Peeling is applying a chemical agent to exfoliate the epidermis by remodelling the collagen and elastin fibres in the dermis.A peel removes several layers of sun-damaged skin cells, leaving fresh skin with a more even surface and color.It may stimulate new collagen to be formed, improving skintexture.The result of the first peel may be disappointing, but after repeated peels, significant improvements is usually evident. 

Principles of chemical peels

1. Exfoliation of the superficial dead layer of skin (Stratum Corneum) 

2. Promotes collagen production

3. Stimulates new cell growth 

4. Cleansing of clogged pores

5. Reduces production of the sebum by the oil glands 

6. Regulation of moisture level.

Principles of chemical peels

⦁ Exfoliation of the superficial dead layer of skin (Stratum Corneum)

⦁ Promotes collagen production

⦁ Stimulates new cell growth

⦁ Cleansing of clogged pores

⦁ Reduces production of the sebum by the oil glands

⦁ Regulation of moisture levelChemical Agents used for peeling

1]AHA----Alpha Hydroxy Acids- i.e. Glycolic Acid, Lactic Acid, Mandelic acid

2] BHA----Beta Hydroxy Acids- i.e. Salicylic Acid

3] PHA----Poly Hydroxy Acids – combination peel 

4] TCA----Trichloroacetic Acid 5] Phenols----Carbolic AcidTypes of peels

⦁A] Very Superficial ----Glycolic acid

⦁B] Superficial ----Lactic acid

⦁C] Medium ----PHA, Salicylic acid, TCA

⦁D] Deep ----PhenolsOf these peels, the Alpha Hydroxy Acids are the most commonly used.Introduction –Benefits of AHA’s were first discovered by Dr. Eugene van Scott in 1970.AHA- Alpha hydroxyl acids----They are also called fruit acids as they occur naturally in certain fruits.Different AHA’s with their sources-----

⦁ Glycolic Acid – Sugarcane

⦁ Lactic acid – Fermented milk

⦁ Mandelic Acid –Bitter Almonds

⦁ Malic acid – Apples

⦁ Tartaric acid- GrapesOf these the Glycolic acid & Lactic acids are used generously.Glycolic acid has the smallest molecular weight and is easily able to penetrate the skin. It is a weak acid. It has a keratolytic action. with higher pH it acts as a moisturizer. Since it is a weak acid, it does not have a self-neutralizing action by coagulation of proteins hence it has neutralized with water or a weak buffer.Glycolic acid results in superficial skin injury and are well tolerated-the ‘lunchtime’ peel. They remove a thin lesion on the skin surface, reducing pigment and surface dryness.There are newer glycolic peels that are most potent and still do not irritate. These peels contain Strontium Nitrate. One such brand widely used is Refinity (70% Glycolic acid+Strontium nitrate30%) and Cosmodrome (50%Glycolic acid +Strontium nitrate 50%)

INDICATION OF GLYCOLIC ACID

1) Acne

2) Hyperpigmentation

3) Freckles

4) Fine lines and wrinkles

5) Sunspot

6)Open pores

7) Clogged pores

8) Under eyes dark circles

CONTRAINDICATIONS:

1)Active infection [Herpes Simplex]

2) Open cuts

3) Photosensitivity

4) Past reaction to the peels

5) Facial surgery in three months.

6] Sensitive Skin.

7] Un cooperative Patient.

QUALITIES OF GLYCOLIC ACID:

1]Full face or spots

2] Very superficial

3]Expensive

4]Long life

5] Available as liquid

6] Difficult to prepare

PRIMING:Preparing the skin before the peelPriming is done for 10 days daily with a lower concentration of glycolic acid (6%) applied only at night. Stop application on days 11,12,13th and the peel are done on the 14th day.

BENEFITS OF PRIMING:

1) More uniform penetration of the peel

2) Reduces the risk of hyperpigmentation

3) Reduces wound healing time.

PEEL SENSITIVITY TEST:It is done on the side of the neck to detect sensitivity to the peeling agent. During this first apply 20% GA and watch for 3 mins. The patient will feel slight burning or itching sensation. If this sensation is mild with no redness in the area for 3 mins that means the patient can tolerate the peelon the face. So, wash the peel with cold water and proceed to the face.On other hand, if after application you notice redness within 1-2 mins then immediately neutralize the part. Dilute the peel with 2 drops of rose water, and repeat the test patch on the other side of the neck. If patients tolerate this then do the diluted peel on the face.On the day of peel:Materials Required for peel----⦁ Required peel [ Glycolic, Acne Peel etc.]

⦁ Neutraliser

⦁ Measuring cups x2

⦁ Brush x 2

⦁ Cleanser

⦁ Vaseline

⦁ Earbud

⦁ Headband

⦁ Cotton, Tissues.

⦁ Rose water

⦁ Eye pads

⦁ Mask

⦁ Sunscreen 

PROCEDURE:1)Elevate the client's head by 45 degrees.

2) Tie the Headband

3) Cleanse the face with pre-peel cleanser (to be used according to the skin texture, i. e. oily, normal, dry, etc)4)Apply Vaseline to sensitive areas like the outer and inner canthi of the eyes, angle of the mouth, and nose with an earbud.

