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Chemical peeling, or chemical exfoliation, involves applying a chemical substance to the skin, intentionally causing controlled epidermal damage with or without affecting the dermis. This controlled damage prompts skin regeneration and remodeling, thereby improving overall skin appearance and texture. Skin resurfacing with a chemical peel can restore a youthful appearance of the aging face, neck, and hands while addressing medical conditions such as acne and actinic keratosis. Chemical peels are of various types—each with a unique pH level, application method, time, and associated risks and complications. A comprehensive understanding of appropriate patient selection, peel choice, and contraindications, as well as associated risks and potential complications, is imperative before administering chemical peels to individuals. This topic delves into patient selection, evaluation, and the supervision of individuals undergoing chemical peeling while highlighting the integral role of the interprofessional team in enhancing the overall patient care undergoing this procedure. Objectives: Identify suitable candidates for chemical peeling based on their specific dermatological concerns, skin types, and treatment goals. Differentiate between the various chemical peels and their indications by understanding their pH levels, application methods, and penetration depth. Assess the patient's skin conditions, sensitivity, and medical history before the procedure to determine the most suitable chemical peeling agent, concentration, and pH for their treatment. Collaborate with an interprofessional healthcare team for comprehensive preoperative, postoperative, and intraoperative patient care. Access free multiple choice questions on this topic.

Chemical peeling, or chemical exfoliation, involves applying a chemical substance to the skin, intentionally causing controlled epidermal damage with or without affecting the dermis. This controlled damage prompts skin regeneration and remodeling, thereby improving overall skin appearance and texture. Chemical peels are of various types—each with a unique pH level, application method, time, and associated risks and complications. A chemical peel can offer potential benefits for various skin conditions, including acne vulgaris, melasma, wrinkles, actinic keratosis, photodamage, photoaging, pigmentation disorders, and acne scars.[1] Skin resurfacing with a chemical peel can restore a youthful appearance of the aging face, neck, and hands while addressing medical conditions such as acne and actinic keratosis. Healthcare professionals frequently use chemical peels for both therapeutic and cosmetic purposes to enhance facial skin's appearance, whether utilized independently or combined with other approaches such as laser treatment or dermabrasion.[2][3] Chemical peels are typically categorized based on their depth of skin penetration, which can range from light to medium to deep. Several factors, including pH and concentration, application technique, and the patient's skin condition and sensitivity, influence the extent of the therapeutic effects.[2]

Deeper peels are associated with increased therapeutic effects and more significant risks.[17] Individuals with darker skin tones with a known history of hypertrophic scar formation are at the highest risk of complications. Recent or ongoing exposure to isotretinoin can adversely affect the outcome of a chemical peeling treatment. Therefore, patient selection and counseling are crucial in maximizing results and minimizing complications. Furthermore, it is imperative that patients strictly adhere to post-peel care instructions, with particular emphasis on sun avoidance, to optimize their outcomes.[1] Complications from chemical peeling can be classified as immediate or delayed. Immediate complications occur during or shortly after the procedure, while delayed complications may occur weeks or even months later. Immediate Complications Immediate complications include skin edema, burning and itching sensation, blistering, anaphylaxis, ocular mucosal splashes, cardiac arrhythmias, and systemic toxicity or salicylism.[18][19] Delayed Complications Delayed complications include bacterial, viral, or fungal infections; acne and milia eruptions; postinflammatory hyperpigmentation; hypopigmentation and lines of demarcation; and incomplete responses.[14][18] Notably, before phenol peeling, it is advisable to conduct liver and kidney function testing to diminish the risk of toxicity. Salicylism, although infrequent, is a complication characterized by symptoms such as tinnitus, nausea, vomiting, dizziness, psychosis, stupor, coma, and death in severe cases.

Identifying the risk factors and conducting a comprehensive patient assessment before proceeding with a chemical peel is imperative. Adopting an interprofessional team approach is optimal for enhancing overall outcomes and mitigating complications associated with facial peels. Only an experienced healthcare professional should evaluate patients for chemical peeling treatment If anesthesia is warranted, it is essential for both a primary care clinician and an anesthesiology specialist to assess the patient's suitability. In the case of phenol peels, conducting liver and kidney function tests can help minimize the risk of toxicity. To achieve the best possible results, an interprofessional team of aestheticians and healthcare professionals with specialized training should be readily available before, during, and after the chemical peeling procedure. Healthcare professionals performing the chemical peeling procedure must possess the expertise to choose and apply the appropriate chemical peel. They should also be able to recognize potential complications for minimizing morbidity and mortality rates in patients. In the immediate postoperative phase, it is essential to have close monitoring by a healthcare team who are experts in post-procedural care for chemical peels. Their role involves vigilant monitoring of the patient for any potential complications. The healthcare team must provide coordinated patient education on proper post-peel skin maintenance and explain the importance of minimizing sun exposure during the initial weeks after the procedure. This approach is crucial for achieving optimal results and preventing complications. In this regard, a well-trained, cohesive interprofessional team can be invaluable in improving overall patient outcomes.

Over-the-counter pain medications are generally sufficient to manage post-procedural facial discomfort. To reduce erythema and dryness, patients should follow the 0.25% acetic acid soak procedure as previously described and apply petroleum jelly several times daily until the treated area completes its peeling, which usually takes around 5 to 10 days. Although intense erythema may be present immediately after skin desquamation, it gradually diminishes over several days. Patients are strongly advised to refrain from direct sun exposure during the first several days after the procedure. Protective measures should be implemented for several weeks to months, including using sunscreen and wearing wide-brimmed hats outdoors. Makeup may be applied again after approximately 1 to 2 weeks once re-epithelialization is completed, and the skin is healed and healthy.[5] Close follow-up after the procedure is recommended to assess for any potential complications. If the patient wishes, photographic documentation should be conducted approximately 2 to 3 months postoperatively.

Close follow-up during the initial postoperative period is crucial, and this monitoring can be conducted by a wound care nurse and a clinician experienced in the post-procedural care of skin resurfacing with chemical peels. This ongoing evaluation should be comprehensive, assessing potential complications ranging from localized skin reactions to systemic cardiotoxicity.[5]