By Stephen Ho, MD
The use of chemical peels dates back to ancient Egyptian times. However, over the past few decades, the science behind chemical peeling has advanced dramatically to improve our understanding of the process. In a recent review by the International Peeling Society published in the Journal of the American Academy of Dermatology, superficial peels are again validated to be effective for mild to moderate acne and melasma, which dermatologists have been utilizing for a long time.
Superficial peels produce injury limited to the epidermis (top surface layer of skin), which make them quite safe overall. Common superficial peels include glycolic acid, salicylic acid, Jessner’s solution, trichloroacetic acid (TCA) 10-35%, and others. Some of the modern commercial peels will contain unique combinations of peeling agents, such as the PCA Sensi Peel® with TCA, lactic acid, azelaic acid, arbutin, and kojic acid to capture the various benefits from these active ingredients while remaining quite gentle and applicable to all skin types (one of our favorite peels applied by our highly trained aestheticians at AboutSkin Dermatology in Greenwood Village and Lone Tree Colorado).
Salicylic acid (SA) peel in 20-30% concentration is a classic option for acne with known anti-inflammatory, antimicrobial, and skin brightening properties. Because salicylic acid is lipid soluble, it is particularly effective to help treat clogged follicles or blackheads, as well as improving other inflammatory acne lesions. It is safe in all skin coloration types (from fair to dark skinned).
Another option with success in treating acne and acne-prone skin is to combine the benefits of a salicylic acid peel and microdermabrasion with DermaSweep or SilkPeel (medical microdermabrasion with dermal infusion). These devices are allow for infusion of salicylic acid into the skin during a microdermabrasion procedure, allowing for improved penetration into the pores and targeted skin layers.
Jessner’s solution consists of 14% resorcinol, 14% salicylic acid and 14% lactic acid in 95% ethanol. It is a superficial peel we use to treat skin pigmentation, such as melasma. Because the treatment effect is quite uniform and rarely goes deeper than expected, it is a good choice for patients with thin and sensitive skin.
Pre-treatment before any chemical peeling could include the use of a topical retinoid, such as tretinoin cream, for 2-4 weeks to promote a uniform treatment effect and improving healing time. The tretinoin cream might be stopped 1 week prior to the peel, especially in darker skin types, in order to prevent over-penetration of the peeling agent and subsequent prolonged post-peeling discoloration issues.
Sun protection is vital before and after any chemical peel procedure to optimize cosmetic outcomes. I prefer physical blockers like zinc oxide, such as EltaMD UV Daily sunscreen.
We perform many of these superficial chemical peels at AboutSkin Dermatology in the Denver area (Greenwood Village or Lone Tree). Feel free to call and speak with one of our cosmetic coordinators if you have questions about the procedures that we offer. Thanks for reading!