What's new in skin rejuvenation I: chemical peels

Studies using computer simulations have shown that changing the quality of the skin can add or subtract 20 years from the estimated age of an individual. The concept of using topical agents on the skin to improve its appearance is at least as old as ancient Egypt, where nobles applied sour milk, containing the active ingredient lactic acid, to improve the appearance of their skin. In the Middle Ages old wine was used in a similar fashion. Currently fruit acids, the alpha hydroxy acids, are frequently used for the same purpose.

The underlying goal is to improve the skin quality by producing a controlled injury which is then allowed to heal. Generally the deeper the injury, the better the results, but also the longer the healing time and the greater the risk of problems. The peels mentioned so far are all superficial peels that produce mild results.
In search of better peeling agents, physicians and eventually lay peelers experimented with stronger agents. The father of modern chemical peeling was Dr. Paul Gerson Unna, a German dermatologist who lived from 1850 to 1929. He experimented with salicylic acid, resorcinol, phenol and trichloroacetic acid,  agents that are still in use today. At the turn of the last century, Dr. George MacKee, a dermatologist, began using phenol on scars. In the 1960s Baker and Gordon developed a phenol based deep peeling solution that dramatically improved deeper lines and wrinkles.
The usefulness of peeling has been limited by its potential complications, including color change, usually prolonged or permanent lightening, but also darkening at times. Other potential problems are scarring, prolonged redness, occasional infections and flaring of acne.
The  practice of  chemical peeling  appears to have reached a dead end.  While  many chemical peels  are still performed,  both in salons and medical offices, there have been no recent advances in chemical peels. No new peeling agents have gained acceptance and there have been no recent advances in technique.
Where progress has been made has been in replacing chemical peels with laser peels (MicrolaserPeel), other laser treatments which produce similar results without peeling ( Fraxel laser ) or newer technologies that specifically target sun damaged skin ( Levulan photofacial and superphotofacial ). These technologies can achieve the same results as the traditional chemical peels with significantly less risk and greater reproducibility.

Gerald N. Bock MD
Stockton, CA
California Skin Laser Center