Chemical Peels

Managing acne vulgaris and its scarring is a long-term journey that needs a personalized approach. Factors like age, gender, acne severity, past treatment results, and how well a person follows the treatment plan play a key role. Including Chemical Peel Treatment early on can improve results and help reduce scars while managing acne.

Non-medical options like Chemical Peel Treatment have been around for years, but their popularity has grown recently with new techniques and advancements. These treatments provide fresh ways to tackle acne and scars, especially when traditional medical treatments fall short.

Even the best medical treatments can’t always fully clear up severe acne, leaving stubborn or leftover acne that is tough to manage. Recent studies suggest starting anti-scar treatments, including Chemical Peel Treatment, while still on acne treatment or right after acne clears. This is because a person’s tendency to scar depends on their body’s inflammatory response during healing.

Acting quickly with Chemical Peel Treatment can make a big difference in preventing scars. By addressing acne and scars at the same time, these peels help smooth the skin, reduce redness, and improve overall skin texture. This proactive approach not only treats current acne but also minimizes the long-term impact of scars, giving patients a clearer and more confident outlook.

In an era dominated by lasers, lights, and energy-based treatments, Chemical Peel Treatment in Mumbai remains a leading choice in skincare. Chemical peels have evolved over the years, using graded exfoliation techniques to address various skin concerns. Today, there are numerous peeling agents available in a wide range of formulations, allowing us to effectively target acne, acne scars, pigmentation, wrinkles, and texture issues.

While traditional peels have their benefits, they often require multiple sessions and may not always deliver the desired results. For example, using only glycolic peels can be challenging; high-strength peels may pose a risk of complications on Indian pigmented skin, while low-strength peels often fall short of expectations.

Understanding how peeling agents work at the tissue level has also advanced. When selecting the right peel, factors like formulation complexities, molecular size, combinations, and compatibility must be considered to ensure the best outcome for each specific skin issue. In Mumbai, Chemical Peel Treatment continues to provide reliable and effective solutions for those seeking to improve their skin’s appearance and health.

Based on the new dimension of peel actions, the single agent peels used in the initial years have now paved path for combination of many agents in the same formulation and these combination peels dominate the scene right now. An in-depth knowledge of the dominant molecule in a peel helps one to stay abreast and perform peels with superior results.

Peels are introduced at early stages of anti-acne therapy as they;

• Improve coexisting comedonal and papular acne.
• Alleviate post acne erythema.
• Improve pigmentation at base of healed lesions.
• Improve the depth, contour and cause softening of associated scars.
• Added improvement in texture – glow.
• More youthful appearance of the skin.

Though the alpha, beta hydroxy acids and Trichloroacetic acid (TCA) form the basic peels, we know interplay between these agents is possible and this concept has laid base for development of sound, rational and evidence based revolutionary techniques in peels. The segmental, sequential, rotational, and switch peels are the newer techniques used.

Current trends to optimize outcomes in chemical peels for patient with acne and scars are:

A decision to use a peeling agent as an intervention should be made after thorough priming in a well sun protected, compliant patient who has realistic expectations. The priming agents for different indications do differ and this should be taken into account while prescribing.

Indications need to be carefully selected; an acne patient needs a different peel than an early acne scar patient. For acne patients the stage at which a peel is introduced is very essential. Choice of peel is also based on predominance of acne lesions such as comedonal, papular, inflammatory etc. A younger skin responds well to a different formulation than a mature aging skin and pigmentation and texture issues have to be kept in mind at all times while evaluating the outcomes.

Some of the peels works on the new controlled release principle and are termed as the slow release peels. In these peels a gradual release of the product happens progressively and ensures complete penetration and full action of all components in the solution. The popular Easy phytic peel is composed of three hydroxyl acids with phytic acid, 3 AHA’s are glycolic acid, lactic acid and mandelic acid- the release and action of each is progressive and hence this peel does not need to be ‘Neutralized’ by the physician.

