How to Peel Back the Years

The history of chemical peels.

Of interest, is the fact that sour milk was highly valued as an exfolient, most probably because it contained lactic acid, an alpha-hydroxy acid commonly used today. But, time like the sun in the sky passes on and eventually an Egyptian family from Luxor waged a fierce set of wars against the foreign Hysos kings and finally drove them out of Egypt forever. Many years later a copy of the formulations of these chemical skin cures was found between the legs of a mummy in the Assassif district of the Theben necropolis. The manuscript passed through many hands until it was eventually purchased by Edwin Smith in Luxor in 1862, and thereafter became known as the Ebers Papyrus. In Europe, that year, Otto van Bismarck became premier of Prussia, dissolved parliament and started collecting taxes for a conflict that ended with the Franco-Prussian War. The war had Bismarck's desired effect of unifying the southern Germanic states and unfortunately nearly cost the life of a young German army physician called Paul Gerson Unna. In 1871, in spite of serious injuries he returned to the University of Heidelberg to continue his studies and eventually become one of Germany's greatest dermatologists. In 1881, Unna opened the Dermatologikum private dermatological hospital in Hamburg and the following year he described a chemical peel composed of resorcinol, salicylic acid, phenol, trichloroacetic acid that is still in use today.

In 1903, as Mayor George Mc McClellan was inspecting the final touches to New York's subway system, the Chairman of Dermatology of that city's university told a hushed audience about the advantages of using phenol peels for acne scarring. This means of exfoliation continued to be used and during World War I, its antiseptic properties was used for wound care, especially after the rising number of explosion burns to the face in the dirty trenches. It was during this period that a French physician called LaGasse noted the improved aesthetic out-come of wounds that had been dressed in phenol bandages. It is not known whether any of these soldiers eventually died of cardiac toxicity but we do know after the war ended his techniques were brought to America by his daughter Antoinette who then began a cosmetic practice in California. The art of chemical peeling remained amongst these cosmetic practitioners until the early sixties when Litton and later Baker and Gordon presented patients that they had treated with some of these cosmetic formulations to their dermatological colleagues. The Baker-Gordon peel of about 50-55% phenol is still widely in use today. It is made by combining 3 cc of 88% phenol, 2 cc of distilled water, 2 drops of croton oil, and 8 drops of Septisol. The croton oil and Septisol are added to allow deeper penetration and more absorption of the phenol.

In 1966, Baker published results of its effect on 250 patients. It was the same year that John Lennon caused record burnings in the Southern US's "Bible Belt", after he was quoted in the London newspaper, The Evening Standard as saying that the band was now more popular than Jesus.The types of chemical peels.

Before we look at the different types of chemical peels, we should first establish what skin problems we are trying to alleviate. In general most peels are used to reduce the effects of chronological aging, sun damage, scarring or pigmentation changes. These conditions occur at different levels within the skin and the type of chemical used must reflect that. Some pigmentation problems such as melasma occur in the upper epidermis and can be treated with superficial peels while other defects such as perioral wrinkles around the lip may require a deep peel such as phenol. Either way, these chemicals will tend to result in a more youthful, smoother, less blotchy or more even textured skin. The cosmetic doctor must choose a peel that relates to a certain depth of injury in order to create a desired effect and individually balance this against potential toxicities and complications in each individual patient. In general peels are divided into three categories superficial, medium and deep. The type of peel a physician uses often also has a lot to do with his personal experience and whether he has had previous problems with the various agents.

Superficial peeling agents

When people talk about superficial peels they generally mean AHA (Alphahydroxy Acids) peels involving the use of fruit acids such as glycolic acid derived from cane sugar at concentrations of 50% or higher. These peels are generally used to clear the upper layer of the skin in comedonal acne, to remove fine lines and sometimes to improve dry flaky skin. In general there are five main fruit acids:

- Glycolic Acid Peels
- Citric Acid Peels
- Lactic Acid Peels
- Tartaric Acid Peels
- Malic Acid Peels

There is something deeply humbling when we realise that most of these agents have been around since medieval times. We know that the ancient Egyptians used the lactic acid in sour milk to improve the effects of sun damage. Cleopatra is said to have used asses' milk to bathe in. It is known that tartaric acid from wine was popular with French ladies during the seventeenth century and if we look at the other acids, citric from lemons and limes, malic from apples we soon get the emergent picture. These chemicals are generally safe to use and their effect is time dependent.

The milder concentrations (