Chemical peeling in ethnic/dark skin

Abstract

Chemical peeling for skin of color arose in ancient Egypt, Mesopotamia, and other ancient cultures in and around Africa. Our current fund of medical knowledge regarding chemical peeling is a result of centuries of experience and research. The list of agents for chemical peeling is extensive. In ethnic skin, our efforts are focused on superficial and medium-depth peeling agents and techniques. Indications for chemical peeling in darker skin include acne vulgaris, postinflammatory hyperpigmentation, melasma, scarring, photodamage, and pseudofolliculitis barbae. Careful selection of patients for chemical peeling should involve not only identification of Fitzpatrick skin type, but also determining ethnicity. Different ethnicities may respond unpredictably to chemical peeling regardless of skin phenotype. Familiarity with the properties each peeling agent used is critical. New techniques discussed for chemical peeling include spot peeling for postinflammatory hyperpigmentation and combination peels for acne and photodamage. Single- or combination-agent chemical peels are shown to be efficacious and safe. In conclusion, chemical peeling is a treatment of choice for numerous pigmentary and scarring disorders arising in dark skin tones. Familiarity with new peeling agents and techniques will lead to successful outcomes.

Chemical peeling in ethnic skin: an update

“…28 As a peel it is self-neutralizing, typically creating a white frost on the skin, which is not desired in SPT IV-VI due to the risk of dyschromias and scarring. 8 Chun et al 29 evaluated the use of varying concentrations of TCA (10-65%) pressed firmly and focally onto a range of benign pigmentary disorders (65% TCA for seborrhoeic keratosis, 50-65% TCA for solar lentigines and freckles and 10-50% TCA for melasma) in 106 patients with SPT IV and V. No significant complications were observed, and patient satisfaction rates ranged from 55% for melasma to 86% for seborrhoeic keratosis.…”

“…Photoprotection and bland emollients should be started immediately after the peel, and wetting the area should be avoided for 24 h, followed by a return to normal cleansing activities. 8 One week after the peel, hydroquinone and topical retinoid therapy may be restarted.…”

“…Unlike SPT I and II skin, where peels are mostly used to treat skin changes associated with photoageing, SPT IV-VI peels are used mostly for mottled dyschromia, acne vulgaris, postinflammatory hyperpigmentation (PIH), melasma and pseudofolliculitis barbae. 8 Clinicians are faced with specific challenges when using peels on ethnic skin. Although darker skin confers the advantage of added photoprotection, it is the often unpredictable response of melanocytes to injury that can cause disfiguring postinflammatory pigmentary changes.…”

Rhamnus intermedia Steud. et Hochst. – a New Source of Bioactive Phytochemicals

“…27 Salycilic acid is also commonly used in dermatology in anti-acne treatments. 28,29 Abudance of salycilic acid in R. intermedia bark indicated that salycilic acid is probably the active component in bark of some Rhamnus species used in Bosnia and Herzegovina to treat mange and skin diseases.…”

Chemexfoliation and Superficial Skin Resurfacing

“…Africans and darker African Americans (skin types V and VI) have better results with salicylic acid peels because the risk for PIH is higher with glycolic acid peels. Finally, serial glycolic acid peels and salicylic acid peels have been successful in improving the skin texture in patients with pseudofolliculitis barbae [22].…”