- Best Results1-5 sessions
- Treatment Recovery0-8 days
- Procedure Time10-30 minutes
- Skin SpecialistNurse & Davin Lim
- Duration of Results2-5 years
- AnaestheticNil-sedation
- Back to WorkVariable
- Cost$-$$$
Chemical Peels for Sunspots
TCA & Jessner Trichloroacetic Acid peels are really old-fashioned peels. The flipside is that they have a high clearance rate for solar keratosis, sun induced pigmentation, freckles, as well as age spots. AHA peels, including glycolic acid are other treatment options that address both pigmentation & pre-cancerous changes.
FactsFacts on Chemical Peels for Sunspots
- Chemical peels are an excellent option for both treatment of sunspots & prevention of actinic keratosis
- The peeling agent can be customised according to depth, location & downtime
- AHA peels including glycolic & lactic acid are classed as superficial peels
- Superficial peels have no downtime
- Jessner TCA peels are medium depth chemical peels
- Jessner TCA has a recovery period of 6-9 days
- Peels can be combined with CO2 lasers for better results
What types of peels are used for treating sunspots?
The four main peels used to treat sun damage are-
- Jessner TCA peels: This is rated as a medium depth chemical peel.
- Phenol Croton Oil peel: This is a deep chemical peel.
- Retinoic Acid: either de novo or laser assisted peels, classed as superical.
- Glycolic acid or AHA peels: classed as superficial peels.
How are they different from fuzzy cosmetic peels?
Specialist peels differ primarily with the depth & concentration of peels. For example, my peeling protocol for Jessner TCA gives a downtime of 6-9 days, retinoic acid peels are approximated 150 to 200 times stronger than retinol, whilst glycolic acid peels are maxed out at 70%.
How good are peels compared to Efudix, Aldara & Photodynamic therapy?
It depends on what is used, namely peeling agent, concentration & coats. Medium to deep peels are equal to or more effective than topicals including Efudix, Aldara & PDT. Peels have the advantage of addressing both sunspots, pre-cancer, superficial cancer & cosmetic elements such as pigmentation & wrinkles.
What is the best peel for sun damage?
Medium to deep peels are best. The flipside is the recovery, ranging from 7 to 14 days. If downtime is an issue, AHA peels have a quick recovery of 1-4 hours, whilst retinoic acid peel recovery ranges between 2-9 days.
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Which is better, chemical peels or lasers for sun damage?
Once again it depends on the type of laser & the type of peel. Both give great results, however high density Fraxel or LaseMD is more cost effective. Skin recovery is faster with a laser. One laser treatment cost $1290 with a recovery of around 5 days.
In comparison, the cost for a deep Jessner-TCA is double that of a laser (I personally perform all medium & deep peels. My clinical staff perform fractional lasers).
What chemical peel has the least downtime?
AHA peels including lactic, madelic, citric & glycolic peels are known as lunchtime peels. They do not have any downtime. The flipside is that your skin needs to gradually tolerate these peels. A typical step up ladder goes like this; 20, 35, 50, 70 percent.
AHA Peels; most common is glycolic
Indication: Solar keratosis & pigmentation
Downtime: Nil
Cost: $98
Jessner TCA peel, one session
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👉This is a medium depth peel. Occasionally I prep with retinoic acid beforehand, but thin skin like this patient, RA is not needed. I scrub with acetone, then coat with 2-4 layers of Jesser. I then have a cup of coffee then come back to finish off with TCA at 35%
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😁Was having a friendly banter with my mentor & close friend @aprofphilipbekhor last night. Peels vs lasers. Why do I like peels? My chill out time. No loud noises apart from the patient's muffled screams 😱😱(joking). Despite the tech of lasers, I still like looking carefully at end points from peels. It is tactile, much like driving a manual car vs an automatic. Sure the latter is easier, but sometimes it’s the challenge to get the downshift perfectly matched, or the epidermis so evenly gray that the entire sheet slides from the dermis. It’s old school cool
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👊🏻Disclaimer: You do need to watch your peel patients more closely cf. NA laser patients, that is fact💯
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#tca #jessner #jessnertca #chemicalpeels #dermatologist #dermatology #drdavinlim #skinrejuvenation
TCA peels are a simple way to rejuvenate skin. This picture is over a decade old, but I still enjoy peels over lasers (more tactile). It’ much like driving a older vintage car, it’s slower to get to your destination but the drive is more enjoyable🚘
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🔬Skin science: TCA can be applied as a superficial, medium (most common) & deep peel. In this case I employed it as a medium depth peel, to the upper papillary dermis. In some cases I combine it with Jessner for deeper penetration
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👉Downtime: 5- 8 days depending on the strength and coats
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😢Pain: Tolerable with topical application of numbing and skin cooling. I do give oral conscious sedation if deeper peeling
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👍🏻Good for: Skin type 1-2+, pigment, freckles, sun damage, solar keratosis, mild to moderate wrinkles, lentigos/ age spots
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👎🏼Not good for: Darker skin, deep wrinkles, melasma
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#chemcialpeels #TCApeel #jessner #jessnerTCA #skinrejuvenation #skinlightening #skinbrightening #davinlim #dermatology #skinscience
What are retinoic acid peels?
