Kapsul Buka Aura






A History of Chemical Peeling
Harold J. Brody, MD,* Gary D. Monheit, MD, Sorrel S. Resnik, MD, and Thomas H. Alt, MD§


THE ANCIENT EGYPTIANS1,2 used animal oils, salt, alabaster, and sour milk to aesthetically improve the skin. When sour milk was used to produce smooth skin, lactic acid, an alpha-hydroxy acid, was the active agent. Poultices containing mustard, sulfur, and corrosive sublimate of limestone were used later by the Greeks and the Romans. Pumice, frankincense, myrrh, and tree resins have served to lighten the skin and remove freckles and wrinkles. The Turks used fire to singe the skin in an attempt to induce light exfoliation. Indian women mixed urine with pumice for skin application. In Europe, Hungarian gypsies passed their particular formulas down from generation to generation.

Dermatologists pioneered skin peeling for therapeutic benefit (Table 1). The Viennese dermatologist Ferdinand Hebra (Figure 1), the father of topical dermatology, treated freckles and melasma in the mid-1800s by using exfoliative agents in various combinations.3 Repetitive application of tinctures of iodine and lead could lighten freckles. Croton oil, cantharides, and sulfuric, acetic, hydrochloric, and nitric acids were cautiously used. Four hours of lime-based compresses would irregularly blister the epidermis. After puncturing these blisters and covering with starch, removing the crusts would lighten the epidermis. Tilbury Fox described the limited use of 20% phenol to lighten the skin in 1871, and in 1881 Henry Piffard mentioned inflammation from croton oil, an ingredient in phenol peeling formulas. These pioneer dermatologists were the first to work with peeling chemicals. In 1892 Edmund Saalfeld, a German dermatologist, reiterated Hebra's sublimate poultices and published on the removal of freckles with phenol and on the value of masks and paraffin, both topical and injectable. In 1882 P. G. Unna (Figure 2), a German dermatologist, described the properties of salicylic acid, resorcinol, phenol, and trichloroacetic acid (TCA). Work in the 1990s on salicylic acid's properties as a beta-hydroxy acid are based on this work. Unna's paste of zinc oxide, resorcinol, ichthammol, and petrolatum applied for 3 days promoted “rejuvenation” of skin that was wrinkled from irregular pigmentation and actinic keratoses.4 Lassar's paste, which used beta-naphthol with sulfur in petrolatum, was coupled with Unna's paste as the chief agents of the European peeling experience of the first decades of the 20th century.

The first American article on phenol was by California dermatologist Douglass Montgomery in 1917. He recounted experiences using phenol under bandages for healing and using the agent as a “beautifier.”

George Miller Mackee, a British dermatologist who eventually became chairman of the dermatology department at New York University (NYU), began using phenol peels for acne scarring in 1903 and published his results in 1952 with his associate Florentine Karp. The publication was the first attempt to correlate the histology of peeling with clinical results. They managed a phenol clinic to treat acne scars in the 1940s at NYU and noticed simultaneous improvement of skin texture.5 Karp gave detailed instruction and demonstrations of the phenol peeling technique to young dermatology trainees.

During the first half of the 20th century, sporadic reports on peeling appeared in textbooks and the early American medical literature. A colleague of Mackee's, George Henry Fox (Figure 3), wrote of the treatment of facial freckles with phenol in his textbook in 1905.6

During World War I, phenol solutions were an acceptable treatment for gunpowder burns of the face. Dr. la Gassé noted that an injured area that was treated with phenol and covered with adhesive tape healed with cosmetic improvement. His techniques in 1918 wartime France were brought to the United States by his daughter Antoinette, who practiced lay peeling near Los Angeles in the 1930s and 1940s to improve scarring and wrinkles.7 Francis and Miriam Maschek, lay peelers in south Florida, probably learned portions of the technique from Antoinette la Gassé and from her protégé Cora Galenti of Los Angeles. The House of Renaissance was one of several salons operating at the time in Florida. In addition, the salons sometimes served as fronts for physicians performing massive silicone injections.

