Retinoic acid peel (Yellow peel)
Retinoic acid peel (yellow peel) belongs to skin treatments with a short recovery period. Retinoids (synthesized equivalents of vitamin A) regulate the processes of differentiation, proliferation, and intercellular communication. When retinoids get into a cell, they make a bond with nuclear sensors. As a result, particular sections of the cell genome are activated or decelerated.
Indications for Use of Retinoic Acid Peels:
• lack of collagen production
• disruption of skin’s natural moisture balance
• mimic wrinkles
• loss of skin elasticity and strength
• need for skin whitening
• excessive pigmentation caused by solar radiation
• skin aging and photoaging
Retinoic acid peel can also effectively cleanse the skin, has anti-inflammatory effects, makes skin glow, improves skin texture and structure, and provides a lifting effect.
Contraindications for Retinoic Acid Peels:
• various allergies – indicate the probability of severe skin reaction to the treatment, also increased with the use of retinol that makes skin more reactive
• atopic skin, eczema, seborrheic dermatitis etc. – indicate skin hypersensitivity (reactivity)
• viral infections – under the influence of retinoids and acids, can cause herpes lesions in patients with a history of herpes
• warts – can cause further viral shedding from a wart
• photosensitivity – high skin sensitivity to solar or other types of UV radiation
• compatibility with pharmaceutical products – those who have taken roaccutane should wait at least half a year before getting a retinoic acid peel
• liver diseases, including previous hepatitis infections
• pregnancy or pregnancy planning within a year, as well as lactation, for retinoids are embryotoxic.
Retinoic Acid Properties
Retinoic acid, also known as tretinoin, is an active form of retinol (vitamin A). In nature, it can be found both in vegetable substances and in animal products. It is capable of making bonds with nuclear receptors and initiating a cellular response with their help. It is worth mentioning that almost all cells in a body are sensitive to tretinoin. To prevent tretinoin accumulation in tissues, which in many cases may lead to various side effects, masks with high concentration of this substance are used.
The mask should be applied once in 1 – 2 weeks. The result is active exfoliation, which leads to epidermis renewal at the cellular level. The quality of the extracellular matrix of the dermis is also considerably improved.
Studies have shown that 4 – 5 treatments with an interval of 1 week lead to the same results as the use of cream for 5 – 6 months. Moreover, the probability of side effects is considerably reduced.
Benefits of Retinoic Acid Peels (Yellow Peels)
The effect of retinoids on skin during the peel procedure does not lead to skin damage, destruction of living cells, and protein coagulation. Interactions between retinoids and other chemical structures are based on the use of nuclear receptors of cells. Basal keratinocytes, fibroblasts, and melanocytes have such receptors.
The results of a retinoic acid peel, as it affects the epidermis, are the following:
• an increase of mitotic activity of basal keratinocytes
• a normalization of keratinization, differentiation, and melanogenesis
• an activation and stimulation of epidermal lipid synthesis, as well as the components of the extracellular matrix of the dermis
• a decrease in atypical cells
The peel helps to slow down the skin’s ageing process, improves skin texture and remodels its contour, and achieves a pronounced rejuvenating and whitening effect. There is also a strong antioxidant effect.
Histological studies have shown that the effect of a retinoic acid peel lasts for 4 months (after the latest procedure).
Other benefits which are worth mentioning include safety, short post-peel period, and low probability of complications, which allows to perform this kind of peel even in summer.
Stages of a Retinoic Acid Peel:
• preparing for treatment,
• peel procedure,
• post-peel care.
Preparing for Treatment
This stage includes diagnostic procedures and history taking, skin checkup, medical interview, signing of an informed consent, and pre-peel care.
During the first visit the doctor determines patient’s skin type and conditions, looks for signs of photoaging, skin pigmentation disorders, scars, inflammations, or elastosis. Patient’s skin exposure to the sun is also discussed. All relevant data should be added to the patient’s medical record, together with the photos showing skin condition before the treatment, and the informed consent signed by the patient.
