THE SALON SPA TRAINING INSTITUTE

CHEMICAL PEELS: 101 (West Virginia)

Course Hours: 2; Course Eligibility: Cosmetologists (C), Estheticians (E), Teachers (T)/Instructors (I)

This Course is Offered to Licensees in: North Carolina and West Virginia

Note: *Please take the allotted time for this 2 hr. course to read, reflect, and retain the information.  After you read through your course for the allotted 2 hrs., you can take and submit your end-of-course exam at the bottom.  Please include your name, license number and contact information at the beginning of your end-of-course exam. At the end of your exam, please press the "submit" button to submit your exam.  We will then email your exam results and course completion certificate within the same business day. If your exam is submitted after 7:00 p.m., we will email your results the next business day. Thank you and if you have any questions, please feel free to contact us at 919-672-4698, or email at SalonSpaTraining@aol.com (Note: Our online CE courses have  a timer/timing element; but it is presently being rebooted for our system, and will be up soon. Therefore, this is an alternative way you can take your online CE course.  Thank you for your patience, and we hope you enjoy your course!).

*NOTE: AFTER YOU REGISTER/PAY FOR YOUR COURSE, YOU MUST READ THIS COURSE FOR THE 2hr. REQUIREMENT. PLEASE DO NOT SUBMIT YOUR END-OF-COURSE EXAM UNTIL 2hs. AFTER YOUR COURSE PAYMENT. 

This Course Was Written and Created by:

Dr. Terri Rowland (Owner/CE Provider/CE Instructor)

The Salon Spa Training Institute℠, P.O. Box 51074, Durham, NC 27717

919-672-4698 (Phone); 919-287-2688 (Fax); SalonSpaTraining@aol.com (Email); http://www.salonspatraining.com/ (Web Site)

Lesson Objective:

This course is designed as a 2-hour Online (Internet-based) course for Cosmetologists, Estheticians, and Teachers (Cosmetology and Esthetics Teachers respectively). This two-part course (Chemical Peels 101 and Chemical Peels 102) gives the foundation of chemical peels with an emphasis on: ingredients, strength, how they affect the skin, and anticipated results. This course also addresses how chemical peels are administered; what precautions must be taken; and contraindications are discussed as well.

Overall, Light (AHA & BHA); Medium (Tricholoracetic Acid); and Deep Peels (Phenol/Carbolic Acid) will be discussed - but there will be greater emphasis on light peels, including Alpha Hydroxy Acid (AHA) peels and Beta Hydroxy Acid  (BHA) peels respectively. There will also be a discussion of the skin, including anatomy, physiology, and skin conditions - as well as discussion regarding antioxidants and free radicals of the skin and body; and various vitamins, extracts, and chemical peel acids that can treat the skin. 

Course Eligibility: Cosmetologists, Estheticians, and Teachers (Cosmetology & Esthetics)

Time Allotment: Course participants will have up to 30 days to complete this 2-hour Online course.

Note:The end-of-course exam is included at the end of your Chemical Peels 101 Online CE Course.  Please remember to include your name, telephone number, license type and license number, and your email address at the top of your end-of-course exam.

                                                                                                                            

 "CHEMICAL PEELS 101"  -  120 Min./2 HOURS

Module I: Introduction (20 Min.)     

Course Introduction/Chemical Peel Overview (7 min.)

The esthetics industry has seen a boom in the past decade with skin care services, and chemical peels have been a longstanding service, in which clients have seen vast results.  Known as a non-invasive treatment, chemical peels - also known as "epidermal exfoliation," "chemexfoliation," or "derma-peeling" have elevated advanced esthetics to a new level, with cost effective means of improving the overall appearance of the skin. Chemical peels are comprised of a chemical solution, oftentimes an acid solution; that is applied to the outer layer of the skin, better known as the "epidermis." There are also chemical peels that are administered that penetrate past the epidermis and into the initial layers of the "dermis" or the true skin. Ultimately, the anticipated results of the chemical peel, are to improve the overall appearance of the skin by working against "free radicals," in which overtime, promote cell damage and skin deterioration. Upon application of the chemical peel acid solution, various results occur - depending upon the type of chemical peel and the skin type of the client.

      There are various types of chemical peels that help with a multitude of skin conditions and skin imperfections (to be identified as acne scars, uneven pigmentation, and the like). Some of the visible improvements that chemical peels have been able to improve include (but are not limited to): (a) helping to reduce the appearance of facial blemishes, freckles, fine lines, wrinkles, age spots, and dark marks from pregnancy (a condition known as melasma); (b) improving uneven pigmentation, particularly with hyperpigmentation (darkening of the skin) and dyspigmentation; (c) aiding in the appearance of clients with skin conditions including acne, rosacea, and pilaris; and (d) to improve the overall skin texture and vibrancy by enhancing the appearance of dull skin.  Chemical peels also help to increase cell renewal, as they promote a "new skin", which has shed dead skin cells, and has begun a fresh "cell turnover."

            Ultimately, chemical peels have produced results which have led to a large client following of advanced esthetics services.  Depending upon the type of chemical peel administered, there are regulations and restrictions upon who can perform a chemical peel, whether it be a physician and or board-certified dermatologist; a medical professional such as a nurse; an esthetician, who in some states may solely administer chemical peels in the esthetics and cosmetology industries, or may work directly under a physician or dermatologist; or cosmetologists, whom in many U.S. States, have licenses that allow them to work in esthetics-related capacities as well. However, with all the present-day information regarding chemical peels, at one time in history: (a) the types of chemical peels administered, (b) who was licensed to administer them, and (c) how they were applied has an historical element.  

            History of Chemical Peels (4 Min.)

