Peeling

Peeling is a cosmetic or dermatological procedure used to treat minor skin blemishes and wrinkles. The principle consists in the removal of dead skin scales from the top layer of the skin (epidermis) by various methods. The various methods differ from each other mainly in the substances used and the depth of penetration into the skin layers. Already in ancient times there were attempts to improve the skin‘s appearance. The Egyptians used salts and alabaster in combination with animal oils. A similar ancient variant of mechanical peeling can be found in India. The Indians mixed urine with pumice stone. Today, there are countless variations of exfoliation. Over-the-counter peels usually represent a light, less aggressive form of mechanical and chemical peeling, although these peels should also be used with caution. The following peeling methods are used:

Enzyme peeling – Proteases are used in this method. Proteases are enzymes (biocatalysts) that can cleave proteins (proteins). Thus, the horny layer of the skin is also detached.
Chemical peeling – Here substances are applied, which by their special properties loosen the connection between the horny cells of the stratum corneum (top layer of the epidermis, which consists of horny, dead cells) and thus facilitate their exfoliation. Mainly acids such as various fruit acids/α-hydroxy acids (AHAs; glycolic acid, mandelic acid, tartaric acid, citric acid), salicylic acid, trichloroacetic acid (TCA) etc. are used. There are three forms of chemical peeling, which differ in the concentration of substances: a superficial, medium and deep peeling.
Mechanical peeling – For this peeling, abrasive particles are selected, which by mechanical friction detach the dead skin cells. These are usually sand particles, healing clay, bran or silicates. Professional, elaborate procedures are called, for example, microdermabrasion.
Physical peeling – For this peeling, a laser is used such as in laser skin resurfacing therapy.

The term medical peeling represents aesthetic procedures that should only be performed by an experienced physician, as complications are common. This includes almost all the above-mentioned variants of peeling. Dermabrasion, for example, is a dermatological surgical procedure that is an invasive form of peeling. It involves mechanical abrasion of the epidermis.

Indications (areas of application)

A (chemical) peel is performed for:

Acne – acne vulgaris, acne comedonica, acne excoriee.
Actinic (light) damaged skin
Actinic keratosis – change in the skin that occurs on light-damaged skin. It can be the precursor to squamous cell carcinoma of the skin, which is why it is considered a precancerous lesion (precancerous lesions; KIN (keratinocytic intraepidermal neoplasia)).
Chloasma (melasma) – hyperpigmentation that occurs on the face.
Dyschromia (pigmentation disorders).
Wrinkles
Hyperkeratosis (disorder with increased keratinization of the skin surface).
Scars – especially acne scars
Lentigines solaris (sun spots) or lentigines senilis (age spots).
Seborrheic keratosis (age warts).
Verrucae vulgaris (warts) – benign skin tumor caused by a viral infection of the skin.

Before treatment

At the beginning of a medical or deep peel, an informative patient interview and a patient history (anamnesis) is necessary to rule out any allergies or diseases (e.g. herpes simplex) that could jeopardize the treatment. For deep peels, pre-treatment with a light superficial peel is suitable. The skin should be thoroughly cleansed before the procedure.

The procedures

A peel can be used once or twice a week after cleansing (this applies to light peels). This is a good way to remove the dead skin scales of the top layer of the skin (epidermis). It is the combination of a mechanical peeling (fine abrasive particles) and a mild chemical peeling that results in uniquely smooth skin. Peeling also removes skin impurities. The excess, dead skin cells are often responsible for a sallow complexion.After peeling, your skin feels smooth and is more receptive to subsequent care products. Another effect of the peeling is that after the dead skin cells are removed, the subsequent younger cells can reach the skin surface more easily. The skin gets a better cohesion, the pores are refined. At the same time, the water retention of the skin is increased, keratoses (cornifications) of the skin are reduced and the surface structure of the skin is improved. The cosmetic result is fresh and vital skin. The following list briefly represents the variety of possible peeling methods:

Enzyme peeling – Enzymatic peeling is a biological method consisting in the application of fat and protein splitting enzymes. This method is often used for acne.
Green peel – This peeling is also called herbal peeling and consists in the application of herbal, natural ingredients to remove the dead skin cells and promote blood circulation. The method is used to tighten sagging skin, cellulite, wrinkles and blemishes, among others. Ingredients include field horsetail, water bag horsetail, aloe vera, calendula, seaweed, chamomile, lungwort, pansy and ribwort. The herbs are mixed with distilled water and a buffering substance and applied. This scrub requires special attention to any allergies.
Blue peel (obagi) – This special chemical peel was developed by Dr. Zein Obagi from Beverly Hills. A mixture of 15-20% trichloroacetic acid and a blue food coloring is applied. The dye provides an indicator that allows the treating physician to accurately control the depth of penetration, thereby reducing the rate of complications. Disadvantage of this treatment is the slight discoloration of the skin that can last a few days.
Fruit acid peeling – This peeling is one of the superficial, chemical methods. Fruit acids or ɑ-hydroxy acids (AHA) effectively act as keratolytics (substances that dissolve keratinization) and are used in their natural form as lactic acid (from old cheese, sour milk, sauerkraut), glycolic acid (from unripe grapes or sugar cane juice), malic acid, tartaric acid (from grapes or old wine) or citric acid (from berries or lemons). They loosen the cohesion of the horny layer and ensure the regeneration of elastic and collagen fibers. To prevent damage, the acid must be neutralized by sodium bicarbonate or water after treatment. The procedure is performed by a physician depending on the acid concentration and has a low penetration depth. It is therefore suitable for superficial wrinkles, acne vulgaris, hyperkeratosis (increased keratinization) and coarse-pored skin, among others.
Salicylic acid peeling – salicylic acid is applied in the form of Jessner’s solution (ethanol (ethanol), resocinol, salicylic acid, lactic acid) and achieves superficial chemical peeling.
Trichloroacetic acid (TCA) peel – This chemical peel should be performed by a physician, as TCA (keratolytic agent) can cause a relatively severe burn to the skin. The concentration of the acid determines the depth of penetration, which is classified as superficial, medium or deep (performed exclusively by a doctor!). This peeling is also used in combination with dermabrasion or laser skin resurfacing therapy. Note: prophylaxis of herpes reactivation in infected people.
Phenol peel – This peel is also one of the deep, chemical procedures and should only be used by a physician. The active ingredient, phenol, should only be applied in small amounts, as it passes well through the skin into the bloodstream and is toxic to the liver, kidney and heart. The peeling solution is prepared according to the Gordon Baker formula. Swelling, redness and scabbing can be expected after the treatment. Healing takes a long time and infections are common. Note: prophylaxis of herpes reactivation in infected people.
Microdermabrasion – This procedure is a mechanical peel. Special sterile microcrystals are moved over the skin using a vacuum and compressed air system. The device carefully carries away the dead cells and removes the remnants.
Laser skin resurfacing therapy – This physical laser peel uses a special carbon dioxide laser (CO2 laser) to remove the top layer of skin.The procedure is used to remove superficial skin imperfections and signs of aging. In particular, wrinkles can be treated very well.

After treatment

Following a deep peel, a bandage may be necessary. In order not to complicate the healing process, a strong sunscreen is very important.

Your benefits

With its many variations, peeling is an effective way to treat small wrinkles, blemishes and other skin conditions (see above). Deep peels should only be performed by a physician, however, caution should be used with the other procedures as well, as the skin can be damaged quickly.