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Skin is a
constantly regenerating organ; everyday, cells divide at the basal layer
of the epidermis and move upwards to the top-most layer of stratum
corneum from where they are shed. As they move upwards, they undergo lot
of changes and this process is called keratinization.
Chemical peeling is a
procedure wherein the exfoliation is accelerated and organised by
application of exfoliating agents to the skin. The use of exfoliating
agents to peel the epidermis dates back to ancient Egypt. Sour milk
baths (containing lactic acid) were used by ancient Egyptian women to
soothe the skin. The main purpose of peeling is for rejuvenation and
to erase the marks of photo-damage and ageing.
The chemical peel
creates changes in the skin by three mechanisms:
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Stimulation of
epidermal growth through removal of stratum corneum
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Destruction of the
specific layers of the damaged skin and replacement with normal
tissue.
-
Induction of
inflammatory reaction deeper in the tissue, leading to activation of
mediators of inflammation, resulting in the production of new collagen
and ground substance in the dermis.
The agent, usually a
solution, removes varying amounts of epidermis and depending on the
strength, affects the dermal collagen. Wound repair consists of epidermal
regeneration by migration from surrounding structures and replacement of
new dermal connective tissue resulting in rejuvenation of the skin. In
addition to improving the texture of the skin, peeling is also useful in
the treatment of acne, acne scars, pigmentation caused by acne and other
conditions like lentigines, melasma etc.
The choice of the agent
depends upon the depth of the peel required. Broadly, peeling is
classified into:
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Superficial -
Stimulates epidermal growth; agents used are CO2
slush, liquid
nitrogen spray, glycolic acid (30-50%), Trichloroacetic acid (TCA, 10%)
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Medium - Glycolic
acid (70%), TCA (20-30%), combination of TCA and CO2
snow
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Deep - Phenol.
Superficial and medium
depth peeling are most often used in our set-up. Superficial peels are
usually used for rejuvenation, comedonal acne and epidermal
pigmentation. Medium depth peeling is used for acne scars and fine
wrinkling due to ageing.
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