            The term "chemical peel" is seemingly a technical term which has an advanced esthetics overture.  However, World history documents that chemical peels and spa services were administered long before the 1980s, 1990s and the first decade of the 2000s.  Egypt has long been known as part of the "cradle of civilization," and there were rituals and grooming routines that promoted the chemical peel procedure. These rituals and routines were also adapted in Greece and Rome, as sour milk baths were used to rejuvenate the skin. Why use sour milk baths? Sure, this may seem unusual, but one ingredient that is a derivative from sour milk is lactic acid, and it was used for the chemical peeling process and promoted the overall health of the skin.

            Additionally, in the ancient times and Middle Ages, tartaric acid, which is derived from sour grapes, was also utilized for chemical peeling through the use of wine.  Of course in those times, the term "chemical peel" may not have been the first term used to define the actions of sour milk baths and the usage of wine - but the anticipated results were relevant to heath, beauty, and grooming of individuals. Tartaric acid and malic acid both derive from grapes, and the longer the grapes form and ferment - the more prevalent acid appears.  According to Pandell (1999), "TA" is an acronym for the "total acidity" of wine. Dr. Pandell also explains that tartaric and malic acids are "nonvolatile." This means that if grapes that contain tartaric and malic acids are boiled or heated - then the acids will not evaporate.  Therefore, tartaric and malic acids are very prevalent and in historical Egyptian, Roman, and Grecian times, these two acids were "paving the way" for chemical peels and non-invasive exfoliation in today's times! Lastly, from a chemical perspective, a typical pH balance of wine could range at about 3.4 on the pH scale, therefore, the potency of the pH will affect the skin and will cause a chemical reaction (pH balance will be discussed in more detail in Module IV: The Chemical Peel Procedure) that will emulate the "chemical peel." This just shows that in ancient times, some of the same grooming procedures and results are relevant to today's esthetics procedures and results as well.

            Types of Chemical Peels: An Introduction to Light, Medium, and Deep Peels (9 Min.)

            As mentioned previously, chemical peels promote various chemical reactions that aid in improving the skin such as: reducing the appearance of facial blemishes and marks; improving pigmentation; helping with skin conditions such as acne and rosacea; and improving the overall skin texture and promoting resiliency with a more "new skin." The increase of cell renewal and fighting free radicals are also important aspects of chemical peels and these topics will be discussed in greater detail throughout this online course.  However, there are certain categories of chemical peels that need to be introduced - so a greater understanding can take place.

            There are primarily three (3) types of chemical peels which include: light peels [often referred to as "superficial" or "lunchtime peels"]; medium peels [or TCA peels]; and deep peels [better known as carbolic acid or phenol peels). The classification of these three types of chemical peels are relevant for a number of reasons including [but not limited to]:  (a) peel strength and contents, (b) peel candidates, (c) peel application and administration, and (d) anticipated results of the desired chemical peel. (Note: in Module III: "Types of Chemical Peels: A More In-Depth Perspective," there will be greater discussion regarding the light, medium, and deep chemical peels respectively).

            Light peels can be administered in the esthetics and cosmetology environments - such as a full-service salon, skin care clinic or spa; and light peels can also be administered in medical environments - such as a doctor's office that may be supervised by a physician, a dermatologist, a plastic surgeon, and the like. In a full-service salon or spa environment, light peels are usually administered (applied) with up to a 30% acid solution, and any solution above 30% will have to be administered under the supervision of a medical doctor. Light peels are also associated with being either Alpha Hydroxy Acids (AHAs) or Beta Hydroxy Acids (BHAs), and further information regarding AHAs and BHAs will be discussed in Modules III and IV. Light peels are also known as a deep exfoliants and can aid in the removal of dead skin cells in a non-invasive (non-surgical) manner.

            Medium peels, which traditionally comprise of trichloroacetic acid (TCA), are usually administered in a doctor's office, surgery center, or dermatology clinic.  Medium peels also have to be administered under the supervision of a medical doctor. Depending upon the respective State Laws and Rules, licensed estheticians and/or licensed cosmetologists may be able to aid in the application of the medium chemical peel - or they may only be allowed to assist with pre-or post-operative procedures. Traditionally, the doctor or licensed medical professional administers and oversees the medium peel process, and the recovery time is not within the lunch hour or even 24 hours.  The recovery time usually takes days and there is definitely "down time" required after the medium chemical peel procedure.

            The deep chemical peel is the strongest of all chemical peel procedures and is associated with phenol or carbolic acid.  The chemical solution and potency of this peel is oftentimes considered as the "heavyweight" of peels.  This peel is performed by a medical doctor and there may be a need for anesthesia before this procedure.  This peel produces a totally "new skin" and is known to literally burn off the old skin over time.  The down time is for weeks (even months), and [again] the deep peel is the strongest of all chemical peel solutions.

Although this course strives to educate regarding light, medium, and deep chemical peels, the majority of this course will focus on the light chemical peel procedure.   Emphasis of all three (3) types of peels is important - however, for the licensed esthetician or licensed cosmetologist (to also be referred to as "beauty professionals"); this course strives to educate and inform regarding more advanced esthetics topics.  Although the term "light" is mentioned throughout this course, please note that it does not imply that the content is "light" in nature.  Chemical peels knowledge is important and the beauty professional has to serve as decision-maker in regard to what type of light chemical peel to use and how to administer it. There are several contraindications (i.e., various conditions, or allergic reactions) that are involved with the light chemical peel process and ultimately, advanced education is key to the betterment of your light chemical peel service. For those that are working with a medical doctor, this course may also shed light on the overall chemical peel process and ultimately, this course strives to help all beauty professionals from an advanced education perspective.

Module II: The Skin - An Overview (33 Min.)

Anatomy & Physiology (6 Min.)

