A chemical peel (chemexfoliation) is the application of caustic material to the skin resulting in destruction of the epidermis and/or superficial dermis in whole or part. By applying chemical solutions such as trichloroacetic acid (TCA) or phenol, the amount of layers removed from the epidermis or superficial dermis can be controlled. Chemical peels are most commonly used to treat photoaged skin (e.g., wrinkles, solar elastosis) and to correct pigmentation abnormalities. They are less commonly used to treat multiple actinic and other keratoses and acne scars. They are used even less frequently to treat acne lesions.
Chemical peels can be used for both the epidermal and dermal layers. A chemical peel that affects the epidermal layer is called an epidermal peel. This application is commonly used to treat fine or subtle lines, lighten skin due to hyperpigmentary disorders, and improve the skin's texture and appearance.
A chemical peel that affects the dermal layer is called a dermal peel. This application is commonly used to treat some premalignant lesions, such as, but not limited to, actinic keratosis (considered a precursor of squamous cell carcinoma), actinic cheilitis (a condition that is similar to actinic keratosis but occurs on the vermilion of the lips), and epidermodysplasia verruciformis (an uncommon autosomal recessive disorder that predisposes individuals to the development of squamous cell carcinoma). Chemical peels are appropriate when there are numerous lesions. Additionally, dermal peels can be used to treat actinic damage, deep wrinkles, and acne scarring.
The American Academy of Dermatology (AAD) has noted that a review of the published, peer-reviewed scientific literature yields insufficient evidence to support the use of any type of chemical peel in the treatment of active acne vulgaris. The efficacy of chemical peels for the treatment of acne vulgaris is unproven due to the absence of randomized controlled studies that compare chemical peels with standard treatments.
Cosmetic services are those provided to improve an individual's physical appearance, from which no significant improvement in physiologic function can be expected. Emotional and/or psychological improvement alone does not constitute improvement in physiologic function.