Syllabus for Chemical Peel Class

• Introduction:
  What is a chemical peel?
• History of chemical peeling.
• Ingredients in peeling solutions.
• Peel solutions and applications:
• Contraindications
• What to expect after peel.
• Possible complications
• After care and follow up

History of Chemical Peels

Chemical peels are used today to improve skin’s texture, smooth out skin tone and lighten dark patches or hyperpigmentation, and to improve the appearance of fine lines and wrinkles. They use chemicals to remove the surface of the skin, allowing healthier, smoother new skin to grow in its place. Deep peels, performed with phenol, can treat excessive scarring, severe hyperpigmentation, deep wrinkles and even precancerous growths. Skin peels have a long history, going all the way back to ancient Egypt.

Chemical Peels in Ancient Times

The ancient Egyptians believed that cleanliness was vital to the health and beauty of skin. They were the first to use skin peels. Cleopatra was known for bathing in sour milk, a practice that was common at the time. Sour milk contains lactic acid, an ingredient still used in mild chemical peels today.

The ancient Egyptians also bathed in old wine to achieve the same effect. Wine contains tartaric acid, a fruit acid that is still used in mild chemical peels today.

Chemical Peels in the Middle Ages

Sour milk and old wine remained in use as skin peels during the Middle Ages. Europeans in the Middle Ages began using lead oxide as a main ingredient in facial chemical peels and skin lightening creams. They borrowed this practice from the Greeks, who used lead oxide to whiten their faces. As pale skin became more fashionable from the 15th century onward, skin whitening creams and chemical peels made with lead oxide became more popular. The side effects of applying lead oxide to the skin include disfigurement, muscle paralysis and death.

Chemical Peels in Modern Times

In the early 20th century, Americans and Europeans received chemical peels at spas and health resorts. These facilities produced their own chemical peel solutions. They guarded them chemical peel formulas closely. These chemical peels were mild and no doubt contained some of the same gentle acids that have been used to perform mild peels for centuries.

Medium-depth and deep peels weren’t developed until the mid-20th century. In the1950s, dermatologists began administering medium-depth and deep peels using new ingredients, like trichloroacetic acid, resorcinol, salicylic acid and phenol. These ingredients are still in use today, along with newer ingredients like pyruvic acid and glycolic acid.

The advent of medium-depth and deep peels meant that chemical peels were no longer strictly a cosmetic procedure. Dermatologists could, for the first time, begin treating skin conditions with chemical peels. While mild and medium-depth peels are still used cosmetically, dermatologists can now treat severe scarring, deep wrinkles, severe discoloration of the skin, and even skin cancer using deep chemical peels.

Today, mild and medium-depth chemical peels are popular among those who want to improve the appearance of their skin. Mild and medium-depth peels are appropriate to improve the appearance of fine lines and wrinkles, mild hyperpigmentation, and mild scarring. They are sometimes used to treat mild skin conditions like acne. Mild and medium-depth peels are administered on an outpatient basis, and many people have chemical peels regularly for cosmetic reasons.

Deep peels, however, have a much longer recovery

Ingredients Of Chemical Acid Peels

Alpha hydroxy acids, or AHAs, occur naturally in some foods, although they can be artificially in a laboratory. Naturally-occurring AHAs, however, can be found in such things as sugar, fruit, and even milk (ever hear of lactic acid?)

Here are a few common fruits and the specific acid that they produce:

Almonds: mantellic acid

Grapes: tartaric acid

Apples and pears: malic acid

Oranges, grapefruit, and other citrus fruits: citric acid.

Of all the acids found naturally in foods and other Glycolic acid is derived from sugar cane, and is considered one of the safest and most gentle of all acids used in a chemical peel. Of all the acids, any of the AHAs, such as those listed above, and glycolic acid are the weakest, and thus are used most often.

What is a chemical peel?

• A Chemical peel or skin peel involves the application of a specific solution to the surface of the skin to peel away the outermost layers, revealing the fresh skin beneath.
• Chemical peels are most often performed on the face but may also be beneficial on the neck, chest, back, hands, arms and legs.
• Chemical peels are chemical treatments to produce an improved appearance of the face.
• Chemical peels are used for the treatment of:
  • photoaging (from sun damage),
  • wrinkles,
  • scarring,
  • acne,
  • pre-cancerous lesions,
  • discoloration (dyschromia) or uneven skin tone.
  • Chemical peels produce controlled injury to the skin to promote the growth of new skin with an improved appearance.
  • Many different chemicals are used including glycolic acid, trichloroacetic acid (TCA), salicylic acid, “Jessners“ solution, and phenol

How Glycolic Acid Works?