Cells are "the basic units of all living things" and the human body is made of cells which in turn produce tissues; tissues produce organs; and organs produce various systems in which the body functions. Cells can grow and even reproduce and replace cells during their appropriate life cycle.  However, if the body is not functioning properly, toxins in the body can impair the overall health of the cells. When the overall health of the cells are affected, cell damage can occur. This damage can result from various things such as: sun damage and over exposure; life style factors (such as rest, daily schedule, and stress); diet, exercise and food/nutritional intake; smoke exposure; environmental influences (such as pollution); or aging. Ultimately, there are internal, external, and environmental factors that can contribute to the overall health of the skin and skin conditions.

Tissues are also an important part of the body's function, and epithelial tissue is a vital part of the skin and its body function.  Epithelial tissue is located all over the body as it usually represents a covering of various internal and external parts of the body such as: the skin, digestive organs, and various systems including the respiratory system.   Cells of the epithelial tissue are also packed very closely together. Below is a model of human connective tissues of the body:

Skin.Image.1.jpg

The skin is known as the "largest organ of the body." Oftentimes, persons don't see the skin as an organ, but the skin is one of the primary organs, along with the brain, heart, lungs, liver, kidneys, stomach, and intestines. The skin is also part of the body's ten (10) systems, which combine to make our body function on a day-to-day basis. The ten body systems include the: Integumentary System; Skeletal System, Muscular System, Nervous System, Circulatory System, Endocrine System, Excretory System, Respiratory System, Digestive System, and the Reproductive System respectively. The Integumentary System - is comprised of the dermis and epidermis skin layers. These layers of the skin are very important regarding not only anatomy, but the chemical peel process.  This system [again] is part of the largest organ of the body, the skin. It also has "sensory receptors" that aid us with the feeling and touching senses. Regarding our body temperature, this system regulates our body temperature - therefore, allowing us to feel hot, cold, warm, etc.  Below is a model of the skin, and the various layers of the skin which include the epidermis and the dermis (the epidermis and dermis represent the actual skin layers).

Skin.Image.2.jpg
Cited from: www.nlm.nih.gov

 

The Epidermis & Dermis (14 Min.)

            The skin is comprised of two layers: the epidermis and the dermis. These two layers help to protect the body from germs, toxic elements, and [again], these layers help the body to function.  Connected together, these two skin layers adjoin and connect capillaries and ducts, which produce feelings and sensation through our skin. Therefore, the dermis and epidermis are vital parts of our body.

            The epidermis is the layer in which beauty professionals can work with - without the direction of a physician. As mentioned previously, if chemical peels are administered that will affect the dermis, then a medical professional such as a physician or dermatologists will have to provide supervision and will only be able to administer the chemical peel from their respective clinics/medical practices.

The epidermis is known as the "outermost layer of the skin," and is also a very thin layer of the skin. [Again] the epidermis has "sensory receptors" that aid us with the feeling and touching senses. Even our body temperature is regulated through the epidermis - therefore, allowing us to feel hot, cold, and warm senses. The epidermis has four layers, including the Stratum Germinativum, Stratum Granulosum, Stratum Licidum, and the Stratum Corneum (an additional layer, the Stratum Spinosum will be mentioned as well).  The term stratum means a "layer of tissue," and again, cells help to create tissues, tissues help to create organs, and organs help to create our bodily systems.

  • The first layer of the epidermis, the Stratum Germinativum, contains only a single layer of cells.  Melanin, which is responsible for pigmentation in the skin, is located in the stratum germinativum.
  • The next layer of the epidermis is the Stratum Granulosum, in which "cells represent granules." Included in the stratum granulosum are keratin and intercellular lipids (which will be discussed further with the Stratum Corneum).
  • The next layer of the epidermis is the Stratum Lucidum, which represents transparency and lucidness. This unique layer is evident in the palms of the hands, as well as the soles of the feet.
  • The Stratum Corneum represents the top layer of the epidermis, and this layer is most exposed to the elements such as the sun, pollution, smoke, topical products, etc.  This layer of the epidermis is also known as "the horny layer." Beauty professionals will work mostly with the stratum corneum, as dead skin cells will begin to shed - as well as the goal of using various products and services, such as the chemical peel; which will accelerate the shedding process and will promote cell turnover/renewal. In the stratum corneum there is: soft keratin and keratinocytes, and these cells and proteins aid the cell renewal process. According to the National Institutes of Health Medline Dictionary (2009), keratin is a . . . "fibrous protein that forms the chemical basis of horny epidermal tissues [such as] hair and nails . . . ." Additionally, keratin is located in all the layers of the epidermis. Soft keratin produces keratinocytes, which is in turn, is a cell that produces keratin. Therefore, keratin and keratinocytes play an important role in cell renewal and the shedding of dead skin cells.  Hard keratin is a protein that is represented in the hair and nails.  
  • The Stratum Spinosum is not an "official layer" of the epidermis; however, it is located in between the Stratum Germinativum and the Stratum Granulosum. This layer has a "spine" prefix in its title, because is resembles a thorn-like or "prickly spine."

                        The dermis is oftentimes called the "true skin." The dermis is beneath the epidermis, and although it does not have direct exposure to the sun, such as the stratum corneum, the dermis is still a very important part of the skin, the integumentary system, and the body as a whole.  The dermis layer is composed of connective tissues that are considered live.  These living tissue layers of the dermis are 25 times thicker than the epidermis, and the two layers of the dermis are: the Papillary Layer and the Reticular Layer (Gershon, 2004).