5) If the client is about to undergo peeling for the first time, then a Peel Sensitivity Test should be performed.6) Apply 1 ml 20 % Glycolic acid in stroke with a peel brush. As you touch the peel brush on your face starts the timer. Strokes should be outward to inward, single stroke application approximately time of application should be 45 secs and peel to be kept for 3 mins only. This 3 min includes your time of application also.7) Mild itching and burning sensation are experienced, which is normal.8) After 3 mins, dab the under eye and upper eye with cold water 1st then neutralize the rest of the face with 2ml of neutralizer.9) Neutralization of peel can be done 2-3 times in the same manner During neutralization patient feels a warm sensation. This is due to the acid-base reaction.10) Then clean the face with cold water and give a cold compress to the face when the patient complains of any burning.11) Apply face mask [hydrating, whitening] for 20 mins.12) Remove the mask and apply sunscreen according to the skin type.Precautions: While doing peel if there is unbearable burning, stinging, or frosting immediately neutralize the peel with a cold compress.POST PEELING CARE –1) Can wash with plain water after 2 hours. Soap can be applied after 12 hours.2) There will be mild redness for 1-2 hours.3) Avoid direct sunlight. Apply sunscreen 20 min before sun exposure.4) Avoid swimming and sweating for 2-3 days.5) No facial bleach, threading, waxing, or plucking for 7 days before and after the peel.6) Avoid make-up for 12 hours.7) Do not use medicated cream for 2days before and after the peel.8) Do not pick, picking delays healing and causes scarring.9) Moisturize- use moisturizers after the peel.OTHER PEELS1) BETA HYROXY ACID – SALICYLIC ACID –Salicylic acid is derived from sweet birch, willow bark, and wintergreen leaves. It is lipophilic and acts as a keratolytic agent by dissolving the intercellular lipids, surrounding the keratinized epithelial cells. Due to its lipophilic nature, it acts on the sebaceous follicle, has excellent comedolytic activity, and hence is very useful for acne. It has antiinflammatory and antimicrobial properties.INDICATIONS:➢ Active pustular acne➢ Open poresPROCEDURE—Salicylic acid is used only as spot peel.DO NOT USE ON FULL FACE.Used in combination with a glycolic peel.2) POLY-HYDROXY ACID PEELAlso called body peel. To be used only on the body. Don’t use on face.INDICATION:➢ Fine lines and wrinkles➢ Rehydration of skin➢ Dark back, elbow, forearms➢ Pigmented feet, handsPROCEDURE- Same as Glycolic acid. Only in this case test patch not required as we are doing on the body. Cleaning, application, timer, and neutralization remain the same. Post Peel Instructions remain the same for all peel procedures.1] SKIN WHITENING PEEL— (PEEL BOOSTER)INDICATIONS➢ Tanned skin➢ Pigmented skin➢ Melasma➢ Dark underarms, hands, feet… PROCEDURE:➢ Elevate the client's head by 45 degrees➢ Tie headband➢ Cleanse the face with pre-peel cleanser (to be used according to the skin texture. i.e. Oily, normally dry, etc.)➢ Apply Vaseline to sensitive areas like outer and inner canthi of eyes, angle of mouth, and nose with an earbud.➢ Take 1 ml of peel booster in a measuring cup and with the brush apply it in the same direction on the entire face. NO TIMER is required. After application let it dry completely.➢ After drying now over the booster apply 1ml of glycolic acid 20% (here timer is necessary)➢ Time for 3 mins if the patient is comfortable then neutralize after 3 min.2)LACTIC ACID PEEL: -INDICATIONS:➢ Sensitive skin➢ Dehydrated dull skin➢ Under eyes dark circles4) DARK CIRCLE PEEL: -INDICATIONS: --➢ Under eye dark circles.➢ Periorbital melanosis➢ Fine lines, wrinkles➢ Open pores.5)ANTIACNE PEEL: -INDICATIONS: -➢ Acne➢ Boils, Pustules.➢ FolliculitisDIFFERENCE BETWEEN AHA and BHA AHA BHA1) They are water soluble 1) They are lipid soluble2) Has keratolytic action. 2) Anti-inflammatory, anti-microbial, comedolytic3) Requires neutralization 3) No neutralizer is required4) No frosting occurs 4) Pseudo frost occurs5) Glycolic 5) Salicylic6)For pigmentation 6) For acne7) Prepared from sugarcane 7) Prepared from Sweet birch, willow bark, Wintergreen leaves.Combination Peels – Multiple peeling agents in combinations are used to complement their synergistic activity and enhance their efficacy and depth.E.g., Salicylic acid with a Mandelic acid targets the Seborrhoea, residual acne, post acne pigmented early grade 1 scar as well as textural improvement. Mandelic acid has antibacterial properties and is safer for dark skin types.Sequential Peels – One peel is printed and terminated and followed sequentially by another peel in the same sitting which can be terminated or left on slow-release peel.E.g., Salicylic acid followed by Mandelic acid, Glycolic acid, or Retinol peel. Salicylic acid peel followed by a TCA obtains moderate depth effects.Switch Peels – Includes usage of different peeling agents in rotation in subsequent sittings. E.g., Salicylic acid or a Retinol peel in comedogenic or Inflammatory acne switched over afterclearance to Glycolic, Mandelic, or Phytic in subsequent sessions to improve scars and texture.Slow-Release Peels – Some peels work on the controlled (gradual)release of the product progressively and ensure complete penetration and full action of all components in the solution. Easy phytic peel is composed of three hydroxyl acids with Phytic acid, 3 AHA are glycolic acid, lactic acid, and Mandelic acid.