Table 2.

Safety and Efficacy of AHAs Peel in Patients with Acne

Study ID	Design	Sample size	Patients	Interventions	Main Outcome	Findings
Kessler et al, 200861	Split-face, double-blind, randomized, controlled study	20	Mild to moderately severe facial acne vulgaris	30% GA	Quantitative assessment of papules and pustules	The glycolic acid and salicylic acid peels were similarly effective. The salicylic acid peel had sustained effectiveness and fewer side effects.
				30% salicylic acid
Ilknur et al, 201062	Single-blind, randomized, right-left comparison study	24	Mild to moderate Acne	GA (from 20% to 70%) peels	Cutaneous tolerability assessments	Both GA and AFA peels are efficacious for comedonal acne. And, compared to a GA peel, an AFA peel is less irritating and better tolerated.
				AFA (from 20% to 60%)
EI Refaei et al 201563	Single-center, open-label RCT.	40	Mild to very severe acne	35% GA (in distilled water)	Objective and subjective assessment/ Patients’ safety and satisfaction	Both peeling agents were effective. However, SMP proved to have a higher efficacy than the more commonly used GAP.
				20% SA+10% MA (in ethyl alcohol vehicle)
Kaminaka et al 201464	Single-center, double-blind, split-face RCT	25	Moderate to severe Acne	40% GA	Reduction in acne lesions	Forty percent of GA peels significantly improved moderate acne in this study. It is effective and safe in Asians.
				Placebo (hydrochloric acid in polyethylene glycol vehicle)
Kim et al 199967	Single-center, single-blind, split-face RCT.	26	Mild to moderate Acne	70% GA	Reduction in acne lesions and safety profile	Considering the equal treatment effect and a lesser degree of exfoliation in GA, it was recommended to use GA over Jessner’s solution for acne patients.
				Jessner’s solution (resorcinol, salicylic acid, lactic acid in ethanol)
Dayal et al, 202265	RCT	20	Atrophic Acne Scars	35% GA	Goodman and Baron’s qualitative and quantitative global acne scar grading systems, physician’s global assessment, and VAS	Both combinations were equally efficacious in treating acne scars. Glycolic acid peel delivered additional advantage of improvement in skin texture.
		20		15% TCA peeling
Dayal et al, 201972	Comparative study	25	Mild-to-moderate acne vulgaris	45% mandelic acid	Reduction in acne lesions and safety profile	About 45% MA peel was found to be equally effective as 30% SA peel in mild-to-moderate facial AV. However, safety and tolerability of MA peel were better than SA peel.
		25		30% salicylic acid
Bs et al, 202173	Comparative, retrospective analysis	22	Acne and Acne-Induced Pigmentation	Salicylic acid-mandelic acid peel	Complication rate and patients’ satisfaction	The use of isotretinoin did not result in any complications; hence, they encouraged combination therapy to achieve enhanced and faster resolution of acne.
		18		GA peels (20%, 50%, and 70%)
		7		Modified Jessner’s peel
Dixit et al, 202274	Double-blind randomized single-center interventional open-label study	28	Acne tarda	Low-dose isotretinoin alone	Reduction in acne lesions and safety profile	The combination of oral isotretinoin with SM peeling was highly effective and could be used as newer therapy against AT without any serious side effects.
		30		Low-dose isotretinoin and combination with salicylic acid and mandelic peel
Nofal et al, 201875	Comparative study	15	Mild-to-moderate acne	Modified Jessner’s solution followed by TCA 20% on the right (Rt) side of the face vs TCA 30% on the left (Lt)	Reduction in acne lesions and safety profile	Combination peels achieved a higher and earlier therapeutic response with a reasonable cost that is maintained for a relatively long periods than single peel. Combination sequential peels gave the best results.
		15		Combination peels of salicylic (20%) mandelic (10%) acids (SM) mixture on the Rt half vs salicylic acid 30% on the Lt half.
		15		Combination sequential peeling of MJ and TCA on the Rt side vs SM combination peels on the Lt side.
Dayal et al, 201676	RCT	20	Mild-to-moderate facial acne in Indian patients	30% SA	Michaelsson acne scores (MAS) and clinical photographs	30% SA peels were more effective than JS peels in the treatment of noninflammatory lesions, that is, comedones and in overall improvement of mild-to-moderate facial acne vulgaris.
		20		Jessner’s solution peels
How et al, 202077	A randomized, double-blinded, split-face, controlled trial	36	Acne vulgaris and postacne hyperpigmentation in patients with colored skin	Salicylic acid (SA) 30%	Michaelsson acne score (MAS), photographs, and postacne hyperpigmentation index (PAHPI)	Both JS and SA were equally effective in the treatment of acne vulgaris and reducing postacne hyperpigmentation in patients with colored skin.
				Jessner’s solution
Jae et al, 201868	Prospective, randomized, evaluator-blind, split-face clinical trial	20	Acne vulgaris	Jessner’s solution	Reduction in acne lesions and safety profile	Chemical peeling using the 50% GA (pH 3.0) + 0.5% SA solution can be as effective and convenient as the conventional peeling using Jessner’s solution in the treatment of acne vulgaris and may show fewer adverse events than the conventional peeling.
				50% GA (pH 3.0) + 0.5% salicylic acid (SA)
Perić et al, 201166	Comparative study	30	Acne	20% GA	Safety profile	Chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in acne type I.
		30		35% GA
		30		50% GA

Abbreviations: RCT, Randomized Controlled Trial; GA, Glycolic Acid; AFA, amino fruit acid; JS, Jessner’s solution; VAS, Visual Analog Scale; AT, Acne tarda.