Table 5.

Clinical studies evaluating the safety and efficacy of chemical peels for acne in skin of color

AGENT	AUTHOR	SKIN-OF-COLOR PATIENTS (FST)	STUDY DESIGN	EFFICACY	SAFETY	PIH EFFICACY
GA 35% vs. 20% SA-10% MA	Garg et al113	N=44, all Asian Indian (IV-VI)	Two groups: Six peels at two-week intervals	Both agents were effective but SA-MA peel had greater efficacy for active acne lesions (P<0.001) and hyperpigmentation (P<0.001)	17.3% had burning or stinging sensation. Desquamation more common with GA. Dryness more common with SA-MA	Yes
GA 70% vs. Jessner's	Kim et al114	N=26, all Korean (III-IV)	Split-face: Three peels at two-week intervals	Both sides showed improvement in acne grade score; however, no statistically significant difference between the peels	Acute eczema (GA), exfoliation, which was noted to persist longer after the Jessner's peel (p<0.01)	NS
GA 35%, 50%	Wang et al115	N=40, all Taiwanese (IV)	Two groups: Four peels at three-week intervals	All patients used a 15% GA home product for one week prior to peeling. Significant reduction in the number of comedones, papules, and pustules. Improvement in skin texture and appearance and smaller pore size.	5.6% of patients developed side effects including PIH (3), mild local herpes simplex infection (3), and mild skin irritation (3) Some had acne flare after first treatment	Yes
SA 30%	Dainichi et al116	N=42, all Japanese	42 survey respondents after SA peel	Majority of patients noted a clinical improvement in acne, satisfaction with the treatment, and a spontaneous improvement in skin texture and color	Side effects were minimal	NS
SA 30%	Hashimoto et al117	N=16, all Japanese	Five peels at two-week intervals	There was a 75% reduction (p=0.001) in the comedone count from baseline to the endpoint of the study and improvement in the comedogenic acne severity grade in all patients	Mild burning and erythema were noted in three patients during the procedure	NS
SA 30%	Lee et al118	N=35, all Korean (III-IV)	Five peels at two-week intervals	There was a significant reduction in both inflammatory and noninflammatory lesions. The mean acne grade reduction from Baseline to Week 12 was 1.29 (p<0.01).Based on pre-peel and multiple post-peel measures, skin barrier function was found to be uncompromised by repeated peels.	Most common side effect was dryness but erythema, exfoliation, burning sensation, and crusting were also noted	NS
SA 20–30%	Grimes et al54	N=25, African American and Hispanic (all V-VI) Acne (9), PIH (5)	Five peels at two-week intervals	There was a rapid resolution of papules, pustules, and comedones in acne patients. Moderate to significant improvement occurred in 89% of acne and 100% of PIH patients	Side effects were mild including crusting, dryness, transient hypo- and hyperpigmentation	Yes

GA= Glycolic acid

SA= Salicylic acid

MA= Mandelic acid

NS= Not stated

PIH= Postinflammatory hyperpigmentation