The skin is the largest organ of our body and one of the most complicated. It performs a critical role in the maintenance of life and health. The skin has many potential problems that lurk above and below its surface. More than three thousand ‘skin entities’ have been identified (Lim et al, 2017). Fortunately, there are ways in which we can significantly improve its health and appearance. Chemical peels are used to treat visible skin conditions, and can dramatically reduce the signs of ageing.
Layers of the skin
Apart from their wide application in improving the appearance and texture of skin, chemical peels are also used to remove precancerous growths (small areas of roughness due to excessive sun exposure). To gain an appreciation of how peels can improve the skin, it is useful to know how the skin is structured; The skin comprises three layers:
1) the epidermis is the outermost layer of skin (the skin’s colour is made by cells (melanocytes) that are located in the epidermis)
2) The dermis is the second layer and contains tough connective tissue, sweat glands and hair follicles
3) At the deepest subcutaneous level of the skin is the hypodermis. This layer contains connective tissue and fat
The aim of a chemical peel
As we age and are exposed to the sun these successive layers of skin change in their composition. The aim of chemical skin peeling is to visibly improve and regain the structure of damaged or aged skin. This is achieved by accelerating the skin’s natural process of exfoliation. Chemical peels are used to improve the texture and appearance of face, neck or hands. Facial peels in particular, have become increasingly popular in younger age groups. This is due to their immediate impact in improving the appearance of skin, whether damaged over time by UV rays, or perhaps more recent scarring, through acne.
Which skin problems can a peel improve
Chemical peels are used to successfully lighten skin pigment problems such as, age spots, refine acne scars, and crow’s feet, improve the texture of sun damaged skin wrinkles, reduce large pores, correct superficial hyper-pigmentation (darkening of the skin or discolouration) and melasma (brown or grey patches on the face). Following a chemical peel the skin can be revitalized with a healthy looking even skin tone and pigment.
Is it always the sun that causes the problem?
There are many reasons why our skin changes in appearance and texture. These include, genetics, cellular metabolism, hormone and metabolic processes, exposure to sunlight, pollution, ionizing radiation, chemicals and other toxins. Behaviour and lifestyle will also impact the appearance of our skin. Overall, a combination of factors lead to structural and physiological changes in skin layers, particularly in the areas that are exposed to the sun.
The cumulative harmful effects from exposure to ultra violet (UV) rays are the major cause of premature ageing, and damage to skin. Additionally, as we age collagen on the surface of skin, declines at about 1% each year(Matts et al, 2010). In photo-aged skin (premature ageing of the skin due to U.V rays), chemical peels reduce wrinkles and regenerate new skin by increasing its dermal volume, collagen and elastin fibres (Han et al, 2011, Butler et al, 2001). Chemical peels can reverse many of the visible signs of ageing, and stimulate the production of collagen. This results in long term improvement in the health of skin, long after treatment.
How does a chemical peel work?
Chemical peels work through the skilled application of specially formulated acids on to the target area of skin. The acid is safely and gently applied to create a mild superficial burn. This destroys layers of the epidermis and dermis by protein coagulation which causes exfoliation and the skin to peel off. The result is a tighter more even skin that follows inflammation of the epidermis and dermis.
Chemical peels and acne in Singapore
Peels are frequently used in the treatment of acne. According to studies, acne results in minor scarring in most people that have suffered the condition. More severe acne occurs in around 1 in 4 sufferers. A Singaporean study suggests that acne vulgaris is the second most common skin diagnosis in Singapore and effects some 10.9% of the adult patient population (Handog et al, 2012). In cases of acne, the Asian skin type is particularly prone to pigmentation. Chemical skin peels can be highly effective in diminishing acne scarring and resolving pigmentation problems. In chemical peels the main types of acids used are salicylic acid. These peels are shown to have some beneficial effects in whitening the face of Asian patients with acne (Ah et al 2006).
Superficial, medium and deep chemical peels.
Chemical peels are classified by their depth, superficial, medium or deep. The depth of the peel correlates with the changes to the skin that are needed. The greatest change is achieved by a deep peel. However, superficial peels are the most common treatment (often called the lunchtime treatment as it only takes a short time to perform) and penetrates just the outer layer of skin.
