Chemical peeling for pigmentation is a common dermato surgical procedure performed without any surgical instrument.
Chemical peeling or chemical peel for hyperpigmentation on face is the application of one or more chemical agents on to the skin resulting in dry desquamation or moist maceration followed by its exfoliation and subsequent resurfacing of the epidermis along with remodelling of collagen and elastic fibres and the deposition of glycosaminoglycans during the repair process in the dermis.
The idea behind the best chemical peel for hyperpigmentation on face is to wound the skin to bring it to a desired level, which is deep enough to cause exfoliation of the layers, while being superficial enough to allow regeneration from the appendageal structures and papillary dermis through wound healing and, reduce pigmentation.

FORMULATION USED:

  1. Trans-retinoic Acid Peels
    These peels belong to a class of retinoids. They act by combining with retinol receptors and take part in the epidermal cell regulation.
  2. Combination Peels
    These cause deeper penetration up to the level of upper reticular dermis (medium-depth peels) and are used to treat resistant hyperpigmentary dyschromias including melasma, photomelanosis, LLP, mild photodamage and multiple actinic keratoses. The healing phase lasts for 7-10 days and these can be repeated once in 2 months.

MECHANISM OF ACTION OF PEELS

The outer skin layers are removed through keratolysis and kerato coagulation. In keratolysis, the peeling agents such as glycolic acid or lactic acid penetrate through stratum corneum, break the intercellular desmosomal band and disrupt the keratinocyte cohesion. In kerato coagulation, the peeling agent such as TCA destroys the surface cells through protein denaturation and keratinocyte coagulation. Most of the very superficial peels primarily cause epidermal wounding whereas medium and deep chemical peels cause both epidermal and dermal wounding.

STAGES

1.  Coagulation & Inflammation
2.  Reepithelialization
3.  Granulation Tissue Formation
4.  Angiogenesis
5.  Collagen and Matrix Remodelling

  1.  No set rule, no limit in the number of light peels.
  2.  Once in 3 weeks, for 6-10 sessions.
  3.  Maintenance as and when required.
  4.  If partial recurrence is experienced then the patient can go for additional light peels, at necessary intervals.
  5.  At home: Cold water/ice compresses, calamine lotion are given for drying and soothing. Promote epidermal desiccation and separation for the first 24-48 hours and restrict emollients.
  6.  Day 1 and 2: Skin becomes dark brown-black, desquamates completely in 5-10 days (there are early and late peelers).
  7.  Once the skin starts peeling, there is a sense of tightening and cracking. Apply emollients and keep the skin moist.
  8.  On completion, underlying skin is erythematous. Protection from sunlight with sunscreen and moisturizers is advised for 1-2 weeks.
  9.  Use of a very mild soap on face is recommended.

Pre Procedure
Selection of the depth of the peel required

  • Determine the colour complexion (fair, wheatish, semi-dark or dark)
  • Assess the depth of the lesion (epidermis, dermal or both)

    2.Priming Preparing the skin for the best chemical peel for pigmentation is an important part of the procedure, as it contributes in achieving optimum results. This can be achieved by using topical drugs at least 2 weeks prior to the planned day of the peel. Peeling agent is applied on the full face gently.

    • Reaction:

      1)  Takes several minutes to appear and consists of erythema, blanching, and white frosting. Frosting is caused by denatured proteins of the skin.
      2)  Appearance of uniform white coast of frosting is a good sign
      3)  The water is wiped off the eyelids and the patient is asked to open his/her eyes.
      4)  Patient then continues to dab cold water on the face till the burning sensation subsides.
      5)  Rubbing is to be avoided, frosting disappears and normal skin colour returns in half an hour.

      Sun Protection

      1)  Sun restriction with minimum sun exposure.
      2)  Use of hat, cap, scarf, umbrella, etc.
      3)  Sunscreens - Broad spectrum sunscreen blocks both ultraviolet A(UVA) and ultraviolet B (UVB).
      4)  Patients are advised to follow the above instruction for at least 10-15 days prior to the peel.
      5)  Working professionals should plan the procedure ahead of a weekend because the skin peels for 2-3 days after the procedure.

      Indications
      • Acne
      • Post-acne hyperpigmentation
      • Superficial scarring following acne
      • Acne excoriate
      • Comedolytic acne
      Contraindications
      • Active infection (herpes labialis/bacterial)
      • Open cuts
      • Patient on photosensitive drugs
      • Non co-operative patient
      • Unrealistic expectations