Chemical Peels

 

Chemical Peels for Professionals:

 

Dermatology offices provide light exfoliation and peel services for medical and cosmetic therapy. Glycolic acid body lotions labeled up to 10-20% are currently available over-the-counter (OTC). General consumer use of these products is described as safe by the U.S. FDA, and application of these low strength glycolic acid lotions to the skin would not constitute the practice of medicine.

 

 

 

 

Many glycolic acids are currently available as over the counter products, are very safe, and have very little risk of injury if applied to the skin. With standard use and per package instructions, glycolic acids typically penetrate to the very surface cells of the outer skin.

 

 

Similarly, 10-20% glycolic pads are very superficial level peels and readily now available over the counter for consumer sales and use.  Multiple U.S. commercial vendors have these types of low level superficial peels available for home use. These are generally safe, cosmetic products.

Lactic acid and salicylic acid are available as over the counter (OTC) products and home peels. Am Lactin 12% is a 12% lactic acid lotion available over the counter for home use.

Per U.S. FDA (Reference 7) last updated 07/06/2011 “Some products containing AHAs have been marketed for uses such as treating acne, removing scars, and lightening discolorations. Among these are some products marketed as “skin peelers,” which may contain relatively high concentrations of AHAs or other acids and are designed to remove the outer layer of the skin. Products that are intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease, or to affect the structure or any function of the body are drugs under the law (Federal Food, Drug, and Cosmetic Act, Sec. 201(g)). For example, products intended for use as acne treatments or skin lighteners are considered drugs. For more on this subject, see Is It a Cosmetic, a Drug, or Both? (or Is It Soap?)1 and the Warning Letter issued to Global Esthetics2.”

“Based on industry-sponsored studies, the Cosmetic Ingredient Review (CIR) Expert Panel — the industry’s self-regulatory body for reviewing the safety of cosmetic ingredients — concluded that products containing the AHAs glycolic and lactic acid are safe for use by consumers if:

ü  The AHA concentration is 10 percent or less.

ü  The final product has a pH of 3.5 or greater.

ü  The final product is formulated in such a way that it protects the skin from increased sun sensitivity or its package directions tell consumers to use daily protection from the sun.”

Per US FDA, (Reference 4) This guidance has been prepared by the Office of Cosmetics and Colors in the Center for Food Safety and Applied Nutrition (CFSAN) at the U.S. Food and Drug Administration. The draft version of this document, “Labeling for Topically Applied Cosmetic Products Containing Alpha Hydroxy Acids as Ingredients,” was issued by FDA on December 2, 2002.  In its final report, published in 1998 (Reference 3), the CIR Expert Panel reported the following conclusion: “Based on the available information included in this report, the CIR Expert Panel concludes that Glycolic and Lactic Acid, their common salts and their simple esters, are safe for use in cosmetic products at concentrations 10%, at final formulation pH 3.5, when formulated to avoid increasing sun sensitivity or when directions for use include the daily use of sun protection. These ingredients are safe for use in salon products at concentrations 30%, at final formulation pH 3.0, in products designed for brief, discontinuous use followed by thorough rinsing from the skin, when applied by trained professionals, and when application is accompanied by directions for the daily use of sun protection.””

Per the U.S. FDA: “FDA’s surveys found that, in 64 consumer products, exfoliation claims were the most common and were made on 50% of the products. In 33 salon products, exfoliation claims also were the most common and were made on 64% of the products. The surveys suggest that approximately half of the AHA-containing products on the market have an intended use as an exfoliant, as determined by the presence of “exfoliant” claims on the product labeling. Even some salon products containing high levels of AHAs did not specify “exfoliation” as an intended use.”

 

While these preparations may not have been previously made available, they are now part of the expanded array of over the counter preparations available for home and personal use.


