Resumen

Objectives: Peeling agents showing improvements in different dermatologic and aesthetic concerns have made chemical peels a very versatile procedure. Different molecules have unique mechanisms of actions and combining them in different ways can offer a synergistic effect on the primary condition. Sequential peel is a technique in which peels are applied in sequence and is an effective treatment for acne, post inflammatory hyperpigmentation, scars, photoaging, tanning, melasma, lichen planus pigmentosus, keratosis pilaris, acanthosis nigricans, cutaneous amyloidosis and skin rejuvenation. Introduction: Sequential peel is a technique in which peels are applied in sequence. The first peel is applied, and its action is terminated after a specific amount of time. This is followed by the application of another peeling agent which can be left on as a leave on peel or may be neutralized after a certain amount of time. The first peel enhances the penetration of the second peeling agent by causing a controlled exfoliation resulting in a greater peel depth. Different peeling agents have different acidity (pKa) and combining them in a single formulation may not be pharmacologically compatible. Results: SA 30 % peel followed by GA 35-70% peel is an effective treatment modality for acne with post inflammatory hyperpigmentation (PIH) as well as pustular acne. For melasma, combination peels containing glycolic kojic acid followed in sequence with the application of a combination peel containing TCA and tranexamic acid (TXA) may also be tried to improve pigmentation. For dermal pigmentary conditions like cutaneous amyloidosis, acanthosis nigricans and lichen planus pigmentosus a superficial peel containing GA may be followed by a medium depth peel containing TCA 15% & Phenol 15 % Conclusion: Different molecules have unique mechanisms of actions and combining them in different ways can offer a synergistic effect on the primary condition. Sequential peels are an effective modality of treatment for acne, PIH, melasma, dermal pigmentations and skin rejuvenation. Sequential peels carry lower risk when two superficial peels are combined as opposed to combining two medium depth peels. Deep peels in sequence in darker skin type should be avoided considering the risk of post treatment complications.