Having been in the practice of dermatology for over 30 years, I felt that there was a void in the industry for an effective chemical peel designed to lighten, brighten, and firm the skin with minimal side effects and downtime. The cosmeceutical industry had several peels on the market that addressed sun damage and produced improvement, but they were often associated with pain and side effects. Chemical peels with strong, caustic acids like high concentrations of trichloracetic acid (TCA) and phenol caused significant tissue destruction, down time, risks, and variable outcomes. The mild alpha hydroxy acid and beta hydroxy acid peels available were less painful with no downtime, but their results were not very dramatic. The challenge to me was to create an entirely new type of peel intended to treat discoloration and sun damage with significant results, minimal downtime and few side effects. I created the Poly-Organic Brightening Peel. This article will discuss the various types of facial peels available on the market, their ingredients and their risks and benefits.

The Chemical Peel: 101

Chemical skin peels can improve skin texture and reduce the appearance of fine lines and wrinkles. They work by removing the outermost layers of the skin damaged by sun exposure, age and skin conditions to allow smooth, healthy new skin underneath to grow. Ideal candidates for skin peels are described in Table 1. Skin peels may be superficial (mild), medium or deep.

Superficial Peels. Superficial peels are used to improve the appearance of pigment changes in the skin, acne scars, mild sun damage or fine wrinkles in all skin types. Superficial peels are less painful, do not require downtime and have very few side effects, but the results are not very dramatic. They can be applied on the face and on other parts of the body. Some dermatologists and estheticians may perform a superficial (mild) peel before a medium-depth peel in order to give a more effective skin peel. Superficial peels typically use alpha hydroxy acids (AHAs) like glycolic acid or beta hydroxyl acids, such as salicylic acid, to remove the epidermis or uppermost layer of skin. A superficial peel may slightly reduce but does not eliminate sun damage and signs of aging. The results may not appear for some time, and when they do appear, they may be minimal. Repeated peels are often needed to produce the effect the person wants. A mild superficial skin peel will need to be repeated four to six times over a period of two to three months. The results of a mild superficial peel last about one month; maintenance peels performed at one to three month intervals are recommended. Superficial peels are done on an outpatient basis, do not require anesthesia, and cause only slight discomfort afterwards. Most people can return to their normal activities immediately. The skin may turn pink after a superficial peel, and usually only minimal peeling occurs. Patients can use makeup to hide any redness until it fades.

Medium-depth Peels. Medium-depth peels, such as Poly-Organic Brightening peels or lower concentrations of trichloroacetic acid (TCA less than 25%), are used to treat discolored skin, hyperpigmentation, fine lines, wrinkles, sun damage and precancerous skin lesions. Medium-depth peels penetrate deeper into the epidermis and usually take 20-30 minutes to administer. Side effects may include moderate stinging or discomfort for 30-60 minutes. Medium-depth peels also cause pinkness of the skin, which may take 24-48 hours to fade. Medium peels are used most often on the face; retreatment may be needed after three to six months to produce the best effect. Medium peels are usually done on an outpatient basis, but patients may need to take a few days off work to recover. The skin takes five to seven days to heal. Moisturizers and make-up can be worn after the peels if they are tolerated well and appropriate sun protection is used. There is little or no pain after the peel, but there may be some slight puffiness and swelling, especially if the area around the eyes is treated. The skin will turn reddish brown in two to three days and then flake and peel over the next few days. Recovery times for medium- depth peels range from two days to a week.

Deep Peels. Deep peels are used to treat severe wrinkles, long-term sun damage, pronounced pigment changes and lesions, acne scarring, severe sun damage and precancerous growths of the skin. They are done only on the face and not on darker skin types because they modify pigmentation.

Deep skin peels penetrate into the dermis. A higher concentration of trichloracetic acid (greater than 25%) is the ingredient of choice for most deep peels. Phenol is more caustic than other deep chemical peel ingredients and carries a greater risk of permanent pigmentation changes, demarcation, and greater skin sensitivity to sunlight and sunburn. Petroleum jelly or another ointment may be applied after a phenol peel to protect the skin. Full recovery can take several months. A deep peel causes a second- degree burn of the skin. Skin regrowth takes 10-14 days after a deep peel. The skin remains extremely red for three weeks, up to two months for some people. Most people take about two weeks off from work. Complete healing of the skin may take several months. Oral pain relievers may be given to reduce pain after the peel. Some people have severe swelling, especially around the eye area. Elevating the head may reduce the swelling to some extent, and corticosteroids may be used to reduce severe swelling. Patients may be given a short course of antiviral and antibiotic medicines to prevent infection. Proper wound care is extremely important after a deep peel to speed healing and prevent infection of the wound. Patients may be asked to shower several times a day to reduce crusting and return to the doctor's office frequently to have the wound cleaned and checked. Laser resurfacing of various depths has replaced phenol chemical peels for most physicians. Generally, laser resurfacing has greater predictability of results and lower incidence of side effects.