            The papillary layer provides connectivity between the dermis and the epidermis.  This layer receives its "papi" prefix from the "papillae" - a group of connective tissues that provide nourishment in the hair follicle (dermal papillae). Within the papillae, there are looped capillaries and tactile corpuscles. The looped capillaries provide nourishment from the dermis to the epidermis; and the tactile corpuscles contain nerve endings that allow us to feel sensations and temperatures (heat, cold, etc.). The reticular layer is known as the "deeper layer of the dermis." This layer boasts protein fibers that affect the elasticity of the skin. The reticular layer produces collagen and elastin, and both work together, to improve the overall elasticity of the skin.  Collagen contains fibroblasts, better known as fibrous proteins; and collagen also represents 70% of the dermis.  Elastin contains elastic fibers and proteins, and does not have as much mass as collagen within the dermis - but nonetheless is still an important part of the natural health of the skin.  Ultimately, within the dermis and reticular layer of the dermis; as cells, fibers and proteins began to deteriorate - the aging (or pre-aging) process begins.  Therefore, wrinkles, fine lines, and lack of elasticity start to take place and the skin and the overall health of the skin starts changing.

            The papillary layer of the dermis also contains subcutaneous tissue which is also known as adipose or "fat tissue." This tissues is located at the bottom of the papillary layer of the dermis and it assist with the skin and body's shape. This will reveal how elastic is the skin and the dermis has a lot to do with how the skin holds with the body (i.e., does a person's skin sag or does it hold in its place).

            Below the dermis is the hypodermis, which is also called the "superficial fascia." The hypodermis represents fatty tissue that is connective, and this tissue helps to bind or connect between the dermis and the rest of the body. This layer of connective tissue is also loose in nature. Ultimately, the explanation of the epidermis and dermis are imperative for the overall understanding of chemical peels, their strengths, and what layers of the skin they affect.  Next will be a discussion regarding what the chemical peels have to combat, in order to produce results.

Free Radicals & Antioxidants (6 Min.)

            As mentioned previously, there are certain internal and external causes that can enhance skin damage and promote slower cell renewal turnover rates. From an internal perspective, a person's aging process may have begun, and elastin and collagen proteins and fibers may not be as prevalent.  From an external perspective, various environmental causes can affect the overall health and appearance of the skin, such as: the rays from the Sun and sun damage; pollution; smoke; weather; and the like.  Also, a person's diet, health, nutrition, and skin care regimen can affect the overall health of one's skin.

            Ultimately, when one's skin does begin to deteriorate, it can be associated with a term entitled "free radicals." Free radicals represent damaged molecules that in turn damage cells.  From a more microscopic perspective, if an atom, or group of atoms have a damaged electron; then the atom(s) would be affected - this is also an example of a free radical. Free radicals cause aging, and cell damage is prevalent within free radicals. Therefore, something has to defend the skin against free radicals, and in the esthetics industry - there are preventative measures and corrective measures that can aid in this defense (such as light, medium, and deep chemical peels).  Nonetheless, various chemical peels aid in the reduction of free radicals, and antioxidants are an important part of fighting free radicals. 

            Antioxidants can be taken orally or topically (Dermatology Times, 2006), and they represent various vitamins, extracts, acids, and natural substances.  Antioxidants are known to be good for your health and they can also help fight against chronic diseases. Some antioxidants include (but are not limited to): Vitamin C, Vitamin E, Vitamin A, beta-carotene, Amino Acids, Minerals, and Green Tea. There is greater discussion regarding antioxidants in the Vitamins, Extracts, and Acids section below; but first, a description of cell renewal and turnover rates needs to be examined - which in turn gives a greater understanding of the need of antioxidants.

            Cell renewal (also identified as turnover) can change over time, and be affected internally, as well as externally and environmentally. Babies' cells may naturally renew every 14 days, whereas teenagers' cell renewal may take place every 21-28 days.  As persons grow into their twenties to their 40s, the cell turnover rate may range anywhere from 21 to 42 days.  As persons turn 50 or older, their cell renewal may range from 42 to 84 days.  What does this mean? This means that at infancy, the body's ability to grow new cells and to shed old skin takes only up to two weeks - in comparison to new skin developing two-three months for older individuals.  Ultimately, the resiliency of the skin, the glow, elasticity and overall health and appearance of the skin will be affected if there is a slow cell renewal (Gershon, 2004).

Vitamins, Extracts, and Acids (7 Min.)

            There are various vitamins, extracts, and acids that are prevalent within the beauty industry.  These elements assist within the chemical peel process, and overall skincare as a whole.  There would be too many to mention in this 4 hr. online course, but below includes a sample (to better educate and inform). Some of the vitamins that help to fight free radicals include the following:

  • Vitamin C - also known as "ascorbic acid," is found naturally in fruits (such as oranges, strawberries, and grapefruits); plants; and vegetables (such as broccoli, brussels sprouts, and collard greens).  Although Vitamin C is natural, it can also be made synthetically as well.  Traditional Vitamin C is water soluble, and helps to strengthen the immune system.
  • Vitamin C Esther - There are various "chemical esther bonds" that can be applied to Vitamin C, such as fatty acids that contain palm oil. This would make the Vitamin C product "oil soluble," and would create a "chemical esther bond."
  • Vitamin A - Vitamin A is fat soluble, which means that it is dissolved through the intestinal tract and it also assists the cell membrane. Vitamin A also has a strong presence in cod liver oil.
  • Vitamin E - is also fat soluble, and has a strong presence in wheat germ oil, dry roasted almonds, and sun flower seeds.

There are also various extracts that can aid in fighting free radicals, and grapeseed, licorice and willow herb extracts are well known extracts (just to name a few). Grapeseed extract is a prevalent antioxidant that is known to combat free radicals.  This extract fights against oxidation (when atoms loose electrons), and is suggested to be quite powerful in potency (in comparison to other vitamins). Willow herb extract helps to calm the skin and give it a more soothing feeling. This extract is ideal for use with a salicylic acid peed (to be addressed in Modules III and IV).  Licorice extract is excellent for sensitive skin and works well with melanin and pigmentation.

