Is an At-Home Chemical Peel Worth Trying? with Shilpi Khetarpal, MD

Podcast Transcript

Jim Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host. Did you look in the mirror today and see a Vesuvius size zit on your face, or a connect the dot series of clogged pores, or maybe a few new wrinkles? If the answer is yes to any of those, you might be tempted to try an at-home chemical peel. This exfoliating treatment can leave your skin looking radiant and rejuvenated if you do it right. Luckily, we've got dermatologist Shilpi Khetarpal on hand to walk us through the process. Dr. Khetarpal is one of the many experts at Cleveland Clinic who visit our weekly podcast to share health tips that you can use in your daily life. Now, let's learn how you can give your skin a little bit of a healthier glow. Dr. Khetarpal, so nice to have you back on the podcast, always love having you.

Dr. Shilpi Khetarpal:

Great, thank you for having me.

Jim Horton:

Today, we're talking about at-home chemical peels and something that people use for when they start having skin problems. Tell us a little bit, I know you have an interesting story as to how you ended up getting into dermatology.

Dr. Shilpi Khetarpal:

Yes, so, I, like many people, had a lot of skin issues growing up as a child. I won't go into detail, but a lot of the run in the mill, like acne and eczema and all of that. I spent more time at my dermatologist's office than most would've liked, but I feel like that kind of made me understand how much of a difference a dermatologist can make and how much it impacted my daily life, from the time before I had treatment to after. Yeah, it's a topic near and dear to my heart, and hopefully, I can make the same difference in my patients' lives that my dermatologist did for me.

Jim Horton:

Well, that's a wonderful way to get into the topic here. Obviously, we're looking at at-home chemical peels, which sounds like a pretty intense kind of treatment when you just hear the name. Can you tell us what it is and what it does?

Dr. Shilpi Khetarpal:

Sure. Chemical peels, as a category, are basically ways to exfoliate our skin. They basically target the different layers of the skin, depending on what product you're using and what strength it is. It can do different things, whether it's targeting things like acne or pigmentation or fine lines or texture, you're basically just helping your skin cells turn over. There's a lot of simple ones that you can do at home, and it just can enhance medical treatment that you might be undergoing or even give you a head start before you even go in and see your dermatologist.

Jim Horton:

What's the science behind it with how it's working that magic on your skin?

Dr. Shilpi Khetarpal:

Yeah, so basically, the chemical that's being used is essentially causing some disruption of your top layer of skin cells, and essentially, they kind of slough off, and that's why your skin peels. And then, those skin cells die and then turn over. It can make the skin look brighter, fresher, things like that. Some of the ones that target acne can actually concentrate in the oil glands in our skin and actually give some improvement for a few weeks after you do them. There's just a lot of different options out there. Depending on what skin type you have and what your concern is, they can be tailored based on that.

Jim Horton:

You mentioned improving acne. What other sort of benefits can you get out of an at-home chemical peel?

Dr. Shilpi Khetarpal:

I would say acne's probably the most common. Those people that have sunspots or hyperpigmentation, maybe in some of our skin of color patients, there's a condition called melasma where women can get some of these brown patches that show up in the summer, or even mild acne scars or just fine lines. Those are all times where chemical peels can help. Or even if you have a special event to attend and you just want to brighten your skin, that can certainly be a time when you might want to do one of these. It probably wouldn't be the first time to try it out before a big event, but it's certainly something that can just make your skin glow and give you that bright look.

Jim Horton:

When you talk about trying it, should you just, I take it, go in slowly at first and just give a little dab somewhere to see how it works?

Dr. Shilpi Khetarpal:

Absolutely. I tell patients to do what's called a use test. Some of them come as a liquid, some of them come in like a peel pad. Just do a small amount, maybe on the jawline or behind your ear, give it a day and see how your skin reacts before you do your whole face. I definitely want to do that, especially if you have more sensitive skin, or dry skin or eczema, just to make sure you don't end up getting more inflamed or react to something that's in it. Generally speaking, people that are younger with oilier skin, acne-prone skin are going to have less sensitive skin and tolerate different types of chemicals and higher strengths than someone that say, has more sensitive or dry skin.

Jim Horton:

Are there different kinds of chemical peels? I thought I had read where there were three different versions.

Dr. Shilpi Khetarpal:

Yeah. The chemical peels vary based on what they're made out of. We have, for example, superficial, medium or deep peels. The at-home ones are just going to be the superficial ones, medium and deep are done typically in a medical office. Then, you could even divide those into two groups. We have beta hydroxy acids and alpha hydroxy acids. Your beta hydroxy are things like salicylic acid, those are the ones that help with acne. Your beta hydroxy acids are things like glycolic acid, lactic acid, mandelic acid. Those are what we call our water-soluble ones. Those beta hydroxy ones are ones that are more going to be concentrated in the oil gland and are going to be a little more aggressive versus the alpha hydroxy are going to be a little bit lighter and can be done on all skin color, skin types, and many of them are even safe during pregnancy and nursing.