In a medical record it should be specifically emphasized whether a patient has taken products containing retinol in the past and what results it had. Special attention should be paid to past medical history. If the patient had allergies, there is a high probability of an allergic reaction to the peel, as retinol intensifies skin reactivity. The history of atopic dermatitis, eczema, seborrheic dermatitis, or rosacea might indicate extreme skin sensitivity and reactivity. In this case a gradual approach should be taken and small concentrations of a peel solution applied for a shorter period of time.
The cosmetician should make sure that the patient is not planning pregnancy. The retinoic acid peel is prohibited to those who are planning pregnancy because retinoids have a negative effect on fetal development. Again, this kind of peel is not recommended for people with a history of hepatitis infections and other liver diseases.
If signs of viral infections are present, herpes lesions might be caused by the combination of retinoids and AHA in the peel treatment. As a part of prophylactic therapy, such patients should take oral antiviral medications before the peel. The peel should not be performed on skin areas where warts occur to prevent further viral shedding of a wart virus.
In case of skin photosensitivity, the doctor should explain before the treatment that afterwards the patient’s skin will require protection from UV radiation sources like the sun, various lamps, indoor tanning facilities. Daily use of photoprotective products is recommended if the patient’s skin is tolerant to them.
The first stage of skin checkup consists in thorough cleansing and examination of the skin. A Wood’s lamp and an illuminated magnifier are used for these purposes. Special attention should be paid to the diagnosis of skin disorders that are considered contraindications for a retinoic acid peel, including herpes, molluscum contagiosum, and viral warts. It is important what skin color and type a patient has. For example, Asian skin is highly sensitive. Patients with this skin type often cannot tolerate any peel treatments, including retinoid-based peel.
During an interview, the doctor has to find out what results the patient expects from the treatment, be it line smoothing, reduction in skin roughness, removal of superficial scars or pigment spots, improvement of skin smoothness, brightness, and tone, skin whitening, or pore size reduction. It is also necessary to find out if the patient has seen the photographs of other patients taken before and after the retinoic acid peel and what she thinks of the presented changes.
Then the doctor determines skin areas which the peel should be performed on to get the required results. It is explained to the patient that in order to achieve sustainable results a series of treatments is required which leads to significant changes in skin appearance, i.e.the peel activates skin exfoliation and intensifies sensitivity. Moreover, higher concentration of retinoids in one treatment leads to more pronounced skin reactions and a longer recovery period. If a patient smokes, she should be told that rejuvenating effect would be lower due to oxidation processes caused by smoking.
Each article of the informed consent should be attentively read and thoroughly explained to the patient. Then it is signed by the patient in two copies, one is given to the patient, the other is attached to the patient’s medical record. Signing of an informed consent on a voluntary basis helps to enhance professional responsibility of doctors and discipline of patients, avoid conflicts and misunderstandings in the future.
Preparing skin to the treatment takes no less than two weeks if patient’s skin belongs to the normal skin type, and no less than four weeks in patients with darker skin characterized by high sensitivity to products containing AHA and retinoids. If skin becomes red or irritated after the use of cosmetic products containing retinoids and AHA, the frequency of their application should be adjusted until the symptoms disappear (their use may even be cancelled). After the safe interval has been determined, skin preparation should be performed with a little longer period.
Pre-peel preparation at home is a huge advantage. For example, the use of cosmetic products containing AHA helps to weaken intercellular bonds in epidermis for more efficient exfoliation. The maximum effect is achieved when a patient uses products containing retinoids (0,025 – 0,1% tretinoin) at home. It is also required to prescribe medicines that have an inhibiting effect on tyrosinase to minimize the risk of post-inflammatory hyperpigmentation. Oral administration of hepatoprotectors is also recommended (methionine, ademetionine, lipoic acid, phospholipids, ornithine) before and after a retinoic acid peel treatment.
Retinoic Acid Peel Procedure
Immediately prior to the peel treatment, the contents of the tube (mask with 5 – 10% concentration of retinoic acid) are squeezed out into a bowl and mixed with a spatula. The mask is uniformly applied to skin, including lower and upper eyelids (along the lash line). The areas of lashes and eyebrows should be avoided. Thanks to this application scheme (close to the orbital area), the peel can be performed even on sensitive areas, which is one of the advantages of the retinoic acid peel. It is not recommended to apply the mask to the eyelids if it contains depigmentating components.