Glycolic acid is the smallest type of alpha-hydroxy-acid and has many applications in skin care products as a natural skin exfoliant. Its capability to penetrate the skin is key when allowing old, sun-damaged skin cells to shed, renewing the skin’s texture and vitality. By loosening the glue-like substance that keeps dead skin cells on the surface of the skin, glycolic acid can help you gain back that healthy glow.

For those wanting or requiring a deeper chemical acid peel, trichloracetic acid, is often used as a chemical peel. The word “trichloroacetic” itself may look complicated, but when broken down, it actually becomes quite simple.

Trichloracetic acid, also known as TCA, is a variation of ordinary acetic acid. Acetic is an organic compound, found in such products as ordinary household vinegar. In fact, itis this acid that makes vinegar smell like, well, vinegar.

Acetic acid becomes TCA when the three hydrogen atoms that are part of the make-up of acetic acid are replaced with chlorine atoms. Thus, the name tri (meaning three) color (denoting chlorine) acetic (for the acid from which it originated) acid.

The range of depth that the TCA peel achieves varies according to concentration potency (available strengths range from 10% -30%),

application methods: time and pressure, and of course skin type. When applied, the solution

penetrates deep into the skin continually seeking protein to neutralize itself. Unlike the progressive peels such as Glycolic or Salicylic, TCA Peels exfoliate the skin more rapidly upon initial contact. The long-lasting results make it an ideal peel for those who prefer less peeling sessions at the cost of moderate downtime.

Skin types/conditions treated by TCA Peels.

• Fine lines and wrinkles
• Hyper-pigmentation
• Stretch marks
• Acne
• Uneven skin tone
• Due to its antibacterial properties, the TCA Peel is an excellent choice for individuals suffering from chronic acne vulgaris as well as the above.

Salicylic Acid Peel

Salicylic acid is a powerful tool to fight acne and wrinkles. Despite its dramatic results, the salicylic acid chemical peel retains a mild and extraordinarily non-irritating approach to skin restoration.

The well-rounded composition of salicylic acid eliminates skin abnormalities including an excess of dead skin cells, sebum and bacteria.

Acne-Prone Skin

Acne is a multi-staged and progressive skin condition involving three critical factors: clogged pores, bacteria and inflammation. The salicylic acid peel counteracts all three by targeting each individually:

• Clogged Pores: Clogged pores don’t stand a chance against beta hydroxy acid, which exfoliates excess dead skin in and around the pore lining.
• Bacteria: The antimicrobial properties of salicylic acid render it highly effective against the acne bacteria responsible for inflammatory acne. In addition, eliminating bacteria will substantially minimize any existing inflammation.
• Inflammation: Due to its close relation to the popular anti-inflammatory aspirin, salicylic acid also functions as a potentate-inflammatory.

TCA is definitely stronger than the AHAs or Glycolic Acid treatments, and is used, as mentioned earlier, for a more extensive chemical peel.

Extreme care should be taken when using TCA

Phenol acid, also called carbolic acid (yes, it’s the same very corrosive acid that you’ve always heard about and were warned about getting close to) comes from either coal tar or is a particular type of benzene derivative. This acid is VERY STRONG, and is generally only used by trained professionals. Has 3 weeks of down time

Chemical peels are not for everyone.

• Poor general health, for example, should not receive a chemical peel.
• Active infections and certain medications (i.e. Isotretinoin (Accutane) may preclude the use of certain types of chemical peels (especially medium and deep). abnormal scarring,
• Certain skin diseases, (ex: scleroderma, skin cancer)
• Recent surgeries should also not have a chemical peel.
• Recent Laser resurfacing

There are two layers of the skin. The outer layer is called the epidermis and the inner layer, the dermis.

Superficial peels (e.g. glycolic acid, lactic acid) produce very superficial injury, confined to the epidermis. Superficial peels can help improve conditions, such as acne and dyschromia.

Deeper peels, (e.g. phenol peels) produce injury within the dermis and can reverse moderate-to-severe photoaging and wrinkles. In general, the deeper peels offer the most dramatic results but require longer recovery periods and carry a higher risk of complications.

The depth of chemical peeling depends on the type of chemical used.

