Superficial chemical peels: Effectiveness varies, M.D. says

March 1, 2006

To begin, ask the patient what they expect. How much downtime do they want: one day, two days, three days or none? Next, select the superficial peeling agent based on what the doctor and the patient are comfortable with.

Atlanta - Among the infinite array of skincare agents on the market, superficial chemical peels probably rank among the most hyped. And with consumer excitement comes high expectations.

For that reason, it's important for dermatologists to be able to delineate for their patients what the over-the-counter peels and peels performed by nonphysicians can do and what they cannot, according to Harold J. Brody, M.D., clinical professor of dermatology at Emory University, here.

"Superficial peels are very helpful in the treatment of pigmentary abnormalities but generally they do very little - if anything - to treat acne scarring, wrinkles or pre-cancers, and they do not tighten the skin," Dr. Brody tells Dermatology Times. "They make the skin feel better to the touch because they flatten the dead skin cell layer, but many times they don't give any clinical results unless they are repeated five to six times."

Key characteristics

Some key characteristics are apparent with superficial chemical peeling agents.

Generally, superficial peels require weekly or monthly applications and are not as effective as a medium-depth peel. They can safely be used on all skin types and colors, and can also be used to amplify deeper peeling agents. But Dr. Brody cautions that just because one superficial peel might induce some dermal collagen doesn't mean it's going to have any clinical results.

"Some remove only the dead cell layer and are not true chemical peels, but rather a chemical wash," he says. "Still, many aestheticians call them chemical treatments.

"Physicians need to be able to separate the wheat from the chaff for the general public so that they understand what they're getting if they aren't getting the peels performed by a dermatologist," he says.

"Many of the superficial peels exfoliate only the top skin layer and have very little effect beyond that. People need to realize that the theory that all these superficial peeling agents induce clinical changes or the production of collagen is just that: a theory."

Patient education

Dr. Brody outlines some steps dermatologists can take when patients ask about chemical peels. There are four main choices, and all are amplified if the patient uses a retinoid cream both before and after the peels.

To begin, ask the patient what they expect. How much downtime do they want: one day, two days, three days or none? Next, select the superficial peeling agent based on what the doctor and the patient are comfortable with. If they want almost no downtime at all, they should select salicylic acid. If they want a little more downtime, then they should select Jessner's solution. If they want even more downtime, TCA 20 percent would be a good choice. They can also select glycolic acid, although these peels are a bit more unpredictable than the others.

"As long as the patient is using sunscreen and retinoid cream, all of the peels will be evenly applied and they will have some effectiveness," Dr. Brody says. "Generally, there is no blistering or crusting with any of these peels; just a light exfoliation. Basically, they allow for deeper penetration of whatever agents you are putting on the skin. In other words, the retinoids or bleaches are absorbed better because you are using superficial peeling as an adjunct, which is why you see diminishment of epidermal defects and dermal defects that are below the depth of the peel, even though you know the peel didn't go as deep as those defects are."

Which to use?

Whichever superficial chemical peel a dermatologist uses or recommends, the first consideration should be whether to use a proprietary peel, meaning one that is patented.

"Dermatologists owe it to themselves to know what's in the products before they put things on the skin," Dr. Brody says. "It would be foolhardy for a dermatologist to apply something to the skin the ingredients of which are not known."

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