Dermatology: Chemical Peeling
Chemical peeling is a controlled resurfacing procedure where a chemical agent is applied to induce skin injury, exfoliation, and subsequent regeneration of epidermal and dermal tissues.
Classification by Depth
| Type | Depth of Injury | Typical Agents |
|---|---|---|
| Superficial | Epidermis only | Glycolic acid, Salicylic acid, Lactic acid |
| Medium | Papillary dermis | Trichloroacetic acid (TCA), Jessner’s solution |
| Deep | Mid-reticular dermis | Phenol (Carbolic acid) |
Clinical Indications
- Superficial: Fine lines, mild acne, uneven texture, and superficial pigmentary changes.
- Medium: Moderate wrinkles, actinic keratosis, deeper acne scarring, and irregular pigmentation (e.g., melasma).
- Deep: Severe photoaging, deep rhytides, and resistant scarring.
High-Yield Exam Pearl:
- Safety: Phenol peels are systemic toxins (cardiotoxic/nephrotoxic) and must be performed in a monitored setting.
- Fitzpatrick Skin Type: Extreme caution in dark-skinned individuals (Types IV–VI) due to the high risk of **Post-Inflammatory Hyperpigmentation (PIH)**.
- Pre-peel Priming: Crucial to use topical retinoids, sunscreens, and hydroquinone (for pigment modulation) for 2–4 weeks prior to the procedure.