Standard guidelines of care for chemical peels

• Published in: Indian journal of dermatology venereology and leprology 2008-01, Vol.74 (7), p.S5-12
• Main Author: Khunger, Niti
• Format: Article
• Language: English
• Subjects: Acne; Acne Vulgaris - pathology; Acne Vulgaris - therapy; Bacteria; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Chemexfoliation - methods; Chemexfoliation - standards; Chemical weapons; Chemicals; Dermatologic agents; Dermatology; Dosage and administration; Drug therapy; Formulae, receipts, prescriptions; Glycolates - administration & dosage; Glycolates - therapeutic use; Glycolic acid, Trichloroacetic acid, Salicylic acid; Health aspects; Humans; Medical sciences; Methods; Patients; Pharmacology. Drug treatments; Postoperative period; Practice guidelines (Medicine); Psychological aspects; Risk factors; Side effects; Skin - drug effects; Skin - pathology; Skin Aging - drug effects; Skin Aging - pathology; Skin Diseases - pathology; Skin Diseases - therapy; Wound healing
• ISSN: 0378-6323; 0973-3922; 1998-3611

Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians′ qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient′s skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The e