Peels are solutions applied to the surface of the skin to strip away the outermost layers, revealing the fresh new skin beneath. They are used to treat a variety of skin conditions from dryness or dullness to acne, rosacea and pigmentation.
Ingredients range from naturally occurring chemicals to herbal extracts, to synthetic chemicals and their effects from mildly brightening to quite aggressive resurfacing.
Most peels are recommended as courses of treatment by dermatologists or skincare professionals, with the stronger solutions requiring fewer applications.
Natural peels
Alpha hydroxy acid (AHA) peels are the mildest option available in salon treatments and can be used on most skin types without sensitivity. They use lactic, fruit or glycolic acids to treat dryness and improve skin texture. While lactic acid is primarily moisturising, glycolic acid works by drawing moisture up through the epidermis into the superficial dead skin cells. As dead skin cells can’t hold moisture, they burst and break away from their healthier, fresher and more flexible counterparts. Glycolic acid works via its pH level, making the skin temporarily more acidic, and the size of its molecules, which enables penetration to the deeper skin layers.
Citric, malic and tartaric acids combined with glycolic acid act as antioxidants, while lactic and hyaluronic acids dramatically increase the water-holding capacity of the skin. These combinations remove dead skin cells while enhancing the environment for and production of healthy cells.
Beta hydroxy acid (BHA) peels use salicylic acid to speed the skin cell shedding process and improve blemished skin.
Chemical peels
Chemical peels are higher strength solutions that may cause stinging during application and some flaking after treatment.
Physicians’ Care Alliance (PCA) peels are used for oilier, thicker and more resilient skin types and sun-damaged skin, as well as cystic acne and asphyxiated skin (dry on the surface, oily underneath). They blend alpha hydroxy, kojic and salicylic acids with hydroquinone to obtain even skin tone and provide more exfoliation. PCA peels containing bleaching agents such as resorcinol and kojic acid are used to treat pigmentation problems such as melasma (hormonal pigmentation), sun damage and hyperpigmentation as a result of acne scarring.
Retinoic acid peels are medical strength chemical peels that use 1 percent pure retinoic acid combined with various strengths of alpha and beta hydroxy acids. This type of peel is used to treat acne, rosacea, fines lines or severe sun damage. A retinoic peel penetrates to the deeper skin layers to stimulate collagen and elastin production and the formation of healthy blood vessels. It reduces hyperactivity of oil glands and clears blocked pores, refines texture and improves scarring.
During the first couple of days after treatment skin will feel tight and shiny. Shedding may range from fine flaking to sheeting, with the entire process taking between seven and 10 days.
Jessner’s peels are primarily used on patients suffering mild acne, acne scarring and photo damage. A mixture of resorcinal, salicylic acid and lactic acid, this peel produces more peeling than the AHA peel and is used for patients who require a deeper treatment.
The Jessner’s peel often turns skin bright red rather than pink at the time of the peel and causes moderate stinging. During the next couple of days the skin may develop a mild red-brown colouration. The skin thickens then exfoliates for an additional two to four days. Normally the skin appears wind-burned with moderate flaking. With a stronger Jessner’s peel the exfoliation may last as long as eight to 10 days. Some sheeting may occur.
Trichloroacetic acid (TCA) peels are medical strength peels used to induce a more profound resurfacing effect on the skin. They are often used when both AHA and PCA peels have been insufficient to treat sun damage or pigmentation problems and are quite effective for treating moderately wrinkled skin.
After treatment the skin will appear sunburnt and will flake. Healing occurs after about seven days with the skin appearing pink and fresh. Skin returns to normal after approximately a month. Exposure to sun must be avoided.
Phenol peels offer a more aggressive form of treatment as the skin produces less pigment as an after effect. This is the deepest chemical peel used for severe wrinkles and sun damage. The chemical phenol is combined with croton oil and an agent allowing deep tissue penetration.
As phenol can affect the kidneys and heart, people with these health conditions are not suited to this treatment and, because of the depth of the peel and its whitening effect, it is not suitable for dark-skinned patients.
The procedure normally takes at least an hour in a hospital setting and recovery usually more than a month. This medical peel is now rarely used.
Post-peel care
Dryness, redness and peeling can be expected for up to a week after the PCA, Jessner and TCA peels. This is similar to sunburn and it is imperative that the peeling skin is not picked at or rubbed as it may scar. Makeup may be worn to cover this, depending on doctors’ instructions. Using a creamy unscented moisturiser helps relieve the tight sensation of treated skin. A mild topical steroid cream or ointment can be used to soothe temporary swelling or redness.
During the healing phase of the peel, patients cannot use scrubs, masks, astringents, toners, retinoic acid or AHAs. Use of these products can be resumed 48 hours after the peel has fully healed. All types of peel electrolysis, waxing, bleaching or dyeing hair and exposure to the sun or solariums should be avoided for a few days to a week. Sun block may be applied to the skin if it is necessary to go out into the sun.
Chemical peels are often used as a safer method of skin rejuvenation than other forms of resurfacing. Over-sensitivity to a peel solution may indicate that the peel is not suitable. Jessner and TCA peels may cause sensitivity in some skin types. Deeper peels may make the face feel hot or in some cases may cause slight swelling, which usually subsides after the first day or so. Colour abnormality or variation may be more pronounced after the peel and this normally resolves with time.
Salon or clinical peels should always be applied by an appropriately trained professional.