Jim Horton:

When somebody's at the store, what exactly should they be looking for when they go shopping for these?

Dr. Shilpi Khetarpal:

I think it's important to look at the ingredients and know what you're treating. If you have acne, you're going to want to look for something with salicylic acid. If you have, say melasma, or freckling or sunspots, you're going to want to go towards something like glycolic acid. If you have both, there are some peel pads and some formulations that contain both but know that the higher the strength and the more ingredients in there, probably the more aggressive the peel will be. You can have more downtime when your skin looks red, sunburned, peels, flakes, so that can be anywhere from three to seven days after one of these. You want to make sure you're not doing it right before a big event or any major social commitments.

Jim Horton:

All right. This is going to sound like a silly question, but we talk about it being a peel. How much peel do you get?

Dr. Shilpi Khetarpal:

That varies from person to person. The skin will exfoliate or peel. Some, it can be mild and some, even with the same treatment, can be more. I think that has to do ultimately with how oily our skin is. Younger people tend to have slightly thicker skin, men have thicker skin than women, and there's also a lot of odd other factors like the pressure when you apply it, how many passes you do, because ultimately, each time, if you put more pressure, you're going to get a deeper peel. If you do more passes, it's a higher strength. I think it also makes a difference if you're pre-treating with anything. If you've been using a vitamin A cream like retinol, tretinoin, adapalene, whether it's over the counter or prescription, it thins the top layer of our skin. Our peel is actually going to go a little bit deeper, so you're going to get more of an effect. Those are all important things to consider determining your downtime and the extent of peeling.

Jim Horton:

Do you recommend a pre-treatment before doing a chemical peel?

Dr. Shilpi Khetarpal:

I think it's a great idea for patients to be on some sort of vitamin A cream, whether it's an over-the-counter retinol or prescription tretinoin, you're just going to get more of an effect. But then, I do warn people that you know are going to have some more downtime. It will be a little bit red, a little bit swollen the first day. Think of it as a mild sunburn and then, it does slough a bit, but when the skin peels underneath, you have a really nice fresh layer of skin, so it has a really nice glow. It can just brighten the skin so nice to do before an event or just as a daily maintenance for your skin.

Jim Horton:

It really is, it's just taking a layer of your skin off and just giving you that whole fresh new look?

Dr. Shilpi Khetarpal:

Absolutely.

Jim Horton:

It's really incredible. When you hear that, though, it kind of makes me wonder, is this safe to do or is it something you can do too much of?

Dr. Shilpi Khetarpal:

Yeah, so I think you have to be careful. You don't obviously want to get this stuff in your eyes or in your mouth. That can definitely cause problems. If you do too much of something, you can really run into problems. Or if you're already on medical treatment, some of our acne patients are on Accutane, so you don't always want to just jump the gun and do it. If you're seeing a dermatologist for other treatment, definitely check with them to make sure it's OK. If you have sensitive skin or you're just not sure how your skin will respond, do that small pretest or patch test. I would say just start slow. Maybe the first time I do a light pass.

If you're nervous about getting it in your eyes, you could even put a little Vaseline® around your eyes, you just want to make sure the skin isn't inflamed, there's nothing open, you don't have any wounds, anything like that, like any cuts. For men, too, you may not want to shave the next day because the skin's a little bit inflamed. When they apply, it might be a good idea to trim the beard or any facial hair so you can actually get the product on the skin, otherwise it just sits in the hair.

Jim Horton:

How often can you realistically do this?

Dr. Shilpi Khetarpal:

Some of them will say once a week, but truthfully, I would say give it a month, because it does take 28 days for our skin cells to fully turn over, and to let everything heal. I would just say to be on the safe side, no more than once a month.

Jim Horton:

Wow. I did not realize it took that long for your skin to, I guess, rejuvenate itself or kind of come back there.

Dr. Shilpi Khetarpal:

Yeah, I think it's also really important if you have a tan or if you're outside a lot, those probably aren't the best times to do it. If you're in a sunny climate, maybe avoid the summertime, because when our skin is healing, it is sensitive to sun, to pigmentation, all of that, so it’s important that if you're going to do one of these treatments, you want to be at your natural skin color when you do it. Probably for the week after, just avoid direct sunlight. If you are going to be outside, use some protection, a hat, sunscreen, things like that, and obviously, hold any medical therapies you might be using, whether it's prescription or over the counter, just because the skin is really fragile, you know are sloughing that top layer of skin. You don't want to put an acne cleanser or retinol on top of it because you could even get a chemical burn.