 

 

There are numerous chemical peel types and countless brands and proprietary commercial names for available peels. While many of the classic peels types are well established and superficial classification known, compounded or “designer” peels may use new variations and adulterated versions. It is not always possible for medical providers to determine with certainty the classification of these proprietary blends and new peels without manufacturer direction and specifications.

 

 

 

Peel classifications typically rely on multiple factors including type, chemical composition, and potential additive interactions of multiple components.  There is no readily available, uniformly accepted standard of classification of peels based solely on % percentage or pH. Most specifically, (Reference 8) confirms that while lower pH may directly indicate greater irritancy potential of a peel, vehicle irritancy must also be considered as does the available free acid concentration, which is difficult to ascertain. Histological classifications of peels are most exact and rely on skin biopsies to show the actual depth of the peel.

 

 

 

Factors that determine whether peels result in mild exfoliation or deeper peeling depend on multiple factors:

  • pH
  • degree of buffering or neutralization
  • vehicle formulation
  • frequency of application
  • condition  of delivery
  • amount of acid delivered to the skin over a period
  • length of time the acid stays on the skin
  • degree of cleansing and skin scrubbing prior to peel application

 

 

 

Per standard dermatology guidelines (Reference 8) chemical peeling is also called chemical resurfacing, chemoexfoliation, or chemosurgery. The process involves applying one or a combination of exfoliating agents to the skin resulting in destruction of portions of the skin. Per this accepted standard reference, the following are all classified as superficial peels and result in epidermal peeling:

 

  • Alpha Hydroxy Acids (AHA’s):  includes lactic acid & glycolic acids
  • Jessner’s Solution (JS): combination of resorcinol, salicylic acid, and lactic acid in ethanol
  • Solid Carbon Dioxide (CO2)- “dry ice”: not a true chemical peel, more of a physical agent
  • Tretinoin (Retin A) acid solutions
  • Trichloracetic Acid (TCA) 10-35%
  • Beta hydroxy Acids (BHA): includes salicylic acid

 

 

 

 

 

 

Superficial epidermal peels such as glycolic acid in typical concentrations of 10-70% have per standard been available for many years and are therefore readily identified by physicians as cosmetic grade. These do not typically affect beyond the “nonliving layers” of the stratum corneum/epidermis. Additionally available superficial peels include salicylic acid in concentrations of 10-20%, lactic acid, retinoic acid, and many others. These are generally very superficial and have very little, if any, significant potential for permanent or irreversible skin injuries. Phenol is not listed as a routine superficial peeling agent.

 

 

 

These chemical peels (although classified as “superficial”) would potentially penetrate past the superficial stratum corenum layers and are not appropriate for independent use by licensed estheticians:

  • TCA
  • Jessner’s
  • Jessner’s Plus
  • Phenol
  • Alpha/Beta Peels
  • Other combination or compounded peels

 

 

 

Medium depth peels are achieved in combined fashion using 2 or more agents.  A typical medium depth peel (combined Jessner’s and trichloracetic acid TCA peel) is readily identified by physicians as medical grade procedure. These are most commonly performed in a medical setting by dermatologists, plastic surgeons, or trained “cosmetic surgeons”. Medium depth peels may uncommonly cause irreversible skin injuries. These are not performed by estheticians or medical assistants.

 

 

 

Deep peels such as phenol have routinely been available for many years and are therefore readily identified by physicians as deep, surgical grade chemical peels most commonly performed in an operating room setting with anesthesia. Deep peels, even with routine and proper use, may uncommonly cause permanent skin damage and injuries. Deep peels are performed by physicians  well versed and highly experienced in handling potential medical complications from this risk laden and invasive procedure.

 

Phenol is a special chemical ingredient with significant potential for deep peeling and dermal injury. Miscalculations or errors in phenol concentration have the potential to scar and cause permanent injury. High concentration phenols may also be used in topical fashion to permanently and irreversibly destroy the nail bed and nail matrix. Therefore, phenols have a known and documented, marked potential for irreversible skin and skin structure injury.