Acids play a large role in the chemical peel process as well.  In Modules III and IV, there is greater discussion regarding Alpha Hydroxy and Beta Hydroxy Acids.  However, Hyaluronic acid, a natural acid within the body, plays a major part in the esthetics field.  Hyaluronic acid assists with hydration, and produces fluids that are between various proteins and fibers. As mentioned previously, the prevalence of proteins and fibers are important for the overall health and function of the body. [Again] beauty industry products can be natural or synthetic, and there are many products on the market that strive to replicate the composition and effects of hayluronic acid.

There are several other extracts and acids that can be mentioned in this course, however, this is merely a sample - and the course is more designed toward chemical peels and the chemical peel process.  Nonetheless, it is important to acknowledge various vitamins, acids and extracts, and their importance in chemical peels, skin care, and the function of the body.

MODULE III: TYPES OF CHEMICAL PEELS (40 Min.)

            Light Chemical Peels: AHA and BHA Chemical Peels (25 Min.)

            Alpha Hydroxy Acids (14 Min.)

            Alpha Hydroxy Acid (AHA) is also known as "Carbolic Acid" and it derives from the "Hydroxyl Group" of acids. AHAs occur in natural ingredients, such as sugarcane, milk and fruits; and are known as exfoliating agents that aid in exfoliating the epidermis - the outermost layer of the skin.  Within exfoliating the epidermis skin area, AHAs are considered a "deep exfoliant" and they are known to accelerate the cell turnover (renewal) rate.  AHA chemical peels have oftentimes been called the "lunch hour peel," and superficial peel - because after the chemical peel procedure, the down time is usually between an hour; and within hours, the skin pH balance should be back to normal. Ultimately, within no more than 24 hours, the client should feel "back to normal" and should not have many side effects.  AHA peels can be applied every 3-4 weeks to maximize results (10-14 days minimum time period at least). Depending upon the client's skin condition, s/he may have a series of AHA peels (such as 4-6 peel sessions) within a few months to achieve desired results.

            Alpha Hydroxy Acids are water soluble, which is different from Beta Hydroxy Acids - because BHAs are oil (lipid/fat soluble).  The water soluble effect simply means that when AHAs are applied to the skin during a chemical peel procedure - the product cannot permeate into skin that has sebum (oil) and build up. However, AHAs and BHAs are still known to help with several skin conditions and imperfections, which include (but are not limited to):

  • Helping smooth out fine lines and wrinkles;
  • Making  the skin seem smoother - which is often felt immediately after the AHA chemical peel procedure;
  • Smoothing out rough skin;
  • Combating hyperkeratosis (thickening of the skin);
  • Promoting desquamation (shedding of the skin);
  • Helping to reduce the appearance of acne scars and scaring overall;
  • Fighting against photodamaged skin (sun damage);
  • Helping to improve the overall skin complexion;
  • Aiding in the pigmentation and coloration of the skin;
  • Unclogging pores;
  • Helping the skin to build elastin and collagen via skin cell renewal and skin resurfacing;
  • Helping to unclog pores;
  • Reducing the appearance of blemishes and age spots; and
  • Making the skin to appear more youthful overall.

Besides chemical peels, AHAs and BHAs are also utilized in other skin care products, such as: facial cleansers, toners, masks; and depending upon the percentage solution, various products are designated for different skin types and skincare needs.

      The most common AHA chemical peel is the Glycolic Peel, which is also known as a glycolic acid peel.  Glycolic acid derives from sugar cane, and is one of the most widely used chemical peels. A glycolic peel overseen and administered (applied) by an esthetician or cosmetologist may range from 10% - 30%; and any other glycolic peel over 30% will have to be administered under the direction of a physician. Glycolic acid is water soluble, and it [again] does not penetrate deeply into sebum oriented skin.

      There are also other AHA peels that are used for various purposes, depending upon a person's skin type and skin care needs.  The primary Alphy Hydroxy Acid Peels include:

  • Glycolic Acid Peel (described above)
  • Lactic Acid Peel
  • Citric Acid Peel
  • Malic Acid Peel
  • Tartaric Acid Peel

Lactic acid, mentioned previously in this course, derives from sour milk and has been used for centuries in Ancient Egyptian, Greek, and Roman times. There were milk baths, rituals and grooming routines that promoted the chemical peel procedure. Cleopatra used sour milk to enhance her skin as well. These rituals and routines were also adapted as sour milk baths were used to rejuvenate the skin.  The lactic acid peel does not have as many side effects, and has even been popular with clients with Melasma. This peel loosens the stratum corneum and helps to "reduce corneocyte cohesion" - i.e., the thickening of the stratum corneum.

Citric acid peels, also known as "fruit acid peels," come from various citrus fruits, such as oranges and lemons. Tomatoes are also considered a fruit and they have a certain acidic level that can affect the skin as well.

Malic acid peels, originate from fruits such as apples and pears.  Malic acid is also prevalent in grapes and wine as well, along with Tartaric acid.  As mentioned previously in the ancient times and Middle Ages, tartaric acid, which is derived from sour grapes, was also utilized for chemical peeling through the use of wine.  Of course in those times, the term "chemical peel" may not have been the first term used to define the actions of sour milk baths and the usage of wine - but the anticipated results were relevant to heath, beauty, and grooming of individuals. Tartaric acid and malic acid both derive from grapes, and the longer the grapes form and ferment - the more prevalent acid appears.  Additionally, tartaric and malic acids are "nonvolatile." This means that if grapes that contain tartaric and malic acids are boiled or heated - then the acids will not evaporate. 

It is also important to note that AHAs and BHAs can be natural or synthetic, therefore - products can be naturally compounded for chemical peels; or they can be synthetically compounded, to emulate the natural products. This is commonplace in the beauty industry, and product developers, chemists, and research companies are always finding ways to better improve the viability of esthetics products - whether natural or synthetic.  Some companies promote that they supply organic products; while other companies might promote that their products are not animal tested. Therefore, there is a wide variety of choices that estheticians and cosmetologists can use in regard to chemical peels, their anticipated delivery, and the client needs and preferences.