In 1927, a Los Angeles physician, H. O. Bames, who became one of the first plastic surgeons, wrote about superficial face peeling with resorcinol. He used phenol covered with adhesive plaster for deep face peeling.8,9 He described phenol complications, the use of thymol iodide powder, and the importance of dividing the facial peel into halves separated by a week's time to avoid phenol poisoning or nephritis.

In 1941 Joseph Eller, a New York dermatologist, and Shirley Wolff, his assistant,10 summarized the peeling formulas available for exfoliation at that time. A slightly more potent variation of the salicylic acid, lactic acid, and resorcinol formula promoted by Jessner in the 1950s was published in this article. Sulfur and resorcinol pastes were described, probably originally derived from the Egyptian, Babylonian, and Indian use of pumice on the skin to cause stratum corneum exfoliation. Phenol, salicylic acid combinations, and carbon dioxide snow peels were detailed, and the dangers of renal phenol toxicity, as well as the importance of degreasing the skin prior to peeling agent application were noted. Beta-naphthol peeling pastes for acne treatment derived from the European experience had been utilized since the early part of the century.11

In 1946 Urkov, an American surgeon,12 described in detail exfoliation by methods including occluded phenol. He also described superficial exfoliation by applying a mixture of resorcinol with lactic and salicylic acids under occlusion. Cantharidin was employed under an occlusive dressing for deeper exfoliation for pits and scars. In 1950 Winter, a Budapest surgeon,13 used “phenol in ether” to remove freckles. The work of Samuel Ayres14,15(Figure 4) in the 1960s combined the TCA experiments of Monash in 194516 with his own conclusions based on clinical experience and the histology of both TCA and phenol. He felt that TCA was the more caustic agent. Marion Sultzberger and others17 at NYU began to treat acne scars. Max Jessner utilized his 14% salicylic acid, lactic acid, and resorcinol combination at NYU.

In the late 1950s and early 1960s, Adolph Brown, a maxillofacial surgeon, and his wife, Marthe Brown, a dermatologist, performed histologic studies, sparked by lay peelers and their formulas in Los Angeles. The Brown's detailed studies on phenol formulas and toxicities18 and Litton's nonsaponified phenol formula19,20 were products of the renaissance in peeling that occurred in the early 1960s. Clyde Litton, a plastic surgeon in West Virginia, met Miami lay peelers and worked to modify their formulas. Sir Harold Gillies, a British otolaryngologist, used phenol and tape in the mid-1950s.21

F. C. Combes, a dermatologist,22 and P. A Sperber attempted to produce a buffered phenol formula that would prove less caustic than full-strength phenol. Sperber tried to soften the effect of phenol with sodium salicylate, camphor, and glycerine. They believed that phenol peeling was superior to mechanical dermabrasion to treat acne scarring. Combes also used the same formula employed by Jessner for superficial exfoliation that is still used today.

Simultaneously in the early 1960s, Thomas Baker, a plastic surgeon in Miami, became aware of a lay peeler who was using a mystery formula to perform peels that seemed to produce incredible results for the treatment of wrinkles. Lay operators of this time would not reveal their exact formulas but gave skeletal information. Complications in the form of scarring and sloughs were frequent sequelae. Physicians were doubtful that a peel could accomplish significant results until Baker and Gordon presented a patient at a national plastic surgery conference in 1972 who had had good results from a peel documented by before and after photographs. From their experience with lay peelers, through the work of Brown and Brown, and from their own research in 1961,23,24 they developed a saponated formula. This 55% concentration of phenol mixed with water, hexachlorophene, and croton oil is still used today.

The 1970s provided an environment for dermatologists, plastic surgeons, and otolaryngologists to perform full-face peels with either TCA or phenol. Thomas Alt was teaching his technique for occluded phenol peeling. Gaylon McCollough, a facial plastic surgeon, popularized the use of an unoccluded Baker's formula phenol peel as a safe alternative for deep peeling. Sorrel Resnik et al.25 published their experiences with TCA during this period (Figure 5). P. N. Horvath26 was utilizing the superficial resorcinol, salicylic acid, and lactic acid peel earlier popularized by Combes and Jessner at NYU. Dupont followed phenol peels with dermabrasion,27 and James Stagnone followed TCA peels with dermabrasion and coined the term chemabrasion.28 These variations were attempts to further refine the methodology in order to improve skin texture. Neither of them is used extensively today.

