- Chemical peels are classified according their depth of penetration into superficial, medium, and deep depth peels. Superficial peels penetrate into the epidermis and papillary dermis.
- Extension of chemical peeling agents into the lower reticular dermis produces scarring and is not indicated.
| Superficial | Epidermis and papillary dermis | Trichloroacetic acid (TCA) (<30%)m Jessner’s solution, Glycolic acid (10-30%) |
| Medium | Epidermis, papillary dermis, upper reticular dermis | TCA (35-50%), phenol (88%), Jessern’s solution + TCA (35%) |
| Deep | Epidermis, papillary dermis, upper and mid reticular dermis | Baker’s phenol, Litton’s phenol |
- The use of antibiotics and antiviral agents pre and post-operatively has been well established as protocol in skin resurfacing to prevent bacterial infection and post surgical herpetic outbreaks.
- Carbon dioxide laser skin resurfacing depth of penetration is reticular dermis
- Alpha hydroxy acids (Glycolic acid) used to achieve keratinolysis to enhance penetration of other topical agents.
- Hydroquinone inhibits melanocytes and increases melanocyte degradation. This minimize post inflammatory hyperpigmentation.
- Tretinoin is used to normalize keratin and increase fibroblast collagen production to allow for faster wound healing. It also allows for removal of superficial cells to enhance the penetration of the CO2 laser.
- Steroids are contraindicated.
- Phenol is rapidly absorbed through the skin and metabolized through the liver, and excreted by the kidney. It can lead to renal failure and hepatotoxicity, and can directly irritate the myocardium, inducing dysrythmias.
- Hormone replacement therapy may contribute to melanocyte activity and pigmentary changes. It is recommended that therapy be stopped one month prior to surgery to decrease incidence.
