Chemical Peels (Medium-depth Peels)

The charts below show the chances of developing various side effects from medium-depth 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)*8% to 100%
SHORT TERM Burning/stinging sensation*4% to 100%
SHORT TERM Skin peeling (desquamation)*up to 100%
SHORT TERM Sun sensitivity (photosensitivity)*up to 100%
SHORT TERM or LONG TERM Skin
darkening (hyperpigmentation)
up to 60%

*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.

Possible/Rare Side Effects

SHORT TERM or LONG TERM Redness (erythema) for more than 1 monthup to 13.3%
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:

Two studies have looked at the side effects of medium-depth chemical peels.

  • Study 1:

    • Authors: Puri5
    • Total # of patients: 50
    • # of female patients: 40
    • # of male patients: 10
    • Age of patients: 11-50
    • Peel type: 20% TCA and Jessner’s solution

      • Duration of treatment and follow-up: 6 treatments
      • Side effects:
        • Erythema: 8%
        • Burning sensation: 4%
        • Hyperpigmentation: 8%
    • Peel type: 20% TCA

      • Duration of treatment and follow-up: 6 treatments
      • Side effects:
        • Erythema: 12%
        • Burning sensation: 8%
        • Hyperpigmentation: 16%
  • Study 2:

    • Authors: Al-Waiz and Al-Sharqi6
    • Total # of patients: 15
    • # of female patients: 14
    • # of male patients: 1
    • Age of patients: Average: 28
    • Peel type: Jessner’s solution and 35% TCA
    • Duration of treatment and follow-up: 1-3 treatments
    • Side effects:

      • Erythema (redness) lasting longer than 1 month: 13.3%
      • Transient post-inflammatory hyperpigmentation: 60%

Study 1: In a study published in 2015 in the Journal of Cutaneous and Aesthetic Surgery, Puri treated 50 patients with acne scars. The patients were randomly assigned to one of two treatment groups. Group 1 received a combination peel of 20% TCA and Jessner’s solution 6 times at 3-week intervals. Group 2 received a peel consisting of 20% TCA alone 6 times at 3-week intervals.  The patients with the combination peel experienced fewer side effects than the patients who received TCA alone.5

Study 2: In a study published in 2002 in the Journal of Cosmetic Dermatology, Al-Waiz and Al-Sharqi treated 15 patients with acne scars with a combination of Jessner’s solution followed by 35% TCA. One patient received 1 session, one patient received 2 sessions, and the remaining 13 patients completed 3 sessions. Two of the patients experienced erythema (redness) that lasted longer than 1 month. In addition, nine patients suffered from transient post-inflammatory hyperpigmentation.6

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).