Histologic Changes After Chemical Peeling: A Clinical Review

Chemical peeling causes controlled damage of the epidermis and dermis for medical and aesthetic improvement. Chemexfoliation can be categorized into superficial, medium, and deep, depending on level of wounding.

This clinical review seeks to understand the architectural changes in the epidermis and dermis.

PubMed was searched to include studies that reported epidermal and dermal changes after chemexfoliation regardless of primary indication. Narrative synthesis was performed to summarize effects.

Thirteen studies ( n = 142) describe the histologic changes after superficial peels. These peels cause epidermal necrosis with regeneration and histologic improvement of the epidermis with equivocal dermal changes. Thirteen studies ( n = 75) describe the histologic changes after medium-depth peels. Medium-depth peels showed mostly increased dermal thickness and collagen content with variable improvement in elastin quality. Thirteen studies ( n = 294) describe the histologic changes after deep peels. Deep peels showed consistent, long-lasting epidermal and dermal thickening and collagen production with mostly improved elastin quality. Limitations include sample heterogeneity and variations in follow-up biopsies.

Chemical peels result in identifiable histologic changes depending on depth and type of peel. Understanding the histologic changes allows the clinician to better select the appropriate peel for the intended pathology needed to correct.