Superficial peels classification

Medium-depth peels are most appropriate for patients with moderate to advanced photodamage (Glogau types 11 and 111). Those with Glogau classification 11 will achieve the most significant benefit. Patients with Fitzpatrick skin types 111, ly y and VI are at an increased risk for postinflammatory hyperpigmentation and should be pretreated accordingly for prevention. As with superficial peels, sebaceous quality, skin thickness, and inflammation should be taken into account and treated accordingly to foster more even peel absorption and optimal clinical... 

The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels, AHA, Jessner s solution, tretinoin, TCA in concentrations of 10-30% and most recently hpo-hydroxy add are used to induce an exfoliation of the epidermis. Medium-depth agents such as TCA (30-50%) cause an epidermal to papillary dermal peel with subsequent regeneration. Deep peels using TCA (>50%) or phenol-based formulations penetrate the reticular dermis to induce dermal regeneration. The success of peeling in darker skin is crudally dependent on the physician s understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedure (see Box 9.1). 

Classification is always restrictive, as it forces highly variable events into a rigid framework. We will see in this book that so many different factors come into play that it becomes difficult to fit all chemical peels into a simplified and rigid classification of superficial , medium and deep . 

Mild to moderate photoaging can be effectively treated with TCA peels. Mild photoaging as defined by the Glogau classification as type 1 include mild pigmentary alterations and minimal wrinkles. Often a superficial TCA peel 10-25% will be all that is... 

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