Chemical Peels (Light / Superficial Peels)

The charts below show the chances of developing various side effects from light / superficial 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 peeling (desquamation)*25% to 100%
SHORT TERM or LONG TERM Prolonged
skin redness (erythema)*
25% to 100%
SHORT TERM Burning/stinging sensation*17.3% to 100%
SHORT TERM Sun sensitivity (photosensitivity)*4.5% to 100%
SHORT TERM Skin darkening (hyperpigmentation)up to 25%

*Skin peeling (desquamation), prolonged skin redness (erythema), burning/stinging, and sun sensitivity (photosensitivity): These percentages are based on clinical studies. Study patients often do not report skin peeling, redness, burning/stinging, 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.

Possible/Rare Side Effects

SHORT TERM Skin drynessup to 14.3%
SHORT TERM Initial acne flare-upup to 4.5%
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

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

Studies:   

Three studies have looked at the side effects of light / superficial chemical peels.

  • Study 1:
    • Authors: Garg et al.4
    • Total # of patients: 44
    • # of female patients: 33
    • # of male patients: 11
    • Age of patients: Average: 22
    • Peel type: 35% glycolic acid
      • Duration of treatment and follow-up: 6 treatments
      • Side effects:
        • Burning or stinging sensation: 17.3%
        • Visible desquamation (skin peeling): 8.7%
        • Dryness: (frequency not reported)
        • Photosensitivity: 4.5% Initial acne flare-up: 4.5%
    • Peel type: 20% salicylic-mandelic acid (SMA) combination
      • Duration of treatment and follow-up: 6 treatments
      • Side effects:
        • Burning or stinging sensation: 17.3%
        • Visible desquamation (skin peeling): 0%
        • Dryness: 14.3%
        • Photosensitivity: 4.5%
        • Initial acne flare-up: 4.5%
  • Study 2:
    • Authors: Sachdeva7
    • Total # of patients: 7
    • # of female patients: 6
    • # of male patients: 1
    • Age of patients: 20-30
    • Peel type: 93% lactic acid
    • Duration of treatment and follow-up: up to 4 treatments, follow-up at 3 months after last peel
    • Side effects:
      • Transient post-inflammatory hyperpigmentation: 14.2%
  • Study 3:
    • Authors: Erbagci and Akcali12
    • Total # of patients: 58
    • # of female patients: 58
    • # of male patients: 0
    • Age of patients: Average: 31.8
    • Peel type: 20% glycolic acid increasing to 35%, 50%, and 70%
      • Duration of treatment and follow-up: 12 treatments
      • Side effects:
        • Prolonged erythema (redness) and desquamation (skin peeling): 17.4%
    • Peel type: 20% glycolic acid increasing to 35%, 50%, and 70%
      • Duration of treatment and follow-up: 24 weeks of once- or twice-daily treatments
      • Side effects:
        • (none reported)

Study 1: In a study published in 2009 in the journal Dermatologic Surgery, Garg and colleagues performed chemical peels on 44 patients whose acne scars had not responded to conventional treatments for 3 months or more. The patients were divided into two groups of 22 patients each. The patients in Group 1 received a 35% glycolic acid peel once every 2 weeks for a total of 6 treatments. The patients in Group 2 received a combination 20% salicylic acid-10% mandelic acid (SMA) peel once every 2 weeks for a total of 6 treatments. The majority of patients in both groups experienced no side effects.4

Study 2: In a study published in 2010 in the Journal of Cosmetic Dermatology, Sachdeva treated 7 patients with superficial atrophic scars with peels consisting of 92% lactic acid. The peels were applied at an interval of 2 weeks to a maximum of 4 peels, and the patients were followed up 3 months after the last peel. One patient exhibited transient post-inflammatory hyperpigmentation.7

Study 3: In a study published in 2000 in the International Journal of Dermatology, Erbagci and Akcali treated 58 female patients with atrophic scars. Each patient received either glycolic acid peels at increasing concentrations of 20%, 35%, 50%, and 70% at 2-week intervals, or 15% glycolic acid once or twice a day. The treatment continued for 24 weeks. After the sixth peel with 70% glycolic acid, four patients experienced prolonged erythema (redness) lasting several days, which was followed by desquamation (skin peeling).12

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).