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Chemical Peels

WHAT IS CHEMICAL PEELING?
Chemical peeling is the use of various chemical agents to remove the upper layers of the skin. There is no significant systemic effect of these agents. The indications for this procedure are to remove some effects of photoaging (sun damage) such as multiple solar keratoses, pigmentation abnormalities, excessive poriness, and fine wrinkling. Chemical peeling works best on persons who have naturally light complexions, have spent a great deal of time outdoors, and are interested in avoiding further sun damage. Depending on the type and strength of agent used the chemical peel can have a "freshening" effect on the skin surface or work more deeply to treat discrete blemishes. Deep wrinkles, scars or lax skin will not be removed. To affect deeper layers and wrinkles use of the Ultrapulse C02 laser, dermabrasion, or deep chemical peeling would be required. Chemical peeling is not indicated for the treatment of skin cancers.

WHAT IS THE PROCEDURE LIKE?
Chemical peeling is generally well tolerated. After cleansing the skin thoroughly to remove oils, the peeling agent is carefully applied. Within minutes there is a very warm sensation that feels like a sunburn. This lasts for a few minutes and is rapidly relieved by the application of cool compresses. When the procedure is completed, a moisturizer may be applied. Occasionally there may be some swelling, especially around the eyes for the first 2 days, but discomfort is minimal. By the 3rd and 4th days, the skin has a "tight" feeling and sheds. This is replaced by skin with a pink color and smooth texture, usually on days 5 to 7.

WHAT ARE THE POTENTIAL COMPLICATIONS?
With the proper patient selection, side effects are rare. Complications that have been reported include:
  1. Pigmentary abnormalities. This is especially true in dark skinned persons, and can result in excessive lightness or darkness. Sun exposure soon after the peel can contribute to irregular pigmentation.
  2. Accentuation of certain blemishes such as dilated blood vessels and moles.
  3. Persistent pinkness and sensitivity to sunlight which may last for several months.
  4. Scarring can occur if non-facial areas are treated such as the neck and hands. Rarely scarring can occur on the face.
  5. Herpes infection. Patients with a history of "cold sores" or "fever blisters" (which are caused by the herpes virus), can have an outbreak after the procedure. It is important to inform your doctor of a history of these lesions so that a medicine can be prescribed to help prevent a possible recurrence.
WHAT ARE THE ALTERNATIVES TO CHEMICAL PEELING
Multiple solar keratoses can be treated by:
  • Cryotherapy (liquid nitrogen freezing)
  • Fluorouracil, a chemotherapeutic agent applied daily for 3 to 6 weeks causing inflammation and eventual resolution of keratoses.
  • Surgery by shave excision, curettage or dermabrasion.
  • No treatment. A small percentage of solar keratoses can become invasive skin cancers. Furthermore, numerous keratoses make it more difficult for your doctor to identify early skin cancers.
Wrinkling can be treated by surgery or collagen injections.

Pigmentation abnormalities will partially respond to sun avoidance, Retin-A cream and mild bleaching creams.