Jim Horton:

If you do have a tan and you take that top layer off with peel, could it come back like a little splotchy or look not quite the same color as everything else?

Dr. Shilpi Khetarpal:

Absolutely. For those people that have been sunburned, and you know when the skin peels, it's very red underneath, it looks blotchy. Some areas are tanned, some are not. That is absolutely what can happen. That's why we recommend not doing that. You want to do this to improve your appearance, not make it draw more attention to it in a negative way.

Jim Horton:

Definitely. Say someone wants to go home and try this, what do you need to get started?

Dr. Shilpi Khetarpal:

I would say for women, you might want to have a headband to keep the hair out of your eyes, out of your face. Not a bad idea to use some Vaseline around your eyes. Areas right under the eye and the upper eyelid, you don't want to get it on because that skin's very thin. In terms of an applicator, you could use a cotton ball or a cotton pad if it comes in a liquid. Some of them come with a peel pad. I would also probably have a washcloth nearby in case you start to get a lot of burning or discomfort, you could wash it and obviously a gentle cleanser. Then, I think aside from that, just have on hand, make sure you have some sunscreen to wear the next day. I'd probably hold off on any makeup or anything like that, but just some simple things, and if you're someone that has sensitive skin on your hands, maybe even a pair of gloves isn't a bad idea.

Jim Horton:

When you're doing the peel, how long do you leave this on when you do it?

Dr. Shilpi Khetarpal:

It depends on the agent and a lot of them should have detailed instructions. The beta hydroxy acids, like our salicylic acid, are ones that we would call self-neutralized. When you put it on, it kind of has this white frost and you don't need to wash it off. The other ones like glycolic acid, things like that, you do have to neutralize it or wash your face. Usually, I would start with maybe one and a half to two minutes, and then subsequent treatments you could maybe go up by 15 or 30 seconds, but if you start to have a lot of pain, a lot of stinging and discomfort, you probably want to wash your face or stop it right away.

Jim Horton:

I was going to ask you what it felt like, and you mentioned the stinging feeling. It can really be that intense as you're putting this on?

Dr. Shilpi Khetarpal:

Yeah, it kind of tingles. It can burn a little bit, and it just feels kind of hot. I don't know how else to describe it, but it's mildly uncomfortable, but you definitely know it's doing something.

Jim Horton:

That's the price you pay for beauty, I guess, at times.

Dr. Shilpi Khetarpal:

Right. Yes.

Jim Horton:

As you're putting this on, too, what do you use to apply the chemical?

Dr. Shilpi Khetarpal:

My preference and the ones I've done and the products I've seen, the pre-soaked peel pads, they come in a little jar, and they have it on already. I think that is an easy way to apply. If you buy something that comes in a liquid form, I will probably just use a cotton ball, but you don't want it to be super saturated. If you dip it in the agent, maybe squeeze it out, remove any excess so it's not dripping, or a cotton pad or something like that. If you wanted to get fancy and use a brush, you can, but just once again, make sure whatever you're using is not too saturated because you don't want to put too much of the chemical and you don't want it dripping as you apply.

Jim Horton:

You had mentioned doing some pre-treatment. What other things should you do in advance of your peel?

Dr. Shilpi Khetarpal:

I would say at least two weeks of, if you want to get a slightly deeper peel, you can use a retinoid, which, over the counter is retinol; prescription is tretinoin. You know, want to protect yourself from the sun. We recommend sunscreen every day, but certainly those days and weeks leading up to it, wear a hat, wear sunscreen. Then aside from that, maybe just hold some medicated topicals. If you're using any acne medication like benzoyl peroxide or any prescription antibiotics that are topicals, maybe just hold those before and just use a gentle cleanser. If you're someone that has a history of cold sores, even a like home chemical peel can trigger a cold sore, so just be careful if you're someone that has a cold sore or tendency to get them. When you're treating around the mouth, make sure you have some of that medication on hand. If you do have an active cold sore or active acne, you probably don't want to be applying anything until things heal.

Jim Horton:

What about immediately after the peel? Are there some steps you should take then to get the best results and protect your skin?

Dr. Shilpi Khetarpal:

Yeah, I would say like a gentle cleanser and then a moisturizer. You've just disrupted that barrier and trying to restore it and help it heal is important, so keep it moist. Use a very bland moisturizer. It could even be something as simple as Vaseline and just be very gentle with it. You want to baby it. Use a very gentle cleanser once or twice a day and then, keep it moisturized until it heals.

Jim Horton:

Well, that kind of takes us through the whole process. I appreciate you taking the time and look forward to having you back on the podcast, I always love having you.

Dr. Shilpi Khetarpal:

Great. Thanks so much.

Jim Horton:

If you're looking for more radiant skin, an at-home chemical peel might be worth trying. Just make sure to follow the instructions and take the necessary precautions. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.