Peeling is the application of chemical agent to bring about exfoliation of the epidermis with remodeling of the collagen and elastic fibers in the dermis . A peel removes several layers of sun damaged skin cells, leaving fresh skin, which has a more even surface and colour. It may stimulate new collagen to be formed improving texture. The result of the first peel may be disappointing, but after repeated peels, significant improvements is usually evident. Principles of chemical peels ⦁ Exfoliation of 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 level Chemical Agents used for peeling ⦁ AHA----Alpha Hydroxy Acids- i.e Glycolic Acid , Lactic Acid, Mandelic acid ⦁ BHA----Beta Hydroxy Acids- i.e Salicylic Acid ⦁ PHA----poly Hydroxy Acids – combination peel ⦁ TCA----Trichloroacetic Acid ⦁ Phenols----Carbolic Acid Types of peels ⦁ Very Superficial ----Glycolic acid ⦁ Superficial ----Lactic acid ⦁ Medium ----PHA, Salicylic acid, TCA ⦁ Deep ----Phenols Of 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 as 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- Grapes Of 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 a self neutralizing action by coagulation of proteins hence it has neutralized with water or weak buffer. Glycolic acid result in superficial skin injury and are well tolerated-the ‘lunchtime’ peel. They remove thin lesion on the skin surface, reducing pigment and surface dryness. There are newer glycolic peels which are most potent and still do not irritate. These peels contain Strontium Nitrate. One such brand widely used is Refinity(70% glycolic acid+strontium nitrate) and Cosmoderm(50%glycolic acid+strontium nitrate) INDICATION OF GLYCOLIC ACID 1) Acne 2) Hyperpigmentation 3) Freckles 4) Fine lines and wrinkles 5) Sun spot 6)Open pores 7) Clogged pores 8) Under eye dark circles CONTRAINDICATIONS: 1)Active infection 2) Open cuts 3) Photosensitivity 4) Past reaction to peel 5) Facial surgery in three months QUALITIES OF GLYCLIC ACID: Full face or spots Very superficial Expensive Long life Available as liquid Difficult to prepare PRMING: Preparing the skin before the peel Priming is done for period of 10 days daily with a lower concentration of glycolic acid (6%) applied only at night. Stop application on day 11, 12, 13th and the pel is done on the 14th day. BENEFITS OF PRIMING : 1) More uniform penetration of the peel 2) Reduces the risk of hyper pigmentation 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. Patient will feel slight burning or itching sensation. If this sensation is mild with no redness on the area for 3 mins that means the patient can tolerate the peel on face. So wash the peel with cold water and proceed for the face. On the hand if after application you notice redness with 1-2 mins then immediately neutralize the part . Dilute the peel with 2 drops of rose water , repeat the test patch on other side of neck. If patients tolerates this then do the diluted peel on the face. On the day of peel: Materials Required for peel---- ⦁ Required peel ⦁ Neutraliser ⦁ Measuring cups x2 ⦁ Brush x 2 ⦁ Cleanser ⦁ Vaseline ⦁ Ear bud ⦁ Head band ⦁ Cotton ⦁ Rose water ⦁ Eye pads ⦁ Mask ⦁ Sun screen PROCEDURE: 1)Elevate the client's head by 45 degrees. 2) Tie Head band 3) Cleanse of 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 outer and inner canthi of eyes , angle of month and nose with ear bud. 5) If 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 peel brush . As you touch the peel brush on face start 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 mins includes your time of application also. 7) Mild itching and burning sensation is 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 same manner During neutralization patient feels warm sensation. This is due to acid base reaction. 10) Then clean the face with cold water and give cold compress the face when patient complaining of any of any burning . 11) Apply face mask 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 , frosting immediately neutralize the peel with 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 , treading , waxing , plucking for 7 day before and after peel. 6) Avoid make up for 12 hours. 7) Do not use medicated cream 2days before and after peel. 8) Do not pick, Picking delays healing causes scarring. 9) Moisturize- use moisturizers after peel. OTHER PEELS- 1 ) BETA HYROXY ACID – SALICYLIC ACID – Salicylic acid is derived from sweet birch , willow bark and wintergreen leaves. It is lipophilic and act as a kerotolytic 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 anti inflammatory and antimicrobial properties. INDICATIONS: # Active pustular acne # Open pores PROCEDURE— Salicylic acid is used only as spot peel. DO NOT USE ON FULL FACE. Used inA combination with glycolic peel. 2) POLY-HYDROXY ACID PEEL- Also called as body peel .To be used only on body. INDICATION: Fine lines and wrinkles Rehydration of skin Dark back , elbow , forearms Pigmented feet , hands PROCEDURE-Same as glycolic acid. Only in this case test patch not required as we are doing on body. Cleaning, application, timer , neutralization remains the same. Post Peel Instructions remains same for all peel procedures. SKIN WHITENING PEEL—(PEEL BOOSTER)--- INDICATIONS *Tanned skin *Pigmented skin *Melasma *Dark underarms , hands, feet… PROCEDURE: *Elevate the clients head by 45 degrees *Tie hand –band *Cleanse of the face with pre-peel cleanser( to be used according to the skin texture .i.e.oily , normal dry etc.) * Apply Vaseline to sensitive areas like outer and inner canthi of eyes, angle of mouth and nose with ear bud. *Take 1 ml of peel booster in a measuring cup and with the brush apply it in 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 patient is comfortable then neutralize after 3 min. 2)LACTIC ACID PEEL:- INDICATIONS: -Sensitive skin -Dehydrated dull skin -Under eye dark circles 4) DARK CIRCLE PEEL:- INDICATIONS:-- ⦁ Under eye dark circles. ⦁ Periorbital melanosis ⦁ Fine lines, wrinkles ⦁ Open pores. 5)ANTIACNE PEEL:- INDICATIONS:- *Acne *Boils , Pustules. *Folliculitis DIFFERENCE BETWEEN AHA and BHA AHA BHA 1) They are water soluble 1)They are lipid soluble 2) Has keratolytic action. 2) Anti-inflammatory, anti-microbial, comedolytic 3) Requires neutralization 3) No neutralizer required 4) No frosting occurs 4) Pseudofrost occurs 5) Glycolic 5)Salicylic 6)For pigmentation 6) For acne 7) Prepared from sugarcane 7) Prepared from Sweet birch, willow bark, Wintergreen leaves. Combination Peels – Multiple peeling agents in combinations are used to compliment their synergistic activity and inhance their efficacy and depth. E.g. Salicylic acid with a Mandelic acid targets the Seborrhea, residual acne, post acne pigmented early grade 1 scars 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 termined 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 after clearance to Glycolic , Mandelic or phytic in subsequent sessions to improve scars and texture. Slow Release Peels – Some peels works on controlled (gradual)release of the product progressively and ensures complete penetration and full action of all components in the solution. Easy phytic peel composed of three hydroxyl acids with phytic acid, 3 AHA are glycolic acid, lactic acid and mandelic acid.