The mask sets and becomes firm in 10 to 25 minutes. Then it is removed, and skin is treated with a special sunscreen.
The main benefit of the mask is that it forms an occlusive film on skin and stimulates uniform tretinoin production. The standard retinoic acid peel includes 4 procedures. The interval between the first and the second one is 2 weeks, between the others – 1 month. In the future, this kind of peel can be performed for prophylactic purposes as a supportive treatment at intervals of 3 months.
Classic yellow peel is applied two days in a row, the treatment can be repeated in 1 or 2 months. The peel is not washed off in a salon, it should be washed off at home in 7-12 hours, then cream with retinoids might be applied to increase treatment efficiency if the doctor has recommended to do so.
Retinoic acid peel. Photo before and after procedure
When a retinoic acid peel treatment is over, a recovery period begins which requires a special skin care regimen. The use of cosmetic products containing retinoids and AHA is prohibited within two weeks after the treatment. Other cosmetic procedures and procedures that use chemicals, like hair dyeing or hair perms, are not recommended.
Any swelling, irritations, and painfulness that might appear should be treated with anti-inflammatory and regenerating agents, for instance, with a special balm consisting of borage oil, shea butter, copper peptides, panthenol, extracts of rosebay, liquorice, and horse chestnut. This balm has a soothing effect and helps skin recover faster to its normal state. Aerosols based on deuterium (heavy) water, which shows strong antibacterial and protective properties, are a good addition to the balm. Facial cleansers that contain no hard surfactants can be used on the second day after the peel procedure. Facial cleansers and skin care products should be fat-free, i.e. water-based or helium-based.
Active skin exfoliation starts in 3-4 days. In order to speed up the process, it is recommended to use a mask rich in lactic acid and cranberry ferments. The latter have pronounced antioxidant, antihistaminic, and antiviral properties, which helps to get rid of the peeling skin.
Possible Complications of Retinoic Acid Peels
Any peel treatment consists in removal of the outermost layer of skin cells, so the main complications and side effects of any peel are similar. The difference is only in how severe they might become. For example, cosmetic products containing retinoids are highly embryotoxic. Due to this fact, their use is prohibited for pregnant and breastfeeding women.
During the retinoic acid peel treatment, it is obligatory to take medicines that protect and repair liver cells, because retinoids are hepatotoxic. Skin rashes may occur in patients with liver diseases.
One of the common side effects of this peel treatment is flaking skin. In this case, it is not necessary to deliberately (mechanically) accelerate this process; it would be better to let it develop naturally, moisturizing the skin when needed. Flaking skin becomes darker, which leads to such common side effect as darkening of some skin areas. Things go back to normal when the flaking is over.
Swelling might also occur as a local inflammatory response to external stimuli. Swellings occur when liquid comes out of capillaries due to increase in their permeability and accumulates in tissues. People with thin skin (usually on the neck and around the eyes) are most prone to this complication. Swelling normally occurs in 1 to 3 days after the peel. Swellings subside in several days.
It helps to remember that after the peel skin is highly sensitive to external stimuli, like low and high temperatures, mechanical action, and sunlight (UV component). In some cases, this complication may develop further resulting in hypersensitivity that might last up to 1 year.
There is a high risk of getting an infection during the treatment as the peel considerably reduces immune response. The most common infections, which disturb patients after a peel treatment, are herpes and streptostaphylococcal pyoderma. The former is treated with antiherpetic agents (aciclovir), the latter with antibiotic drugs and ointments.
Among the most well-known brands and manufacturers of retinoic acid peels are Mene&Moy (USA), Cimel (Italy), Retises (Italy), Medicontrolpeel (Brazil), Mediderma (Spain), GIGI (Israel), and Holy Land (Israel).
A single retinoic treatment costs between $75 and $150. The procedure is most effective when repeated three times, once every three weeks. The retinoic peel is sometimes performed after a BHA or Jessners peel, as those peels can make the subsequent retinoic peel more effective.
How to get Retinoic acid peel: A retinoic acid peel is a strong chemical peel and demands a medical professional, i.e. dermatologist or experienced skin technician, who not only knows the limitations of the skin but who can also administer a mild anesthetic or sedative prior to treatment.