Samuel J. Stegman's (Figure 6) work in the 1980s29,30 on both animal and human models compared the histologic depth of both chemical wounding agents and dermabrasion, paving the way for chemical peeling in a controlled and scientific fashion. These excellent histologic concepts for the evaluation of peeling influenced Harold Brody and Chenault Hailey, who combined two superficial agents, solid carbon dioxide followed by TCA, to coin the term “medium-depth” peel in 1986.31 In 1989 Gary Monheit32 employed another medium-depth technique based on a suggestion of R. F. Bloom utilizing resorcinol, salicylic acid, and lactic acid (Jessner's solution) followed by TCA.

Eugene Van Scott and R. J. Yu33 had been investigating the alpha-hydroxy acids (AHAs) in the late 1970s. Their experimentation with these chemicals as superficial peeling agents came to fruition in the 1980s. Throughout the 1990s, AHAs have been added to the peel spectrum with their promotion by the media, an event unprecedented in the history of chemical peeling. The AHAs are used for peeling in higher concentrations by physicians and lower concentrations by aestheticians. They have been combined with TCA for medium-depth peeling by William Coleman and Josephine Futrell.34 With Richard Glogau's sensible photoaging classification35 and the depth knowledge of wounding techniques, peeling can be accomplished with more technical accuracy than at any point in history.

Throughout the 1990s there have been a number of proprietary and patented products to market chemical peeling agents through both independent and major pharmaceutical companies. These variations have consisted of specific esters and combinations of AHAs with appealing names to market not only the chemical peeling agent but also a regimen of sunscreens and bleaches to be used concurrently. Salicylic acid has been popularized as a beta-hydroxy acid to compete with the AHAs.36 Methods have been detailed with TCA, both in the aqueous form with proprietary additives37 and using TCA creams.38 Variations using phenol and phenol formulas as “new” mask treatments for wrinkles have been promoted in other countries as recently as 1999 and are still reaching the United States. Commercial approaches to chemical peeling are not discussed in this article.

The last 5 years of the 20th century have introduced David Harris's combination of manual dermasanding with TCA peeling39 and Bruce Katz's fluorhydroxy peel40,41 that combines 5-fluorouracil with either glycolic acid or Jessner's solution to treat actinic keratoses. Combination skin resurfacing enables chemical peeling to blend areas on the face with the new resurfacing lasers, particularly using medium-depth TCA combinations. The use of resurfacing lasers in combination with or in addition to peeling agents heralds a new era that demands a knowledge of all resurfacing agents to provide the most efficacious and cost-effective treatments for patient's needs. The scientific, histologic, and clinical evaluation and comparison of the newer agents and techniques with our existing modalities will be the work of the future in chemical resurfacing.



Illustrations for this article were made possible through the generosity of Joe R. Monroe, MPAS, PA-C, of Vancouver, Washington, and the textbook by W. B. Shelley and J. T. Crissey, Classics in Clinical Dermatology, originally published by Charles C. Thomas, Springfield, Illinois, 1953 (out of print).






Harold J. Brody, MD,
Gary D. Monheit, MD,
Sorrel S. Resnik, MD, and
Thomas H. Alt, MD


*Emory University School of Medicine, Atlanta, Georgia,

University of Alabama School of Medicine, Birmingham, Alabama,

University of Miami School of Medicine, Miami, Florida, and §University of Minnesota,
Minneapolis, Minnesota


Address correspondence and reprint requests to: Harold J. Brody, MD, 478 Peachtree St., Suite 711-A, Atlanta, GA 30308.


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Figure 1.  Ferdinand von Hebra, c. 1860....

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Figure 2.  P. G. Unna, c. 1900....

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Figure 3.  G. H. Fox, c. 1900....

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Figure 4.  Samuel Ayres III, 1976....

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Figure 5.  Sorrel S. Resnik, 1976....

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Figure 6.  Harold J. Brody and Samuel J. Stegman, 1986....

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Table 1.  Historical Skin Peeling by Dermatologists...


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