A Beginner's Guide to Chemical Peels
Photo by Louis Hansel @shotsoflouis on Unsplash
You all know that I love me some chemical peels.
I’ve gotten a lot of questions on this topic, so I thought I’d do a rundown on peels for beginners.
Chemical peels are one way to exfoliate and resurface the skin, using acidic substances to break up the top layer of skin, allowing it to "peel" or fall off over several days.
Physical exfoliation is another way to do this, using brushes, scrubs, microdermabrasion, etc. I don't love this because I find that uncontrolled scrubbing can be too harsh. There was even a lawsuit in 2018, alleging the cult classic St. Ives Apricot Scrub caused undue trauma and microscopic abrasions to the skin, leading to infections and scarring. Just say NO to crushed walnut shards on your face.
The post-peel glow after a chemical peel is one of my favorite things in the world.
Once that dead snakeskin falls off, the angels start singing. Unlike physical exfoliation, chemical peels give you a more even exfoliation without undue trauma to your skin. It can be customized, depending on what type of acid you are using and what percentage. With everyone staying home these days, this is a good time to experiment with peels because we have some downtime and it's optimal to stay out of the sun while you are recovering.
An iconic moment for chemical peels. Don’t worry, they all aren’t this painful.
What can peels be used for?
They are versatile and can be used to treat:
Acne
Sun damage, including age spots and fine wrinkling
Skin texture
Pigmentation issues like melasma and post-inflammatory hyperpigmentation
Superficial scarring
The first thing to consider is the depth of the peel.
A superficial peel penetrates the outer layer of the skin (stratum corneum and epidermis) to gently exfoliate it. This will leave your skin feeling smooth and can help with mild skin discoloration.
This is the type of peel you do at home with alpha hydroxy and beta hydroxy acids up to 20%. You likely will have mild flaking over a few days without much downtime.
A medium depth peel penetrates not only the outer layer of the skin, but also goes deeper, into the dermis. This is used for more extensive texture and pigmentation issues, wrinkles and scarring.
These peels are typically administered in a physician's office and have about 7-14 days of downtime.
There will be significant crusting and peeling after several days and you should lay low, avoiding sun, and babying your skin with soaks and thick emollients, even Vaseline.
***Caution: people with darker skin types or if those who tan easily are at high risk for scarring and hyperpigmentation with these peels.
Medium depth peels are a great item in our toolbox and can yield beautiful and longer-lasting results than superficial peels. This is something that can be done a few times a year.
A deep peel penetrates even deeper in the dermis and because of that, it can help address more advanced texture issues. Warning, there is a much higher risk of scarring with this.
These are often done under anesthesia because of how painful they are and require about a month of downtime. This procedure has become less common with the popularity of resurfacing lasers.
What are the chemicals that are used in chemical peels?
Alpha hydroxy acids (AHA)
Glycolic, lactic, malic, tartaric, and citric acids belong in this group and all naturally occur in milk and fruit.
I love these because:
They are effective in both acne and hyperpigmentation
They are safe in skin of color
At lower percentages (<10%), they can be used in pregnancy and lactation*
*This is a bit of an arbitrary designation, as there are a lack of well-controlled studies in pregnant women. However, AHAs have very little penetration past the top layer of the skin and thus, do not have significant systemic absorption. The expert consensus amongst many dermatologists is that they are safe to use at concentrations at less than 10%.
Beta-hydroxy acids (BHA) and salicylic acid (SA)
They differ from AHAs in that they have more lipid-solubility (attracted to fat) and do a better job penetrating the follicle. This makes them better at clearing out pesky blackheads and treating acne. It is used less for hyperpigmentation and anti-aging, although have been shown to be effective. In practice, I have found that salicylic acid products can be a bit irritating for patients and prefer them in washes.
Polyhydroxy acids (PHA)
Polyhydroxy acids are a relatively new kid on the block and can be a gentle alternative for those with more sensitive skin. Gluconolactone, lactobionic acid, and galactose are essentially second generation AHAs. With a larger molecular structure than their cousins, they work more superficially and result in less irritation. There are not as many products using these molecules and often are found in combination with AHAs and BHAs.
Azelaic acid
Azelaic acid is naturally occurring, found in wheat, barley, rye, and even made by yeast that lives on the skin! It is a gentle exfoliant, used primarily to treat rosacea at higher concentrations but also helps with hyperpigmentation. It’s great to use as a daily leave-on product between peels, to help gently maintain that glow.
How do you do a chemical peel at home?
Superficial chemical peels to gently and evenly exfoliate the top layer of your skin (epidermis) can easily be done at home.
Using over the counter products containing alpha hydroxy acids and beta hydroxy acids (either alone or in combination) can help improve acne, skin texture, and mild pigmentation issues.
How do you use them? They come in many different concentrations, but I'm a fan of using these products in slightly higher concentrations (10-20%) as a short contact rinse off product 1-2 times weekly rather than daily. I find that it is more effective than using a lower concentration daily product.
*If this is your first time using acids, I recommend starting lower with either a 5% or 10% product.*
How to do a chemical peel at home:
1. Wash your face and pat it dry.
2. Apply the peeling solution and leave on for 2-3 minutes.
— With subsequent treatments, you can leave it on for longer (7-10 minutes), as tolerated.
—*You should feel a little tingling, perhaps itching, and start to see your skin become a bit pink.*3. After the time is up, rinse off with cold water, pat dry, and apply a gentle, thick moisturizer.
4. For the next day or two, practice gentle skincare and skip your retinoid or other active topical products if your skin is peeling and/or irritated. Makeup is okay (although may not be cute on top of peeling skin).
5. Don't forget that sunscreen. These acids make you more sensitive to UV exposure.
What products do I recommend?
The main thing I look for in a product is the percentage of active ingredient. I generally steer clear of products that don’t list the percentage because I don’t know what I’m buying. It’s like buying a car without knowing the gas mileage.
The other thing I look for is the price. I often find that brands charge a premium for their peel products, but there are plenty of brands that have great products at a reasonable price point.
Here are a few of my personal favorites:
Pixibeauty Glow Peel Pads (20% glycolic)
The Ordinary 30% AHA + 2% BHA Peeling Solution
Glytone Mini Peel Gel (10% glycolic)
Nip + Fab Glycolic 10% Fix Concentrate Extreme
Doing a peel at home once or twice a week is great, but sometimes we all need something a little stronger. That’s where medium to deep peels come in.
Overall, chemical exfoliation with peels are my go-to for improving a wide range of skin issues. It’s so versatile, works for many skin types, is more affordable than laser treatments, and can be done at home. I hope this helped elucidate the concepts around chemical peels and that you’ll try it yourself!
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References
Andrija Kornhauser A, Coelho SG, Hearing VJ. Applications of hydroxy acids: classification, mechanisms, and photoactivity. Clin Cosmet Investig Dermatol. 2010; 3: 135–142.
Sheau-Chung T, Jen-Hung Y. Dual Effects of Alpha-Hydroxy Acids on the Skin. Molecules. 2018 Apr; 23(4): 863.
Soleymani T, Lanoue J, Rahman Z. A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. J Clin Aesthet Dermatol. 2018 Aug;11(8):21-28.