Chemical Peels: Peeling Agents and Their Applications
Last week I wrote about the myths and truths of skin peeling, briefly touching on the different types of peeling agents available in the professional world. Today exists a wide variety of formulas ranging from those strictly for medical use and those for aesthetic.
If you offer, or are thinking about offering, skin peel treatments, knowledge of the types of agents available is essential. While duration, Fitzpatrick classification and technique all play a role in determining peeling depth, the peeling agent used is one of the most important factors. There is an art to preparing acid formulations and requires a very specific understanding of acids. I will focus mostly on the agents used in the aesthetic world, as the more intense formulas are only recommended for medical use.
Medical Peeling Agents
These are deep chemical peels that require longer healing times and also increase the potential for complications as they penetrate much deeper than superficial peels (which work at the epidermal level). Some of the most commonly used include:
- Baker-Gordon formula – a combination of phenol, croton oil, septisol soap and distilled water.
- Phenol acid (88 percent solution) – this is a very intense solution and can lead to irreversible hypopigmentation because of its melanotoxicity. It is not advised for dark skin.
- Medical TCA – TCA in higher strengths, such as the Obaji Blue Peel, are performed in medical settings. There is fast absorption, immediate cell necrosis, and penetrates to the dermal level.
Extreme caution must be used with phenol products as they are very toxic and, as I mentioned, pose considerable risk. Cardiac arrhythmia and toxicity of organs have been known to occur.
Aesthetic Peeling Agents: Superficial Epidermal Exfoliations
Many of these acids you will likely be familiar with or at least heard of, and while they certainly come with their cautions, they are not as extreme as the medical-use agents. These include AHA, Azelaic, Salicylic, Retinol, TCA, and Resorcinol.
- AHAs – naturally occurring, nontoxic organic acids. The most commonly used include glycolic (from sugar cane) and lactic (from milk). Others include malic (apples), tartaric (grapes) and citric (citrus) acid.
- Azelaic acid (up to 15 percent) – created by oxygenating oleic acid, an unsaturated fatty acid found in milk fats. This is used as a lightening, lifting and antibacterial agent.
- Salicylic acid – a beta-hydroxy acid extracted from wintergreen and birch. It is a relatively safe, low-risk acid, as it is self-neutralizing and produces a drying and lifting effect. Repeated applications in high-strength doses can result in systemic toxicity.
- Retinol – a Vitamin A derivative that converts to retinoic acid and is a DNA regulator. It assists in the synthesis of collagen, aids in the formation of blood vessels and encourages healthy cell formation.
- TCA (Trichloracetic acid) – will penetrate only if it used in an aqueous base. It is nontoxic, self-neutralizing and keratolytic, and is very effective in low strengths. It can be used alone or in tandem with other acids.
Jessner and red wine vinegar acid (acetic acid) also fall into this category. Jessner is a combination of lower-strength acids (salicylic, resorcinol and lactic, all at 14 percent), which synergize to produce an efficient exfoliating agent with less risk. Red wine vinegar (acetic acid) is an all-natural acid with high antioxidant content. The theory (though not proven) is it produces exfoliation with less free-radical damage, and thus causes less injury to the skin.
This is merely an overview of some of the most commonly used agents…we would be here all day if I went in depth on all that is available. I encourage you to expand your knowledge on the types of agents available, as it will prove to be the most important component in your chemical peel practice.
Question: What acid formulas do you use the most?