The 3 AHA’s have different rates of penetration in the epidermis, the phytic acid in the easy phytic solution is a large inositol hexaphosphoric acid which fights & neutralizes free radicals, the peeling promotes cell regeneration but during this process it also releases damaging free radicals Phytic acid reduces the cell degeneration induced by free radicals. NO FROSTING should appear-in case of accidental frosting (this may happen if retinol or exfoliating agents have been used) .A sheer vigilance is mandatory as for any other peels. The phytic peel works well for acne residual lesions with early erythematous or pigmented scars of grade 1 or 2. The glycolic acid in the peel works on regeneration and mandelic works on antibacterial and anti-inflammatory properties whereas lactic acid acts as a hydrant and rejuvenating base.

The trichloreoacetic acid peels are very crucial in improving most types of scars. Depth of the peel can be controlled and generally 15 – 25% strength peels in 4 sessions with adequate priming are very helpful in shallow and rolling boxcar type of scars.

Cross technique: A technique consisting of the focal application of higher trichloroacetic acid (TCA) 40% to 65% concentrations by pressing hard on the entire depressed area of atrophic acne scars. This technique is called chemical reconstruction of skin scars (CROSS).

• Performed for fibrotic and superficial as well as deep ice pick scars deep rolling and boxcar scars and shows an excellent improvement in 3 to 5 sittings conducted at monthly intervals.
• Repeated CROSS application destroys the atrophic pit with restructuring and thickening of dermal collagen.
• Best results are seen for fibrotic, ice pick, boxcar scars and dilated pores

CROSS method with dermaroller technique is another way to target improvement in most scars of grade 2 to 3. Cross technique is performed first and in the same sitting followed by a dermaroller therapy in a cycle of 4 to 5 sessions at monthly intervals.

No skin intervention is sans adverse effects and complications.see table 3. Sheer vigilance is of utmost value during peel procedure as most of the adverse effects result from poor priming, noncompliance, wrong peeling agent, etc. Treating skin of color demands additional consideration as one has to focus on preventing pigmentary altercations, so adequate priming and achieving right depth of peel is essential. This is simply achieved by getting the right end point of the peel.

The beneficial fact is that chemical peels can be combined easily with other procedures like comedone extraction, microdermabrasion, subcision, dermaroller, fractional lasers and skin tightening sequentially for better results

Application of a salicylic acid peel 20 -30 % or 30 -50% TCA post extraction is helpful not only in alleviation of retinoid resistant comedones but also prevention of recurrence and inflammation. Addition of an oral and a topical antibiotic post extraction prevents pustular flare.

Better results are obtained by combination of microdermabrasion with chemical peels as it helps enhance absorption and uniform penetration of the peeling agent. Microdermabrasion should proceed a week before the chemical peels. Microdermabrasion before phytic peels which are slow release glycolic peels and TCA peels are to be avoided due to potential risk of deeper inadvertent peel absorption and post inflammatory pigmentary changes which is a problem often encountered while dealing with the skin of color.

Microdermabrasion a week before peels, dermaroller after peels, and comedone extraction before salicylic acid or retinol peels can be combined to achieve good results. Fractionated lasers or fillers can be done following the peels after complete reepithelization occurs and inflammation subsides. However emphasis lays on the physician’s clinical acumen to choose an appropriate patient whose clinical condition seems conducive to such combinations.

With multiple treatment options in conjunction with anti acne medical therapy almost all types of difficult acne and mild scars can be alleviated. Early introduction of treatment modalities prevent progressive scarring in inflammatory acne patients. Choosing appropriate treatment options and combining various techniques are individualized from patient to patient and the onus lies on the physician to choose the safest, efficacious, economical method for alleviating the acne and improving the acne scars.

The information in this article reflects the views of the author only. a qualified health care professional should be consulted before using any therapeutic product discussed. all readers should verify all information and data before treating patients or utilizing any therapies noted in this programme.