Beta Hydroxy Acids (11 Min.)

Beta Hydroxy Acids are also known as salicylic acid, and this acid is the lone representative of BHA peels. Salicylic acid is anti-inflammatory and it derives from the bark of a willow tree (willowbark). Salicylic acid is well known for working with oily skin, as it is lipid soluble and can penetrate fat/lipid cells. Salicylic acid is also popular with use on people of color, and helps persons with rosacea (this is key because again, it's anti-inflammatory.) BHA/Salicylic acid can also penetrate the follicular ostia, which is located at the hair follicle opening - where the hair follicles originate.  This location in closer to the dermis (although BHAs still only penetrate the epidermis). Therefore, BHAs can penetrate deeper into the epidermis (in comparison to AHAs), and they can still have an anti-inflammatory effect, in which the skin does not have to be as irritated. BHA chemical peels, along with AHA peels can be administered between 3-4 weeks (10-14 day minimum); and they can be administered in multiple sessions over time to achieve desired results.         

According to Zoe Draelos, M.D., salicylic acid "offers a true epidermal peel," and it is good for patients with sensitive skin and people of color. However, because of the BHA complexity - it can still affect people of color with scaring and pigmentation. Therefore, there should still be caution in regard to the type and strength of chemical peel that is being applied. BHAs again help to reduce the demodex colonization, and BHAs are lipid soluble. BHAs are also good for clients with periocular dermatitis, in which red papules are prevalent around the nostrils, around the eyes (periocular area), or the mouth (the perioral area). This traditionally occurs between women ages 20-45 and is also known to reoccur as well. BHAs also help in the reduction of acne, which is wide spread among chemical peel clients.

BHAs are known to help with wrinkling and photoaging - however, they can also affect a person's skin sensitivity, and have potential to make the skin vulnerable to photoaging (sun damage). This is ironic because although BHAs are seemingly less irritating than AHAs, they still penetrate the skin deeper and can make the skin more exposed. However, BHAs are still known not to cause as much irritation in comparison to AHAs, and BHAs are also known to be "self-neutralizing" (to be explained further in Module IV).

Irritation is also a common effect of all chemical peels, and regarding AHA and BHA peels, the term erythema , is a more esthetics-related term for irritation. Erythema can cause stinging, burning, and itching, and this term is commonplace in the chemical peel process. "Down time" represents the healing process when the stinging and burning stops. There are different levels of "down times" associated with erythema in light, medium, and deep peels.  It's also important to note that the esthetician or cosmetologist needs to be familiar with the peeling product used in order to determine the strength of the peel, and the down time afterward (this will be discussed in Module IV).

Another fact about BHAs is that salicylic acid derives from acetylsalicylic acid, which derives from aspirin . Therefore, some of the same chemical properties that are topically involved with BHAs are related to the oral product of aspirin.  Aspirin is also known to be anti-inflammatory, and BHAs are anti-inflammatory as well. Acetylsalicylic acid is known to be used in cosmetics, as well.   

There are overall differences between AHAs and BHAs, and to review again, the primary differences between the two include:

  • AHAs are water soluble and BHAs are lipid soluble;
  • Although AHAs and BHAs only penetrate the epidermis, BHAs have a greater penetration potential (again, they are lipid soluble);
  • There are several different types of AHAs, including glycolic, lactic, tartaric, malic and citric acids . . . BHAs have only one acid and that is salicylic acid;
  • BHAs are more anti-inflammatory in comparison to AHAs;
  • Although AHAs and BHAs can treat some of the same skin conditions and imperfections, BHAs work better with sensitive skin.

Medium Chemical Peels (11 Min.)

Medium chemical peels are also known as "TCA" peels, which stands for - trichloroacetic

acid,  also known as  trichloroethanoic acid. Medium chemical peels have similar results in comparison to light chemical peels, however, the power and potency of medium chemical peels is much greater than light AHA and BHA peels.

            Medium TCA peels are known to penetrate into the dermis, or the "true skin." Unlike light AHA and BHA peels - which only penetrate the epidermis, or the top layer of the skin (outermost layer).  Medium chemical peels aid in improving moderate sun damage (photoaging), wrinkles, and uneven skin tone and pigmentation imperfections. TCA peels are also known to work well with darker, olive toned skin and people of color.  They also don't have to be administered as often as light chemical peels, whereas depending upon the client, a medium peel may only need to be administered once or twice a year - up to once every couple of years.           Medium chemical peels should be administered and overseen by a physician, medical doctor, or dermatologist, which is different from light chemical peels - which can be administered and overseen by an esthetician or cosmetologist. 

There are many advertisements online about the purchasing of medium chemical peels - which may allow persons licensed (in the beauty industry) or unlicensed to acquire this TCA product.  Additionally the medium TCA peel acid base may range from 20% - 50% (for example), but just because you see a 20%, please be mindful that the product is much more important than the percentage. For instance, estheticians and cosmetologists can use light AHA and BHA peels, and the acidic percentage may range from 10% - 30%; but AHAs and BHAs are the products that you are working with.  If you see a 20% percentage for a TCA peel, the percentage may be 20% - but the product is Trichloroacetic acid. Therefore, be mindful of your State laws, rules & regulations, and legislation.  Also make sure you contact your State Board of Cosmetology, to make certain that you are in compliance with which type of chemical peels you can administer, and what strength or product of chemical peels you can use.  Also, make sure that within your respective State that you are allowed to administer chemical peels.  In some States, Microdermabrasion (another form of peeling known as a mechanical or "derma" peel) are not allowed to be administered by estheticians or cosmetologists.  Therefore, it is important to make sure you are compliant, because this could be a liability for you and your client, and your business.