It’s best not to assume that allow % of acid is less abrasive than a higher percentage. For example:

• Salicylic Acid 20% is almost as strong as Glycolic 50%.
• TCA 30% is a completely different peeling agent and can penetrate into the upper layers of the dermis, causing burns if not used properly.

Jessner’s Solution

What is Jessner’s Solution?

Jessner’s Solution is a skin peel made with a mixture of AHA Lactic Acid and BHA Salicylic acid with the Phenol derivative of Resorcinol.

This peel, which has also been known as the Combe’s Peel was made popular by MaxJessner, a New York dermatologist. He originally formulated the solution to reduce the toxicity and high potency of the individual ingredients.

Skin Conditions Jessner’s Solution Treats

This peel is ideal for an extensive range of skin conditions such as lightening hyper-pigmentation areas, treating acne and acne scars, treating aged, photo-damaged and sun-damaged skin. (Darker skin types particularly African American, should proceed with caution due to an increased risk of post-inflammatory hyper pigmentation from the Resorcinol exposure).

Application

However, the Jessner’s Solution should only be applied by experience professionals. When the professional is applying the solution, they will gently paint onto the skin (it can be layered). Up to 4-6 coats are applied until a white frost develops (this means the peel is getting rid of your dead, dull skin) or until the pain sensation is too intense. Then rinse your face thoroughly with cool water and pat dry. Be sure to wear a light moisturizer and a sunblock every day following the Jessner’s Solution Peel treatment.

Chemical peels usually begin with vigorous cleansing of the skin. The depth of the peel depends on the chemical used.

Very light peels (low potency glycolic acid 10%-20%) penetrate only the dead skin cells that sit atop the epidermis and produce almost no injury.

Sometimes this level of peel is called “exfoliation”.

Jessner Ingredients

Lactic Acid AHA

The Lactic Acid in the peel accelerates the skin’s cells renewal rate which then softens the epidermis and stimulates collagen growth.

Salicylic Acid BHA

The Salicylic Acid exfoliates deep into the lining of the pores torid of dirt, sebum and debris that can cause blackheads, whiteheads and enlarged pores.

Resorcinol

The Resorcinol breaks down dead, uneven and rough skin due to its anti-septic properties it actively sterilizes bacteria upon contact.

Combination of these three ingredients in the Jessner’s Solution result in an even toned, clear complexion.

Jessner’s Solution can be used in conjunction with other peels, such as Glycolic peels, and TCA peels to enhance the effectiveness of the peel.

Medium peels (Lactic, Glycolic 30%-40%) injure the epidermis and stimulate the regeneration of a new epidermis.

This level of chemical peel may produce a burning sensation during the procedure.

Recovery from light-medium peels is quick- thus the name “lunchtime” peel.

Improvement in the appearance of photoaged skin and scarring is noticeable.

Injury to the dermis stimulates formation of collagen and “plumps” up the skin.

Applying a Chemical Peel:

If unsure of your tolerance level, we recommend using a low strength peel to build tolerance. Only leave it on for 30seconds the first time.

Wash face with mild cleanser to remove dirt and oil or makeup.

Apply a small amount of peel solution to a gauze pad and apply to face – avoiding eyes, lips, and insides of nostrils (see diagram below for proper technique).

After 30 seconds to 1 minute (application time may increase with tolerance)

Gently pat skin – no rubbing.

Apply moisturizer to nourish new skin.

SPF 30 or higher is essential.

** a neutralizer is needed for glycolic acid. No neutralizer needed for salicylic or jessners

What to expect:

AHA/BHA peels:

• Temporary redness, light flaking and dryness.
• Will not prevent you from engaging in your normal activities.
• Improved skin texture.
• Use sun protection SPF 30 or higher.

TCA Peels:

• Moderate discomfort and mild swelling.
• Will subside within a week to ten days.
• Your new skin will be very apparent.
• Use sun protection SPF 30 or higher.

Jessner’s peel (6 or more layers):

• Moderate discomfort and mild swelling.
• Will subside within a week to ten days.
• Your new skin will be very apparent.
• Use sun protection SPF 30 or higher.

Possible Complications:

• Hyperpigmentation
• Chemical burns
• Swelling
• Redness
• Allergic reaction

Home Care Instructions after peel

• Wash area with luke warm water and gentle cleanser
• Wear sunblock daily
• No irritants on skin for a week to ten days
• Avoid sun exposure
• No Strenuous exercise, Saunas or hot showers for 24 hours.
• No scratching or picking flaky skin,
• No exfoliation for 10 days.
• Problems or concerns please call