Poly-Organic Brightening Peel

As mentioned above, the Poly-Organic Brightening Peel is a medium-depth chemical peel, but with several advantages over medium-depth peels of the past. Unlike the traditional exfoliating peels, Rx Systems PF's Poly-Organic Brightening Peel uses a unique blend of safe but effective organic acids intended to cause natural chemical exfoliation of the stratum corneum and epidermis. The peel contains antioxidants and skin lightening and brightening ingredients, in addition to the combination of exfoliative and reparative organic acids (organic compounds are naturally occurring molecules containing carbon, but may have other elements like hydrogen, oxygen and nitrogen). The synergistic effect of these ingredients is intended to create a comprehensive reparative and rejuvenating chemical peel that can be combined with other cosmeceutical products and treatments. This special formulation includes a unique, innovative blend of peeling agents, alpha-hydroxy acid (glycolic acid), beta-hydroxy acid (salicylic acid), dicarboxylic acid (azelaic acid), aromatic organic molecule (resorcinol), and hydroxylpyrone (kojic acid). It can be combined with LAscorbic Acid or Retinoic Acid (physicians only) to individualize the benefits for certain patients. While results are predictable and noticeable after just one 20- minute Poly-Organic Brightening Peel, more dramatic results are seen after a series of peels. The number of treatments needed by a patient depends upon the problem being addressed, but usually ranges from three to six treatments spaced two to four weeks apart. Results are generally seen after just one treatment, but a series of treatments is required for optimum results. Other products and treatments can be used in conjunction with the peel, depending on the skin problems being treated.

Maintaining Peel Results

The changes that occur in the epidermis following a chemical peel last for years. In order to maintain the results, it is critical to avoid sun damage. As with any treatment, it is always important to protect the skin from harmful UV rays after the peel, as this can aggravate and cause damage to the skin. It is recommended that peel recipients use an SPF 30 or higher, which should contain micronized zinc oxide or tintanium dioxide. Patients should use adequate sun protection even on cloudy days.

The patient's skin type, skin care before and after the peel, the doctor's level of experience, and the patient's lifestyle after the procedure can also affect the results. Some types of skin problems respond better to chemical peeling than others. People with lighter skin who limit their sun exposure after the procedure tend to have better results than those with darker skin and those who continue to spend time in the sun.

Peel Side Effects and Risks

Significant complications with chemical peels are infrequent, but potential complications are listed in Table 2. Patients can help minimize certain risks by following the advice and instructions of their doctor, both before and after the chemical peel. Pre-existing conditions may also put a patient at risk. Patients who have a history of herpes, a tendency to form large or unusual scars or have undergone considerable amounts of radiation or facial x-rays should consult their doctor before having a chemical peel.

Managing Patient Expectations

Some types of skin problems respond better to chemical peeling than others. Changes in the color and texture of the skin caused by aging and sun exposure may continue to develop after a chemical peel. Chemical peels treat the problem—not the cause—making good skin care, effective sun protection, and a healthy lifestyle important for slowing new damage.

Chemical peels are designed to wound and remove the upper layers of the skin. Patients will need to prepare themselves for how their skin will look immediately after the peel and throughout the healing process. Patients will also need to be prepared to use moisturizers and cosmetics to blend skin tones in treated areas.

During the early healing period after a chemical peel (before the skin has finished peeling), patients will need to avoid sun exposure. After the early healing period has passed, patients will need to wear sunscreen every day and limit sun exposure as much as possible. New skin is more susceptible to damage and discoloration from sunlight.

Even patients with realistic expectations may not see results for several weeks or months.

Options for skin resurfacing

Chemical peels, dermabrasion and laser resurfacing are the most common techniques for improving the texture and appearance of the skin. Although these techniques use different methods, they have basically the same effect on the skin: they destroy and remove the upper layers of skin to allow for skin regrowth.

No one technique is necessarily better than the others. When done by an experienced surgeon, laser resurfacing may be slightly more precise than chemical peeling or dermabrasion. But the choice of technique is based on the site the patient wants to treat, the patient's skin type and condition, the doctor's experience, the patient's preferences, and other factors. Some people may get the best results using a combination of techniques.

Regardless of the procedure or procedures used to improve aging and sun-damaged skin, a home skincare program is essential to maintaining and protecting the results of any treatment program.

See it online: dermtube.com/video/poly-organic-brightening-peel/

Dr. Samuels is Developer of the Rx Systems PF line of skin care products www.rxsystemspf.com.

Lawrence Samuels, MD, FAAD Chief of Dermatology at St. Luke's Hospital and Instructor, Division of Dermatology, Washington University School of Medicine, St. Louis, MO.