Treatments, take just thirty minutes to several hours depending upon the type of peel. Peeling usually begins 2-4 days after treatment and may last around 3 days. Various strengths and mixes of solutions are used, depending upon the specific type of peel and results needed. In light or superficial peels this may be glycolic, lactic, or fruit acid. These are the mildest of the peel formulas and produce light peels. The results are often immediate with smoother, brighter looking skin, energised and glowing with health. Healing may take just 1-5 days.
Medium peels where wrinkles and lines are deeper, use other acids in various strengths and combinations. These peels are used for superficial scars, pigmentary disorders. Deep peels are used for severe photo-aging, deep wrinkles, or scars. Deep peels may also be used to remove abnormal skin cells (actinic keratosis) which appear as rough dry and scaly patches on the skin, and are pre-cancerous lesions. A deep peel will deeply penetrate the middle layer of skin. It improves shallow scars, lines and age spots and results in the most dramatic improvement in facial appearance.
Recovery times and considerations
Recovery time depends upon the peel performed. Medium and deep take some weeks before the skin’s recovery is complete. Light peels have the shortest healing time of just a few days depending upon the peel.
When deciding upon a chemical peel among considerations to be discussed with your Doctor are:
i) What your skin concern is and the anticipated outcome of a chemical peel
ii) Your work commitments (whether time off work is needed will depend upon the type of peel and number of treatments)
iii) Other professional skincare modalities that may be needed to complement the chemical peel, such as medical micro-needling, microdermabrasion, laser resurfacing, dermal fillers and booster.
Skin sags, bulges, and more severe wrinkles do not respond well to chemical peels. They may need other kinds of cosmetic surgical procedures such as laser resurfacing, a facelift, brow lift, eyelid lift, or soft tissue filler.
It’s good to remember that the ageing of skin is not a condition, but a process. In clinical practice to look better and healthier – does not always mean to look younger (Ganceviciene et al,2012). Although a chemical peel often achieves both!
Butler, P. E., S. Gonzalez, M. A. Randolph, J. Kim, N. Kollias, and M. J. Yaremchuk. 2001. “Quantitative and Qualitative Effects of Chemical Peeling on Photo-Aged Skin: An Experimental Study.” Plastic and Reconstructive Surgery 107 (1): 222-28. https://insights.ovid.com/pubmed?pmid=11176627
“Chemical Peels.” n.d. 2018. https://www.asds.net/skin-experts/Skin-Treatments/Chemical-Peels.
Ganceviciene, Ruta, Aikaterini I. Liakou, Athanasios Theodoridis, Evgenia Makrantonaki, and Christos C. Zouboulis. 2012. “Skin Anti-Aging Strategies.” Dermato-Endocrinology 4 (3): 308-19.
Han, Sung Hyup, Hong Jig Kim, Si Yong Kim, You Chan Kim, Gwang Seong Choi, and Jeong Hyun Shin. 2011. “Skin Rejuvenating Effects of Chemical Peeling: A Study in Photoaged Hairless Mice.” International Journal of Dermatology 50 (9): 1075-82. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-4632.2010.04712.x
Handog, Evangeline B., Maria Suzanne L. Datuin, and Ivan A. Singzon. 2012. “Chemical Peels for Acne and Acne Scars in Asians: Evidence Based Review.” Journal of Cutaneous and Aesthetic Surgery 5 (4): 239-46.
Lim, Henry W., Scott A. B. Collins, Jack S. Resneck Jr, Jean L. Bolognia, Julie A. Hodge, Thomas A. Rohrer, Marta J. Van Beek, et al. 2017. “The Burden of Skin Disease in the United States.” Journal of the American Academy of Dermatology 76 (5): 958-72.e2.
Matts, Paul J., and Bernhard Fink. 2010. “Chronic Sun Damage and the Perception of Age, Health and Attractiveness.” Photochemical & Photobiological Sciences: Official Journal of the European Photochemistry Association and the European Society for Photobiology 9 (4): 421-31. https://www.ncbi.nlm.nih.gov/pubmed/20354634
Rendon, Marta I., Diane S. Berson, Joel L. Cohen, Wendy E. Roberts, Isaac Starker, and Beatrice Wang. 2010. “Evidence and Considerations in the Application of Chemical Peels in Skin Disorders and Aesthetic Resurfacing.” The Journal of Clinical and Aesthetic Dermatology 3 (7): 32-43.