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Peel Away the Mysteries of Acids
By: Rhonda Allison
Posted: February 28, 2013, from the March 2013 issue of Skin Inc. magazine.
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Best practice. Administer peels six weeks apart. It is not recommended to do more than three or four per year.
Peeling agent applications
A wide variety of formulas exist, ranging from those strictly for medical use to those for esthetic use. For skin care professionals offering skin peeling treatments, knowledge of the types of agents available is essential. While duration, Fitzpatrick classification and technique all play a role in determining peeling depth, the peeling agent used is one of the most important factors. There is an art to preparing acid formulations, and it requires a very specific understanding of acids.
Medical peeling agents. Medical peeling agents create deep chemical peels that require longer healing times and also increase the potential for complications as they penetrate much deeper than superficial peels, which work at the epidermal level. Some of the most commonly used include the following.
- Baker-Gordon formula—A combination of phenol, croton oil, septisol soap and distilled water.
- Medical TCA—A high-strength TCA performed in medical settings. There is fast absorption, immediate cell necrosis, and it penetrates to the dermal level.
- Phenol acid (88% solution)—A very intense solution that can lead to irreversible hypopigmentation because of its melanotoxicity. It is not advised for dark skin.
These agents are intense formulas only recommended for medical use. Extreme caution must be used with phenol products as they are very toxic and pose considerable risk. Cardiac arrhythmia and toxicity of organs have been known to occur.
Esthetic peeling agents. Esthetic peeling agents certainly come with their cautions, but they are not as extreme as the medical-use agents. These superficial epidermal exfoliations also offer variety and the ability to create very customized results. Each has a specific purpose and effect on skin cells and tissue regeneration. Some of the most commonly used acids include the following.
- Alpha hydroxy acids (AHAs)—Naturally occurring, nontoxic organic acids. The most commonly used include glycolic (from sugar cane) and lactic (from milk). Others include malic (apples), tartaric (grapes) and citric (citrus) acid.
- Azelaic acid (up to 15%)—A lightening, lifting and antibacterial agent created by oxygenating oleic acid, an unsaturated fatty acid found in milk fats.
- Flower acids—Obtained from hibiscus chalices and characterized by their high level of AHA-like citric acid (10%) and pyruvic acid (5%), flower acids are classified as second-generation AHAs because of their hydrating qualities and ability to increase cell turnover without irritating the skin.
- Jessner’s—A combination of lower-strength acids (salicylic, resorcinol and lactic, all at 14%), which synergize to produce an efficient exfoliating agent with less risk.
- Red wine vinegar (acetic acid)—A natural acid with high antioxidant content, some studies have shown red wine vinegar to produce exfoliation with less free-radical damage and thus, less potential injury to the skin.
- Retinol—A vitamin A derivative that converts to retinoic acid and is a DNA-regulator that assists in the synthesis of collagen, retinol aids in the formation of blood vessels and encourages healthy cell formation.
- Salicylic acid—A relatively safe, low-risk beta hydroxy acid extracted from wintergreen and birch that produces a drying and lifting effect. Although it is self-neutralizing, repeated applications in high-strength doses can result in systemic toxicity.
- TCA—Nontoxic, self-neutralizing and keratolytic that penetrates only if it used in an aqueous base, TCA is very effective in low strengths, and can be used alone or in tandem with other acids.