Chemical peeling in ethnic skin: an update

Abstract

SummaryWith the growth of cosmetic dermatology worldwide, treatments that are effective against skin diseases and augment beauty without prolonged recovery periods, or exposing patients to the risks of surgery, are increasing in popularity. Chemical peels are a commonly used, fast, safe and effective clinic room treatment that may be used for cosmetic purposes, such as for fine lines and photoageing, but also as primary or adjunct therapies for acne, pigmentary disorders and scarring. Clinicians are faced with specific challenges when using peels on ethnic skin (skin of colour). The higher risk of postinflammatory dyschromias and abnormal scarring makes peels potentially disfiguring. Clinicians should therefore have a sound knowledge of the various peels available and their safety in ethnic skin. This article aims to review the background, classification, various preparations, indications, patient assessment and complications of using chemical peels in ethnic skin.What's already known about this topic?• Chemical peels are efficacious therapeutic interventions for many skin disorders.• Many peels exist; however, not all are safe for use in ethnic skin.• Darker skin types have an increased risk of adverse events from chemical peeling such as pigmentary disorders. What does this study add?• This is an up-to-date review of the various peeling agents and their indications for use in ethnic skin.• It provides a summary of newer peeling agents.• It gives practical tips on performing chemical peeling safely and effectively in ethnic skin.

Chemical burn following 50% trichloroacetic acid for acne: Presentation of a case and a focused review

“…Ethnic or Fitzpatrick Phototype III-VI skin is particularly vulnerable to both hyperpigmentation and hypopigmentation. In addition, skin of color responds less predictably to chemical peels, and is more prone to hypertrophic scarring (Roberts, 2004;Salam et al, 2013). These factors preclude such patients from receiving deep peels, and warrant the use of great caution for superficial or medium peels, even by the experienced practitioner (Roberts, 2004;Salam et al, 2013).…”

“…In addition, skin of color responds less predictably to chemical peels, and is more prone to hypertrophic scarring (Roberts, 2004;Salam et al, 2013). These factors preclude such patients from receiving deep peels, and warrant the use of great caution for superficial or medium peels, even by the experienced practitioner (Roberts, 2004;Salam et al, 2013). In addition, use of estrogen containing medications, photosensitizing drugs, and early exposure to sunlight all increase the risk for hyperpigmentation (Nikalji et al, 2012).…”

Is chemical peeling becoming outdated?

“…Deep peeling is indicated for patients with prominent photo-aging (Table 1) [4][5][6][7][8][9][10] . The chemical peeling procedure commonly used today is a quite simple method.…”

Treatment of Hyperpigmentation in Darker Skins

“…Standard options are glycolic acid 10-70%, salicyclic acid 20-30%, trichloroacetic acid (TCA) 10-25% and Jessner's solution. In a recent review, the newers are listed as tretinoin, pyruvic acid, β-lipohydroxy acid, mandelic acid and amino fruit acids [14].…”