            The recovery time for medium/TCA peels is much longer than the light AHA peels, in which TCA peel recovery time is between 5-7 days ( in comparison to a few hours to one day for light AHA and BHA chemical peels). Therefore, the client will have to protect her or his skin from sun exposure, and in Module IV, there will be additional discussion regarding contraindications, side effects, and recovery time for medium TCA peels.

            Two other types of TCA peels to mention are: the Jessner's Peel and the Obagi Blue Peel, which are also two well-known TCA peel procedures. Although the Jessner's Peel has medium chemical peel strength, it has AHA, BHA, and TCA components. The Jessner's Peel contains salicylic acid (BHA component), lactic acid (AHA component) and resorcinol - which according to The Mayo Clinic is ". . . is used to treat acne, seborrheic dermatitis, eczema, psoriasis, and other skin disorders. It is also used to treat corns, calluses, and warts." The Obagi Blue Peel is a TCA peel that helps to minimize fine lines, scars, and dyspigmentation as well. This peel is unique because after application, it turns a blue tint, which allows the medical profession to determine when it is completed. The Obagi Blue peel does color the skin somewhat after the peeling process, and it can take in excess of ten (10) days for the skin to resume its natural pigmentation. The term "frosting" is also associated with the medium/TCA peel, and can occur during the chemical peel process (the skin turns a white, frosting color).

            With the Jessner's and Obagi Blue medium peels, the client may receive a light fan of air blowing on them during the peeling procedure.  This helps to relieve the client from a burning or stinging sensation (erythema).

Deep Chemical Peels (4 Min.)

            Deep chemical peels are the very strongest of chemical peels and they are the most powerful.  Deep chemical peels are associated with phenol or carbolic acid, and they have been called the "heavy weight" of chemical peels. Phenol is also known as carbolic acid, and it is so potent, that is requires up to two (2) months recovery time after the deep peel process. Deep peels are administered and overseen by a doctor, physician, dermatologist, or plastic surgeon - and persons licensed in the beauty industry may assist the doctor with pre-operative and post-operative care. Additionally, other medical professionals such as RN and LPN nurses may assist the physician with phenol or carbolic peel process (and medium TCA peels as well). Deep peels can provide results such as skin resurfacing , the removal age spots, course wrinkles, and crow's feet; and skin blotchiness. Deep peels can also treat patients with pre-cancerous growths. They have been known to be administered in the United States since the 1960s.

            Deep peels are recommended to only be applied once (even in a lifetime); whereas light chemical peels can be applied every other week; and medium chemical peels can be applied a few times a year, to every two years. There is also sedation required for deep chemical peels, and the deep phenol peel process is considered an operative procedure.  Ultimately, there are similarities and differences among light, medium, and deep chemical peels, and how they are applied and administered.  The next Module (Module IV), which begins the Chemical Peels 102 Online CE Course, will give a description of the chemical peel process - mostly from a light AHA and BHA peel perspectives. Note: If you have registered for Chemical Peels 102, you will then be directed to Module III.

Citations/Bibliography

  • Brannon, M.D., Heather. Preventing Wrinkles With Sunscreen. About.com: Dermatology. July 26, 2008.
  • Brannon, M.D., Heather. UVB Radiation. About.com: Dermatology. August 27, 2006.
  • Brannon, M.D., Heather. Alpha Hydroxy Acids/Beta Hydroxy Acids. About.com: Dermatology. March 23, 2007.
  • Dermatology Times. Dermatologic Cosmetic Laboratories. P. 146. March 2006.
  • Facial Plastic Surgery.net. Chemical Peels. 2009.
  • Foltz-Gray, Dorothy. A Beginner's Guide to Facial Peels. Heatlh (Time Inc.). Vol. 11, Issue 7, p. 42. October 1997.
  • Gershon, J. Milady's Standard Fundamentals for Estheticians. Thompson-Delmar Learning. 2004.
  • Guttman, C. Citric Acid Formations Enhance Glycolic Peels. Cosmetic Dermatology/ Dermatology Times. June 1, 2005.
  • Guttman, C. Choice of Peeling Agent Depends on Patient Characteristics. Cosmetic Surgery Times. March 2003.
  • Laing, J. The Peel Deal. Women's Wear Daily/Beauty Biz. Vol. 189, Issue 51, p. 14. 2005.
  • Kotter, M.D., Robert. Peels, Lasers and Microdermabration? Which is Best? WebMD. March 25, 2008.
  • Modern Medicine/Cosmetic Surgery Times. Chemical Peel. November 12, 2008.
  • Oliveri, C. Neutraceuticals, Phytochemicals, and Antioxidants - What are They All About?. Ohio State University Extension. 2000.
  • Sharquie, K. et al. Latic Acid as a New Therapeutic Peeling Agent in Melasma. Dermatologic Surgery. Vol. 31., Issue 2. February 2005.

Web Citations

           

END OF COURSE EXAM - Please answer each question below, and submit your contact information as well (contact information must be included for exam submittal). Thank you.

