Reversing Sun Damage with Chemical Peels

A sobering statistic: According to the American Cancer Society, you have one in five chances of getting skin cancer – even if you haven't baked at the beach in decades. By now most of us know how important sun screen, long sleeves and hats are. What most of us don’t know is that chemical peels can help remove pre-cancerous sun damage.

Just ask Dr. Barbara Crabbe, veterinarian and owner of a private equine practice in Portland, Ore. Growing up in California’s scorching central valley, Barbara was a sun worshiper who walked around with a tan nearly 365 days a year. "Back then, we all wanted that bronzed look, and we never wore sunscreen," she admits. "As a teen I even deepened my tan by mixing iodine with baby oil and using tin foil as a reflector."

When she was a young adult, both of her parents were treated for skin cancer. By the time she realized she'd better start protecting her skin, she was heavily involved in training performance horses and an accomplished dressage rider and competitor.

Unfortunately, Barbara had already set herself up for pre-cancerous growths. Though experts have traditionally told us that exposure to sun during childhood is what damages skin cells and sets the stage for skin cancer, they now believe that continued exposure throughout adulthood is what actually transforms damaged cells into cancerous ones.

"We also now know there is no such thing as a sunless day," says Dr. Lee Robinson, cosmetic facial surgeon and medical director of Oswego Spa & Laser in Lake Oswego, Ore., “ The sun’s damaging rays, both Ultraviolet B (UVB) and Ultraviolet V rays (UVA), are always there, whether we see them or not. In fact, UVA rays are a product of all natural light (not just direct sun), and they can reach the skin through glass, clouds and smog."

New options for treating pre-cancerous facial spots

Like Barbara, most of us have replaced baby oil and iodine with broad-spectrum, high SPF sun screen and protective clothing, and try to stay out of the sun during the most dangerous times of the day, from ten in the morning to three in the afternoon. However, few of us know of other options for helping to prevent pre-cancerous growths, especially those on the face where some forms of treatment might cause scarring.

"As an equine vet and performance rider, I obviously am out in the sun for long periods of time," Barbara said. "There’s only so much that sunscreen, hats, and long sleeves can do. By the time I was 40, my skin was shriveled and I’d already had several pre-cancerous patches taken off."

Initially, Barbara had her lesions frozen with a technique called cryotherapy. She also tried a topical cream prescribed by her doctor but was unhappy with the crusty, oozy results. In spite of the other treatments her skin damage persisted.

"As a doctor, a chemical peel made sense to me," she explained. "I figured it would remove the first layer of skin and let me see what was underneath in the deeper layers. Peels treat the whole skin surface rather than focusing on isolated areas. Once I knew that, my physician and I could decide what to do next."

"Chemical peels aren't just about improving our looks - medical research shows that they can also prevent pre-cancerous growths. A chemical peel that uses trichloroacetic acid (TCA) is considered the safest and most effective for removing pre-cancerous spots," Dr. Robinson added. A recent article in Cosmetic Dermatology, a peer reviewed medical journal listed chemical peels as a proven method to stop the progression of the early stages of skin cancer.

What are chemical peels?

Chemical peels use a chemical solution to remove dead or damaged cells in the outer layers of the skin. The result is rejuvenation of the skin and an improved, smoother texture. In addition to treating pre-cancerous skin conditions, peels help minimize facial blemishes, acne flare-ups and scars, wrinkles and uneven pigmentation. They also "prime" the skin so that it absorbs other products more efficiently.

Trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are the most common chemicals used in facial peels. The precise formula is adjusted to meet the patient's needs. For example, the degree of sun damage on Barbara’s face required a TCA peel, which is much stronger than the AHA peels, but not as strong as a phenol peel.

"Now that I’ve had a TCA peel, people tell me I look 10 years younger," Barbara said. "More important, the peel removed all the spots I was concerned about, and I’m now much more motivated to wear sun screen and protective clothing when I go outside."

Are you a candidate for a chemical peel?

TCA peels are more effective than AHA peels, but Barbara warns that TCA peels are uncomfortable.

As Monica Martin, Barbara’s esthetician, puts it: "It's like rubbing a jalapeno pepper on your face for ten minutes. But, like child birth, once you see the results, you forget the pain."

Monica, who works with Dr. Robinson at Oswego Spa & Laser, alleviates the stinging heat experienced during the peel with cooling air from a high-speed fan. After the procedure, cold packs and a layer of petroleum jelly are applied to soothe the skin. By the time a patient leaves, the discomfort is no worse than that of a severe sunburn.

Monica advises her patients to forego makeup for at least a week and not to wash the face for the first two days. “Every clinician is different, but I’ve gotten the best results from keeping the skin dry and leaving it alone."

Patients who have had a chemical peel should plan on one week of downtime. They should also stay out of the sun and use a SPF35+ sun screen if they want their results to last. Topical creams are also often prescribed to help protect the skin and prolong the results.

Vigilance is important in determining the final outcome

Most practitioners follow up with their patients after two weeks. Patients are advised to see a doctor immediately if spots re-occur anytime after the peel.

Monica is a firm believer in vigilance. "In the ten years I've been working in this field, I've had about five patients with sun-damaged areas that did not disappear after they had a TCA peel. They all had further medical evaluation and discovered they had early forms of skin cancer."

Barbara sums it up this way, "I don't have any facial spots that I worry about now. In my book, peace of mind beats youthful beauty any day."