the face (for example, the nasolabial triangle) and monitor the skin reaction. If the client's response is satisfactory, we perform the procedure on the entire face and neck.

For thin and sensitive skin, start with 3-4 minutes. Then gradually, from procedure to procedure, we increase the time to 7-10 minutes. If there is no discomfort and the skin is well adapted, then the exposure time can immediately be 5 minutes.

When performing peeling, “playing” with exposure is the most important element of the procedure and the key to achieving a good result. Monitor the client’s skin reaction and subjective sensations; in case of extreme discomfort (which is very rare), wash off the glycolic peeling with a neutralizer.

The number of procedures depends on the cosmetic problem being solved and ranges from 7 to 10 with an interval of 7-10 days. Important: peeling will not bring the desired result if you perform less than 6 procedures. Inform the client about this!

Number of courses: 2-3 per year, including during months of increased solar activity, subject to daily use of sunscreen. For photoaging, long-term (10-15 sessions) regular peelings are recommended. For biological aging, the use of 2 annual courses consisting of 6-10 sessions is justified.

The skin reaction to glycolic peeling is calm. It does not cause visible or excessive peeling and may be accompanied by only slight short-term redness. Therefore, it is best to plan the procedure either on the eve of the weekend or in the evening. During the procedure, the client experiences various subjective sensations (tingling, pinching, burning, etc.), as well as redness (erythema), which are absolutely normal for glycolic peeling. Before starting the course, the client should be informed in detail about all this. Discomfort quickly disappears already at the stage of applying a soothing cream after chemical peeling.

Additional Information. The chemical glycolic peeling procedure can also be used when working with the body, for example, with a frequent problem of acne on the shoulders and back, after postpartum stretch marks, etc. The technique for working with the body is exactly the same as when working with the face. The exposure time of the peel may, however, be slightly longer from the first treatment because the skin on the back, shoulders and other parts of the body is rougher and less sensitive than the skin on the face.

Medium peeling

Medium peeling and, accordingly, the acids used for this procedure are designed to solve age-related skin changes - such as stretch marks, post-acne scars, superficial hyperpigmentation, wrinkles around the eyes, forehead, upper and lower lips. The effectiveness of the procedure is comparable to laser skin resurfacing. Trichloroacetic acid (TCA peel) and salicylic acid are used for medium or superficial-medial peels. High concentrations of TCA (40-35%) are already classified as deep effects; this is equivalent to surgical cosmetology and requires special conditions for implementation. A number of authors equate such an intervention to the “deep peelings” that we talked about at the very beginning of our article.

A distinctive feature of TCA peeling is that it produces a frost effect (“frost”)—the treated area of the skin turns slightly white. This is a sign of protein denaturation and the formation of a barrier film that prevents further penetration of acid deep into the skin. The cosmetologist determines the exposure time depending on the skin type: on dry, thin and sensitive skin of the face, frost appears literally in the first or second minute of exposure; on the skin of the body, where it is necessary to remove postpartum stretch marks, the exposure is approximately 10-15 minutes.

After TCA peeling, the skin especially needs care: moisturizing, protection from ultraviolet radiation, stimulation of regenerative processes in the skin. Peeling with trichloroacetic acid is done only in the autumn-winter period, when sun activity is minimal - the likelihood of stimulating pigment formation in renewed skin is very high.

Salicylic acid is used for medium peels due to its ability to cause deep and severe peeling. The acid content in the peeling composition can reach 30%. Typically this is a 20-25% solution of salicylic acid in isopropyl alcohol. The action of the acid is keratolytic, anti-inflammatory, antiseptic, and degreasing. Desquamation (rejection, detachment) of the epithelium begins on the second day after the procedure and lasts 5-6 days. The skin becomes soft and smooth, like a baby’s, and after the procedure it needs photoprotective care and hydration. Salicylic peeling is repeated after about 2 weeks, the number of procedures is determined strictly individually.

Final advice

When performing a chemical peeling procedure, use professional cosmetics. There are a great many preparations for chemical peeling on the Ukrainian market. How to figure out what to choose? Professional cosmetics are always more effective and efficient. It solves serious dermatological problems of the skin of the face and body, determined by a cosmetologist or doctor according to the diagnosis. She responds to client requests. At one time, while still a medical student at the Kyiv Medical Institute, the most authoritative doctor Boris Glukhenky, dermatovenerologist, professor, doctor of medical sciences, author of many textbooks on cosmetology, taught: “Her Majesty is diagnostics, and everything else will follow.” This is exactly how I’ll end: “Her Majesty” diagnosis as the key to successful treatment/care, plus the personal competence of a specialist, creates an effective result.