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1. Chemical peels are known to help reduce the appearance of facial blemishes, freckles, fine lines, wrinkles, and age spots.
 2. AHA is an acronym for "Alpha Hyrdoxy Acid."
3. BHA is an acronym for "Beta Hydrogen Acid."
4. Malic Acid is a known AHA acid.
5. Salicylic Acid is also an AHA acid.
6. Overall, there are three (3) main types of chemical peels, which include light, medium, and deep chemical peels.
7. Deep chemical peels are known as the "heavyweight" of all chemical peels, and they contain phenol or carbolic acid.
8. Deep chemical peels can only be administered and overseen by a physician, dermatologist, or plastic surgeon.
9. Trichloroacetic Acid is a part of the light chemical peel process.
10. Latic acid is best known for its acidic content in - limes, oranges and apples.
11. Chemical peels were performed in ancient Egyptian, Greek and Roman times, as sour milk baths were taken - which were known to soften the skin.
12. Tartaric acid is known to be an active acid in sour grapes.
13. Light chemical peels are also known as "superficial" and "lunchtime" peels.
14. Traditionally, a licensed estheticians and cosmetologists can perform a light chemical up to a 40% acid solution.
15. Cells, which are known as the "unit of all living things," produce tissues; tissues produce organs; and organs produce various systems in which the body functions.
16. Environmental influences, such as pollution and smoke do not affect the overall health of the skin.
17. Epithelial tissue covers the digestive organs, and solely helps for the body's system to digest.
18. The Integumentary System is a respiratory system that does not involve the overall health of the skin.
19. The epidermis is known as the "true skin" and lies below the dermis, which is the outermost layer of the skin.
20. The epidermis and dermis are connected together, and these two skin layers adjoin and connect capillaries and ducts, which produce feelings and sensation through our skin.
21. The epidermis is the layer of skin in which beauty professionals can work with - without the direction of a physician.
22. The first layer of the epidermis, the Stratum Germinativum, contains only a single layer of cells.  Melanin, which is responsible for pigmentation in the skin, is located in the stratum germinativum.
23. The Stratum Corneum represents the top layer of the epidermis, and this layer is most exposed to the elements such as the sun, pollution, smoke, topical products, etc.  This layer of the epidermis is also known as "the horny layer."
24. In the stratum corneum there are: soft keratin and keratinocytes, and these cells and proteins aid the cell renewal process.
25. The living tissue layers of the dermis are 25 times thicker than the epidermis.
26. The reticular layer is not the deeper layer of the dermis. This layer has no protein fibers that affect the elasticity of the skin.
27. The papillary layer of the dermis contains no subcutaneous tissue which in turn, will not produce any adipose or "fat tissue" that can help the skin and body's shape.
28. Free radicals represent damaged molecules that in turn, damage cells. Free radicals are also known to promote the pre-mature aging process.
29. Some antioxidants include (but are not limited to): Vitamin C, Vitamin E, Vitamin A, beta-carotene, Amino Acids, Minerals, and Green Tea.
30. Cell renewal can also be identified as "cell turnover."
31. As persons turn 50 or older, their cell renewal may range from 20 to 45 days.
32. Hyaluronic acid assists with hydration, and produces fluids that are located between various proteins and fibers.
33. Beta Hydroxy Acids occur in natural ingredients, such as sugarcane, milk and fruits; and are known as exfoliating agents that aid in exfoliating the epidermis - the outermost layer of the skin.
34. Beta Hydroxy Acids are water soluble, which is different from Alpha Hydroxy Acids - because AHAs are oil (lipid/fat soluble).
35. Hyperkeratosis is the thickening of the skin; whereas desquamation is the shedding of the skin.
36. Glycolic acid derives from sugar cane, and is one of the most widely used chemical peels.
37. Beta Hydroxy Acids are also known as salicylic acid, and this acid is the lone representative of BHA peels.
38. Salicylic acid is well known for working with oily skin, as it is lipid soluble and can penetrate fat/lipid cells.
39. BHA salicylic acid peels are not recommended to use with clients that have rosacea and sensitive skin.
40. Erythema represents a soothing feeling on the skin after the chemical peel process.
41. SPF, is an acronym for Sun Protection Factor, which is associated with protection of the skin by using sunscreen.
42. The Jessner's Peel and Obaji Blue Peel are associated with deep chemical peels.
43. The term "contraindication" means that there is a symptom or condition that a person may have, or a risk that might be taken - in which a particular service will have an adverse effect.
44. Some of the risks of chemical peels overall include scarring, infections, changes in skin tone, cold sore breakouts, heart disease, and swelling.
45. A skin test is recommended before you perform a light chemical peel.  The skin test can be conducted during the initial client consultation.
46. Sanitation is the lowest level of decontamination in the salon setting, however, it is still very important. Sanitation can help to reduce pathogens on living and non-living surfaces such as your hands (living) and your salon floor (non-living).
47. The traditional light chemical peel system includes the chemical peel: cleanser, solution, neutralizer and moisturizer.     
48. Epidermolysis, involves the chemical peel solution "tightening the epidermis," which in turn, will not allow the chemical peel solution to penetrate into the dermis. 
49. Hydroquinone is a bleaching agent that helps clients with hpyerpigmentation symptoms, such as melaysma - which is oftentimes referred to as the "pregnancy mask".
50. Vasodilation means that the blood can dilate and can cause increased redness.  Therefore, vasodilation can occur with glycolic peels if used on sensitive skin or with clients with rosacea.
51. Adjuvants are not associated with boosters, as adjuvants can decrease light peel penetration for minimum results.
52. pH is measured on a scale from 0 to 16 - which includes two elements: non-acids and alkalis (alkalinity).
53. The skin's pH is normally at 6.5, and although it is not in the "middle" of the pH scale, this is the skin's pH level.
54. For chemical peels to be effective, the chemical peeling solution must have a higher pH acid than the skin's pH acid balance - which is 7.5.
55. The skin renewal process is important, but if the new cells and skin are not protected, then it could harm the skin and cause greater damage - particularly from the sun.
56. Medium (TCA) and deep (Phenol/Carbolic) peels are not allowed to be applied and administered solely by a beauty professional.
57.  Some of the light AHA or BHA peel side effects may include [but are not limited to]: erythema; the skin flaking; a redness or pink tone; skin irritation; a heated sensation; and dryness.
58. UVA rays are known to tan the skin and to only affect the dermis, and they are also known as "longer rays."
59. When the skin is exposed to UVA and UVB rays, a person's skin phototype, known as "SPT" will determine how the skin will absorb their these rays.
60. During the post treatment and recovery stages after the chemical peel, it is important for your client to use sunscreen - to protect their skin from the UVA and UVB rays of the sun.

END OF EXAM.

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