This peel is one of my favourites. Downtime can be controlled with laser delivery, pre-prep & concentration. Retinoic acid concentration is a few hundred times stronger than over the counter retinol.
Retinoic acid peels: most common concentration 1-7%
Indication: Solar keratosis, wrinkles & pigmentation
Downtime: 2-9+ days
Cost: From $98
What are Jessner TCA peels?
This is a seriously good peel. Ideal for treating pigmentation as well as pigmented solar keratosis (PDT cannot do that). Also is an excellent wrinkle remover.
Jessner TCA: Mix of lactic, salicylic & trichloroacetic acids with a bit of resorcinol.
Indication: Solar keratosis, wrinkles & pigmentation
Downtime: Over a week
Cost: From $2990 (done by Davin Lim)
What are spot peels?
These are usually TCA peels that range from 35 to 70%. This peel is delivered via a cotton tip applicator. Phenol croton oil can be delivered the same way. It is old school, but it works well. Spot peels are best used for isolated solar keratosis & is a substitute for cryotherapy. Spot peels will inevitably cause white spots or hypopigmentation.
When do I use peels over Efudix, Aldara & PDT?
Each to their own. Peels have the advantage of providing skin rejuvenation as well the ability to treat dysplastic or pre-cancerous sunspots, including solar keratosis & superficial skin cancers. PDT does not treat brown or pigmented solar keratosis as pigment inhibits illumination of ALA.
If cost is an issue, Efudix is cheap, nasty but it works well. Another cost-effective option are AHA peels, as they cost $98. Aldara is also an option for treating solar keratosis, however the course of treatment is over 16 weeks or so. As for Solaraze, you are better off with some salicylic acid cream & some sunscreen.
Can peels accelerate Efudix treatment?
Yup, peels can potentially accelerate Efudex treatment due to their priming effects. An example is the use of AHA or glycolic acid peels, either as a stat (one off peel) or series of peels.
A sensible way of reducing the inflammation & downtime of Efudix is to pretreat the area with glycolic acid 20, 35, 50 & 70% step up peels. The AHA peel reduces dysplastic load, hence will proportionally decrease 5FU related skin inflammation. Spot treatment with high strength salicylic acid (10-20%) can also reduce hyperkeratosis & hyperkeratotic lesions. Be guided by your dermatologist.
Will each and every sunspot be treated with chemical peels?
Nope. Any field treatment, including Efudix, Aldara, Solaraze, TCA peels, Photodynamic Therapy, laser resurfacing will have a percentage of residual solar keratosis left. This ranges from 10 to 70% depending on the papers you read.
Any residual solar keratosis can be treated with topicals as mentioned above. Alternatively spot treatments can be performed. In some cases a biopsy is required to rule out sinister cancers that lie underneath sunspots.
What is the meaning of combination field treatments for sun spots?
The current literature supports the use of combination therapy for sunspots. Examples include the use of Aldara or Efudex post Jessner TCA peel.
An example is twice a week application of Aldara for a total of 12 weeks to isolated solar keratosis, starting 4 weeks after Jessner TCA chemical peels. Efudix can be used in a similar manner.
Who are not candidates for chemical peels?
If you have olive skin or darker, TCA peels are not a good option. If you have fair skin, but you are really bad at sun protection, any form of peeling is not a good option.
What are the risks of peels?
All procedures carry risks. In the context of medium depth peels the main risk is infection, followed by post inflammatory hyperpigmentation.
If you have a history of cold sores, you are required to take anti-viral tablets for the duration of healing (4 to 8 days for most).
Need to chat to someone about what is the best treatment?
For a no obligation review, book an appointment with my nurses. They can assess your condition and provide you with some options. They are well trained to perform fractional lasers & superficial peels.
My work is focused on medium to deep peels & epic, scary fully ablative laser resurfacing.
Does health insurance cover chemical peels for sunspots?
Nope. Some insurance companies partially over PDT (about 10% of the fee). DVA covers photodynamic therapy for white & gold card holders.
Davin’s Viewpoint on Chemical Peels for Solar Keratosis
Chemical peels are one of my favorite treatments. Why? Because they are tactile & can be customised for each patient. Peels can reduce the burden of solar keratosis, superficial skin cancers, wrinkles & pigmentation. Medium depth peels including Jessner TCA can be combined with lasers such as CO2 for even better results.
Superficial peels can be employed to prevent recurrence of sunspots. These peels include vitamin A peels (retinoic acid) as well as high concentration glycolic & lactic acid. AHA peels can also stimulate dermal collagen & reduce skin pigmentation.
