DISKURS-Interview: A chemical peeling in professional hands is very easy to control

DISCOURSE dermatology interviews Dr. medical Heidi Dötterer-Rieg (3/8, 2023, Frankfurt/Main)

dr medical As a specialist in dermatology and allergology, Heidi Dötterer-Rieg runs her own private practice for dermatology and aesthetic medicine with an affiliated medical-cosmetic institute in Frankfurt am Main. We spoke to the expert about her experiences with chemical peels for various indications.

DISCOURSE dermatology: Miss Dr. Dötterer-Rieg, to begin with, can you briefly explain what types of chemical peeling there are?

dr Dötterer-Rieg: Gladly! With chemical peels, we differentiate between superficial, medium and deep chemical peels, depending on the depth of penetration into the skin, with the concentrations used, exposure times and combinations of different peels offering additional therapy options. Superficial chemical peels that work in the epidermis use glycolic acids (alpha-hydroxy acids known as fruit acids found in sugar cane juice), mandelic, salicylic, lactic and citric acids. Retinol and TCA (trichloroacetic acid) are used as medium-deep peels. Depending on the concentration and exposure time, the penetration depth can be as far as the papillary dermis. With deep peeling, the phenol peeling, the penetration depth can be as far as the reticular dermis. This requires analgesia. The medium and deep peeling procedures should be carried out by an experienced doctor (usually a dermatologist), while superficial peelings can also be carried out by well-trained beauticians under the supervision of a dermatologist.

DISCOURSE dermatology: By peeling off the outer layers of skin, accelerated and controlled skin regeneration is promoted. What are your experiences with different symptoms such as acne, scars, pigment disorders, sun damage and anti-aging?

dr Dötterer-Rieg: Consistently very good. A chemical peeling is very easy to control in professional hands and can be perfectly adjusted to the respective skin type, the complexion to be improved and the season. Depending on the symptoms and skin condition, we often use combination peels in addition to the glycolic acid peels, in which several chemical peeling processes are combined. For example, Acnelan peeling (bexaretyl complex, retinoid, salicylic acid) is used for severe inflammatory acne with scars and Dermamelan (kojic acid, phytate acid, vitamin C, retinol and brightening peelings with mandelic acid and citric acid) are used for chloasma. For anti-aging TCA peeling, retinol peeling, phenol peeling and Jessner peeling are very important.

DISCOURSE dermatology: How long does the regeneration process take, depending on the depth of penetration?

dr Dötterer-Rieg: With the superficial peels, also called lunchtime peels, the skin looks rosy after the treatment and rarely shows minimal scaling and redness. Redness, flaking, crusting and swelling may be visible for up to 1 week with the medium-deep peels. With the deep peels, these symptoms can last up to 4 weeks. After these treatments, it is important to protect the skin with a sun protection factor of 50+ and to care for the skin with moisturizers tailored to the respective peeling. This aftercare is essential, supports the effect of the peeling and prevents side effects such as wound healing disorders, infections, post-inflammatory hyperpigmentation and scarring.

DISCOURSE dermatology: There are various peeling products on the market. Which peeling do you use the most and why or what for?

dr Dötterer-Rieg: In our institute we are very happy to use the extensive range of Mesopeel products, eg the salicylic acid peeling and Acnelan for acne treatment, the Dermamelan treatment for chloasma and currently also the "summer" fruit acid peeling, the modified Jessnerpeel. This acts superficially in the epidermis and is used as a glow/radiance peeling or for light cleaning in warm months. We also often use mandelic acid for large-pored oily skin and lactic acid for very sensitive and young skin.

DISCOURSE dermatology: What are the basic benefits of a chemical peel?

dr Dötterer-Rieg: A great advantage of chemical peels is that in professional hands you can achieve very safe, effective, versatile and personalized results. After several sessions, a complete change in the skin structure can be achieved without major downtime (downtime) and without spending a lot of time. A cure therapy with chemical peelings can often replace or support intensive intake of tablets such as isotretinoin.

DISCOURSE dermatology: Can you briefly describe the course of a treatment?

dr Dötterer-Rieg: After a 14-day preparation period with a special acidic home product, the skin is optimally prepared for a first gentle fruit acid peeling. The medical beautician cleanses and tones the skin so that the pH value is the same all over the skin. A thin layer of the appropriate peeling solution is then applied. After a few minutes, the fruit acid peeling is neutralized with an alkaline spray. Any impurities are gently removed and a cooling, moisturizing mask completes the treatment. The patient goes home with a rosy complexion and a protective sun protection factor on the skin.

DISCOURSE dermatology: Is the treatment painful for the patient?

dr Dötterer-Rieg: If the patient has prepared his skin with suitable acid-based home care preparations, the skin is already "trained" to tolerate a gentle introduction to the fruit acid therapy without unpleasant burning sensations. Only a slight tingling can be felt during the exposure phase. A fan set low or a fan that is moved slightly provides fresh air.

DISCOURSE dermatology: How often and at what intervals should a chemical peel be used or repeated?

dr Dötterer-Rieg: In the case of acute acne, depending on the condition of the skin, a chemical peeling can be carried out every 14 days to reduce sebum, dandruff and bacteria caused by inflammation - provided that there is no bacterial superinfection or massive inflammation. Otherwise, the procedure is repeated in the 4-week cycle according to the cell regeneration process, not more often, otherwise the new formation that has not yet been completed will be interfered with.

DISCOURSE dermatology: Are there any contraindications or possible complications?

dr Dötterer-Rieg: Open wounds, acute eczema or an active herpes infection are contraindications, as is pregnancy or breastfeeding (depending on the peeling). You should always take a break of around 2-3 weeks before and after a skiing holiday. Likewise, a time interval to Botox and hyaluronic acid injections must be observed. Laser interventions should take place no earlier than 4 weeks after fruit acid therapy. Failure to comply always involves the risk of post-inflammatory hyperpigmentation, scarring and infection.

DISCOURSE dermatology: How long does the peeling effect last and how important is follow-up treatment by the patient at home?

dr Dötterer-Rieg: Depending on the peeling method, a skin structure change can be achieved after several sessions, which then sometimes has to be repeated at longer intervals to maintain it. Home care tailored to the treatment is very important for maintaining success.

DISCOURSE dermatology: Can the combination of a peeling with other treatments show even more effective results, depending on the indication?

dr Dötterer-Rieg: After a professional skin structure analysis, we generally create a personalized treatment plan in which several procedures are combined at an ideal time interval. We can use peelings as a treatment enhancer for microneedling or microdermabrasion, or as a preparation for more intensive treatments such as laser or radio frequency therapies. Integrated into a holistic treatment, the fruit acid peeling helps to bring even more intensity to the respective treatment. As a preparatory measure, 2-4 chemical peels serve as so-called "door openers" to remove scales and inflammation and to strengthen the skin barrier.

DISCOURSE dermatology: Last question: What has been your best result so far that you have achieved with a peeling?

dr Dötterer-Rieg: I can't possibly narrow this down to a single result! We have been able to achieve very good results, for example, with acne diseases that have been refractory to therapy with pronounced scarring, with pronounced inflammation and with rosacea patients. Patients with chloasma or melasma require a great deal of experience and selection of the right peeling procedure and coordinated home care, but here too we have been able to achieve impressive results with many patients.

DISCOURSE dermatology: Dear Dr. Dötterer-Rieg, thank you very much for the interview!

The interview was conducted by S. Höppner.