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Chemo Exfoliation - Everything You Need to Know

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Chemo exfoliation removes a desired depth of skin layer to bring about rejuvenated and fresh-looking skin. Read the article to learn more about chemo exfoliation.

Medically reviewed by

Dr. Nidhin Varghese

Published At June 2, 2023
Reviewed AtMarch 4, 2024

Introduction

Chemo exfoliation is otherwise known as chemical peeling. It has been one of the most popular cosmetic procedures in recent years. The procedure involves targeted removal of a desired depth of the superficial skin layer using chemical agents. The chemicals used are caustic agents (chemicals that corrode skin and mucus membranes) in specified concentrations that allow for a predictable and swift ablation (removal) of a uniform skin thickness, ultimately resulting in a better clinical appearance of rejuvenated skin.

What Is the Goal of Chemo Exfoliation?

Human skin gets damaged due to consistent exposure to harmful sun rays, chemicals, and various environmental factors. As a result, the damaged skin will have a dull and unhealthy appearance. Chemo exfoliation aims to remove a specific thickness of the skin layer, allowing for better wound healing and skin revival. It will also minimize the chances of developing scarring and pigmentary changes.

The ultimate goal of chemo exfoliation is to refine the appearance of skin by diminishing the appearance of fine lines and wrinkles, acne scars, and acne lesions, evening out the skin tone, reducing hyperpigmentation, and producing an overall youthful appearance.

What Happens to the Skin in Chemo Exfoliation?

  • Caustic agents are used on the skin to bring about chemical peeling. The caustic agents are chemicals that burn or corrode the skin, mucous membranes, and eyes. In chemical peeling, the agents are used at a specified concentration to control skin peeling without creating unlikely outcomes.

  • The chemicals cause controlled keratocoagulation (denaturation of the proteins in keratin and collagen) and denaturation of several other proteins in the upper epidermal layer of skin, eventually resulting in inflammation. The initial inflammation will release proinflammatory cytokines and chemokines (proteins that act against inflammation). The targeted inflammation caused by the chemical peeling agents will activate the natural healing pathways that involve the synthesis and deposition of new collagen and elastin fibers in the skin epidermis reorganization of the connective tissues and structural proteins. The series of events results in the renewal and thickening of the epidermal layer of skin and an increase in the connective tissue volume.

  • Concurrently, chemo exfoliation improves mid-depth and superficial hyperpigmentation and skin tone. Depending upon the desired outcomes, different types of chemical peels are available today.

  • Recent studies have shown that lasers support chemical peels by having control over the depth of chemical exfoliation; they are easy to use and do not have any side effects or systemic toxicities.

What Are the Indications for Chemo Exfoliation?

The primary indication for chemical peeling or chemo exfoliation is cosmetic. However, it varies for individual patients. Chemical peeling is tailored according to a patient's aesthetic demand for their skin, the ability of one's skin to tolerate the chemical agent, and the skin type based on Fitzpatrick's classification of skin types. Indications of peeling can be categorized into four.

  • Rejuvenation of photoaged skin.

  • Correction of acne and acne-like eruptions.

  • Hyperpigmentation and uneven skin tones.

  • Premalignant epidermal neoplasms.

How to Assess a Patient Before Chemo Exfoliation?

The chemical exfoliant and penetration depth depend upon the patient's evaluation, skin type, and indication.

  • Detailed personal history.

  • Proper patient physical evaluation.

  • Ask for patients' areas of concern.

  • Detailed medical history.

  • History of hyperpigmentation and scarring.

What Are the Different Types of Chemical Peels?

Chemical peels can be classified into three groups based on the ablation depth created by the chemical agent.

1. Superficial Peels: Effects on the epidermis only.

2. Medium-Depth Peels: Effects on the epidermis and papillary dermis.

3. Deep Peels: Effects up to the mid-level of the dermis and sometimes the upper layer of connective tissues.

The ablation depth is influenced by several factors, including

  • The type of chemical peeling agent used.

  • The concentration of the chemical.

  • The mode of application.

  • The number of layers applied.

  • Skin type.

  • The condition of the skin being treated.

The depth of peeling depends upon the dose of the chemo exfoliant. A single-layer application will cause superficial peeling, whereas multiple layers are associated with greater peeling effects. However, the multiple-layer application of a superficial peel is different from a single-layer application of medium-depth or deep peels. The time taken for peeling is inversely proportional to the concentration of chemicals. Therefore, a higher concentration exfoliant brings about peeling in a shorter time.

What Are Superficial Peels?

Superficial chemical exfoliation will cause keratocoagulation and protein denaturation of the cells in the upper epidermal layer. Superficial chemo exfoliation treats conditions confined to the skin's upper layer. The recovery time is less for superficial peeling, and results are displayed early. Side effects are also minimal, with superficial peeling. The commonly used superficial chemical exfoliants are

  • Low-to-medium strength AHA (Alpha-hydroxy-acids).

  • 30 to 50 percent Glycolic acid.

  • 10 to 30 percent Lactic acid.

  • 40 percent Mandalic acid.

  • 30 percent beta-hydroxy Salicylic acid.

  • 50 percent alpha-keto Pyruvic acid.

What Are Medium-Depth Peels?

Medium-depth peels cause controlled kerato-coagulation in the upper dermal layer and papillary dermis. The deeper penetration of chemicals will produce better regenerative outcomes. It has shown excellent outcomes in treating fine lines, photodamaged skin, acne scars, hyperpigmentation caused by melasma, and correcting some premalignant changes. The commonly used medium-depth peels are.

  • Medium to high concentration Glycolic acid.

  • Monolayer application of low to medium concentration Trichloroacetic acid (TCA).

What Are Deep Peels?

The chemical exfoliant reaches the mid-level of the dermis or sometimes even up to the upper connective tissue if not applied properly. It is indicated for patients with moderate-to-severe photodamaged skin, furrowed fine lines, and severe hyperpigmentation. However, the systemic toxicities caused by deep exfoliants and better outcomes with lasers without side effects have led to a decline in the use of deep chemo exfoliants. The commonly used deep exfoliants are.

  • Medium to a high concentration of Trichloroacetic acid.

  • Baker-Gordon phenol (50 to 55 % phenol).

Conclusion

According to data published by the American society of plastic surgeons, chemo exfoliation is the third most commonly practiced cosmetic skin procedure after botox and fillers. Over the past few years, the chemical peeling procedure has gained widespread popularity worldwide, mainly due to its mild properties, minimal or no side effects, and affordability compared to laser procedures. The wide popularity has led to including lactic acid and glycolic acid in several over-the-counter chemical peels.

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Dr. Nidhin Varghese
Dr. Nidhin Varghese

Dermatology

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