Table 2.

Overview of chemical peels in dermatological conditions

ACNE
• Chemical peels can be a useful adjunct to medical therapy for acne—may speed resolution, enhance penetration of topical drugs, and improve associated postinflammatory pigmentary problems
• Peels that have been studied for active acne include SA, LHA, GA 30–70%, and TCA 7–25%
• Need maintenance regimen—for patients who respond to peels, schedule every 3 months
• Primary effect may be on comedones, although reduction in inflammatory lesions may also occur (esp. SA, LHA)
• Peels also provide benefit in superficial acne scarring
• SA and its derivative LHA may often be the preferred peels for acne due to their action on both inflammatory and noninflammatory lesions

PHOTODAMAGE
• At least fair scientific evidence shows that the clinical benefits of chemical peels in photoaging outweigh the potential risks
• A range of chemical peels including AHAs, SA, LHA, TCA, and phenol are used to treat photodamage; selection is based on patient presentation (Glaugau, Fitzpatrick, PIH) and severity of photodamage
• SA, GA, TCA, phenol are all appropriate

MELASMA
• Peels are popular and widely used for melasma
• Peels may be most effective when used in combination with medical therapy or other procedures, possibly because peels remove melanin and other treatments inhibit melanocytes or melanogenesis
• Few formal studies are currently available; most existing studies have small patient populations
• Several peels have been studied in melasma (e.g., SA, LHA, GA, and TCA)
• Maintenance therapy is needed when peeling is used for melasma