Chemical peels in the treatment of acne: patient selection and perspectives

Abstract

Acne vulgaris is the most common skin disorder in adolescents and young adults. It carries a significant psychological and economic burden to patients and society. A wide range of therapeutic options are available, including topicals and systemic therapies. Chemical peeling is a skin resurfacing procedure intended to regenerate normal skin from the application of exfoliative agents. It has been used for the treatment of acne vulgaris and other skin disorders for decades. There are several chemical agents with variable mechanisms of action, usually classified as superficial, medium, and deep peels. When selecting the patient and the appropriate peel, the dermatologist individualizes therapy, and performs an extensive interview, including past medical history and physical exam. Several host factors can affect the outcome of this procedure, including current psychological state, medications, history of surgery, and immune system, among others. The physician must also be confident that the peel is safe and effective for the target patient. The Fitzpatrick skin type scale is a useful tool to classify patients based on skin color and ability to tan, but also can be used to evaluate preoperative risk of postpeel response and complications. Dark-skinned patients (Fitzpatrick skin type IV–VI), including blacks, Asian, and Hispanic/Latino, are at higher risk of postinflammatory/postpeel hyperpigmentation. When treating these populations, deep chemical peels should be avoided, and preoperative preparation emphasized. There are many studies available in the literature supporting the use of superficial to medium depth peels as adjuvant therapy for acne vulgaris. This review article aims to present the most important factors when selecting a patient for a chemical peel, the evidence behind its safety and efficacy, and special considerations when choosing a specific agent.

Acne Protection: Measures & Miseries

“…Patients experience high levels of anxiety, depression, and low self-esteem which leads to impaired quality of life. Therefore, treatment should focus on early intervention to decrease the physical and esthetic burden of the disease, and improvement of quality of life [81]. The cost is estimated to exceed $1 billion per year in USA for direct acne therapy, with $100 million spent on various acne products, as stated by Changqiang et.al, 2019 [75].…”

<p>Clinical evidence on the efficacy and tolerability of a topical medical device containing benzoylperoxide 4%, retinol 0.5%, mandelic acid 1% and lactobionic acid 1% in the treatment of mild facial acne: an open label pilot study</p>

“…Alpha hydroxy acids (AHA) have been recognized as commonly used therapy for acne through chemical peels, inducing exfoliation in hydrophilic areas 9. Mandelic acid is one of the largest AHAs used in mild to moderate acne for its keratolytic, anti-inflammatory and comedolytic effects: it penetrates the epidermis more slowly and uniformly, breaking down follicular plugs and causing desquamation of the stratum corneum 10…”

Cosmetic use of three topical moisturizers following glycolic acid facial peels

“…Facial chemical exfoliation (peeling) is a nonsurgical cosmetic procedure undertaken to reduce the signs of facial aging. It is a well‐established procedure in which the dermatologist uses a chemical agent (usually an acid) to insult the skin, with consequent damage to the cutaneous barrier . There are different types of chemical peels used in dermatologic practice; the most common are retinoids and alpha hydroxy acids, including glycolic acid.…”

“…There are different types of chemical peels used in dermatologic practice; the most common are retinoids and alpha hydroxy acids, including glycolic acid. Glycolic acid enhances the breakdown and decreases the cohesiveness of the corneocytes, causing desquamation . It is one of the most frequently used chemical peels and is considered to be safe when it is used correctly .…”