Chemical Peels (Deep Peels)

The charts below show the chances of developing various side effects from deep chemical peels.4-9,12,13 In general, peels that penetrate deeper into the skin carry a higher risk of side effects. For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Skin redness (erythema)*up to 100%
SHORT TERM Burning/stinging sensation*up to 100%
SHORT TERM Skin peeling (desquamation)*up to 100%
SHORT TERM Sun sensitivity
(photosensitivity)*
up to 100%
SHORT TERM or LONG TERM Prolonged
skin darkening (hyperpigmentation)**
up to 100%
SHORT TERM Acne-like lesions
(acneiform eruptions)†
up to 100%
SHORT TERM or LONG TERM Prolonged
skin redness (erythema)‡
up to 80%
LONG TERM Persistent skin redness (erythema)§up to 20%

*Skin redness (erythema), burning/stinging, skin peeling (desquamation), and sun sensitivity (photosensitivity): These percentages are based on clinical studies. Study patients often do not report skin redness, burning/stinging, peeling, and sun sensitivity as side effects, because these are normal and expected skin reactions to chemical peels. The majority of patients will experience these reactions.

**Prolonged skin darkening (hyperpigmentation): Skin darkening may persist for up to 6 months after a deep chemical peel.

†Acne-like lesions (acneiform eruptions): Acne-like lesions may persist for up to 6 weeks after a deep chemical peel.

‡Prolonged skin redness (erythema): Prolonged skin redness may last up to 4 months following treatment with a deep peel.

§Persistent skin redness (erythema): Persistent skin redness is skin redness that is present for longer than 6 months after treatment.

Possible/Rare Side Effects

SHORT TERM or LONG TERM Scarringincidence not known
SHORT TERM Infectionincidence not known
LONG TERM Clogged sweat glands (milia)incidence not known
LONG TERM Thinning of the skin (atrophy)*incidence not known
SHORT TERM Phenol-based peels only: Irregular heartbeat (arrhythmia)**incidence not known
SHORT TERM Phenol-based peels only: Systemic allergy reaction with possible swelling of the throat**incidence not known
SHORT TERM Phenol-based peels only: Toxic shock syndrome**incidence not known

*Thinning of the skin (atrophy): Thinning of the skin can make the skin appear sunken-in.

**CAUTION. Irregular heartbeat (arrhythmia), systemic allergic reaction with possible swelling of the throat, and toxic shock syndrome: After the chemicals in phenol-based peels are absorbed by the skin, they enter the bloodstream and travel to other organs, where they may cause serious damage. These chemicals are toxic to the heart and may lead to an irregular heartbeat (arrhythmia). They may also cause a systemic allergic reaction, potentially leading to swelling of the throat. A very severe allergic reaction called toxic shock syndrome may also occur.2,11

Studies:

Three studies have looked at the side effects of deep chemical peels.

  • Study 1:

    • Authors: Leheta et al.8
    • Total # of patients: 20
    • # of female patients: 12
    • # of male patients: 8
    • Age of patients: Average: 30
    • Peel type: 60% phenol
    • Duration of treatment and follow-up: 1 treatment, follow-up at 8 months
    • Side effects:

      • Prolonged erythema (redness) for less than 4 months: 80%
      • Persistent erythema (redness) for longer than 6 months: 20%
      • Prolonged hyperpigmentation (skin darkening) for less than 6 months: 100%
      • Acneiform eruptions (acne-like lesions) for less than 6 weeks: 100%
  • Study 2:

    • Authors: Park et al.9
    • Total # of patients: 11*
    • # of female patients: 6
    • # of male patients: 5
    • Age of patients: Average: 34.4
    • Peel type: Exoderm (91% phenol)
    • Duration of treatment and follow-up: 1 treatment
    • Side effects:

      • Post-inflammatory hyperpigmentation: 74%
      • Prolonged erythema (redness) lasting over 3 months: 11%
      • Keloid (raised) scars: 2%
      • Milia (clogged sweat glands): 9%
      • Prolonged hyperpigmentation lasting over 6 months: 2%
  • Study 3:

    • Authors: Mackee and Karp13
    • Total # of patients: 112
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: (not reported)
    • Peel type: Phenol
    • Duration of treatment and follow-up: 2-4 treatments
    • Side effects: Hyperpigmentation (skin darkening): 2.7%

* All patients were Asian

Study 1: In a study published in 2014 in the Journal of Dermatological Treatment, Leheta and colleagues treated 20 patients with atrophic acne scars. The patients received one session of deep peeling with 60% phenol and were assessed 8 months after treatment. Two patients developed persistent erythema (redness) for 6 months, which was treated and cured with topical pimecrolimus cream.8

Study 2: In a study published in 2007 in the Journal of Dermatology, Park and colleagues treated 46 Asian patients, 11 of whom had acne scars, with a peel called Exoderm® containing 91% phenol. Patients were treated in 3-6 sessions. The majority experienced one or more side effects.9

Study 3: In a study published in 1952 in the British Journal of Dermatology, Mackee and reported on their experiences using phenol peels to treat acne scars. Over the course of 10 years, 112 total patients were treated with phenol for 2 to 4 sessions at intervals of 2 months. No patients experienced keloid (raised) scarring or infection following treatment.13

References
  1. Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
  2. Uptodate.com. Management of acne scars. Available from: https://eresources.library.mssm.edu:3285/contents/management-of-acne-scars?source=search_result&search=management%20of%20acne%20scars&selectedTitle=1~27#H1673698. Last retrieved on 6 September, 2017.
  3. Landau M. Chemical peels. Clin Dermatol. 26(2), 200-8 (2008).
  4. Garg VK, Sinha S, and Sarkar R. Glycolic acid peels versus salicylic-mandelic acid peels in active acne vulgaris and post-acne scarring and hyperpigmentation: a comparative study. Dermatol Surg. 35(1), 59-65 (2009).
  5. Puri N. Efficacy of Modified Jessner’s Peel and 20% TCA Versus 20% TCA Peel Alone for the Treatment of Acne Scars. J Cutan Aesthet Surg. 8(1), 42-5 (2015).
  6. Al-Waiz MM, and Al-Sharqi A. Medium-depth chemical peels in the treatment of acne scars in dark-skinned individuals. Dermatol Surg. 28(5), 383-7 (2002).
  7. Sachdeva S. Lactic acid peeling in superficial acne scarring in Indian skin. J Cosmet Dermatol. 9(3), 246-8 (2010).
  8. Leheta TM, Abdel Hay RM, and El Garem YF. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial. J Dermatolog Treat. 25(2), 130-6 (2014).
  9. Park JH, Choi YD, Kim SW, Kim YC, and Park SW. Effectiveness of modified phenol peel (Exoderm) on facial wrinkles, acne scars and other skin problems of Asian patients. J Dermatol. 34(1), 17-24 (2007)
  10. Kontochristopoulos G, and Platsidaki E. Chemical peels in active acne and acne scars. Clin Dermatol. 35(2), 179-182 (2017).
  11. Brody HJ. Complications of chemical peeling. J Dermatol Surg Oncol. 15(9), 1010-1019 (1989).
  12. Erbağci Z, and Akçali C. Biweekly serial glycolic acid peels vs. long-term daily use of topical low-strength glycolic acid in the treatment of atrophic acne scars. Int J Dermatol. 39(10), 789-94 (2000).
  13. Mackee GM, and Karp FL. The treatment of post-acne scars with phenol. Br J Dermatol. 64(12), 456-9 (1952).