Chemical peeling or chemical peeling involves the application of one or more exfoliating agents on the face or in certain areas (carries) in order to destroy portions of the dermis and / or hypoderm, followed by the appearance of a new epidermal and dermal tissue. Chemical peeling is indicated for the treatment of various dermatological conditions: actinic keratosis, sunlight elastosis, pigmentation disorders (postinflammatory, discronics), superficial scars, vulgar acne, rosacea, milli.

The chemical substances used vary depending on the depth of the lesions they produce. So :

– superficial or light peeling – interests the papillary dermis

– Medium peeling – interests the upper part of the reticular dermis

– profound peeling – is interested in the medioretic derma

The most commonly used substances are: phenol, glycolic acid, trichloroacetic acid (TCA), mandelic acid.

TCA is not absorbed through the skin does not produce systemic side effects that can be extremely toxic. Peeling with TCA does not cause very deep burns, so total depigmentation or hypertrophic scarring are far more rare. They can be repeated between 1-3 months.

Peeling with glycolic acid is especially indicated for the treatment of acne. Choosing the right chemical agent is made taking into account the type of skin of the patient.
Prior to the beginning of chemical peeling sessions, a 4 to 6 weeks preparation is recommended with tretinoium and 4% hydroquinone. Tretinoin reduces the thickness of the stratum corneum, thereby increasing the permeability of the epidermal layer to chemical peeling. Hydroquinone suppresses melanocyte activity and prevents tendency towards hyperpigmentation.
Patients who do not tolerate tretinoin will use facial creams with glycolic acid for 4-6 weeks before peeling.
When using phenol, the standard procedure involves the application of adhesive tapes. Peeling should not be done on areas that were taken off during a surgical lifting. The only areas that are suitable for peeling are those around the mouth that have not been surgically altered.

If both procedures are intended, initially surgical lifting will be performed and after 2-3 months chemical peeling.

Peeling with glycolic acid is done through admission for several hours, and the patient can resume normal social activity the next day; the skin gets an intense red look, the color returning to normal after about 12 hours. No scratches or visible skin exfoliation occurs; this treatment can be followed without restriction, over several months, with visible effects of rejuvenation and maintenance of the fresh skin appearance.

Sun exposure is prohibited earlier than 4 weeks, as hyperpigmentation may occur in treated areas that may be definitive. To prevent this complication, it is recommended to use protective creams within the first 2 months of post-peeling.

As possible complications can be:

– non-uniform pigmentation of the face

– nevi hyperpigmentation (moles)

– reactivation of a herpes simplex infection (chemical treatment is postponed for at least 6 weeks from the date of the last infectious patch)

– prolonged erythema (more than 3 months)

– hypertrophic scars

– systemic renal, hepatic and cardiac effects

– milli can occur in the first 6-8 weeks after treatment (to be resolved by a thorough brush wash)

– rhythm disorders

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