Side Effects of Chemical Peels

Q:  I have never had a chemical peel and would like to try one, but I am afraid of the thought of acid on my face. Should I be worried?

A: Chemical peels can improve and smooth the texture of facial skin by removing damaged outer layers and can be helpful in treating dull facial texture and color, fine wrinkles around the eyes and mouth, uneven pigmentation (solar lentigines, or “sun spots”), melasma, mild acne, and even precancerous lesions (ie, actinic keratoses).  

Your concern about having acid on your face is sensible. While peels offer a far less invasive option to smoother skin than plastic surgery or ablative laser procedures (like the carbon dioxide laser), they are not without some side effects – mostly minor – and a few serious risks. The extent and risk of adverse effects depends on the strength of the peel. The higher the strength, the deeper the peel, and a higher risk for numbness, scarring, and infection. And after any peel, you need to be diligent about using sunscreen and moisturizing to protect and nourish the new layers of skin.

The mildest form of chemical peel uses alpha-hydroxy acids (AHA) and improves the texture of rough or sun-damaged skin. Examples of AHA peels include glycolic, lactic, citric, tartaric, and malic acid. These mild acids remove only the outermost layers of the skin and can be useful in treating acne.

Most popular over-the-counter peels use 3–5% glycolic acids, but medical-grade glycolic acid peels generally use 50–70% glycolic acid. The most common anticipated effects with these treatments are a temporary stinging sensation, mild irritation or redness that usually subsides quickly, and peeling and redness that last for several days after the procedure.

Beta-hydroxy acid (BHA) peels that use salicylic acid (the major component of aspirin) penetrate deeply into the oil gland and so are equally or slightly more effective than AHA for acne. Further, BHA peels generally cause slightly less peeling and redness than AHA peels. Another type of superficial peel is the Jessner’s peel, which is a combination of salicylic acid (a BHA), lactic acid (an AHA), and resorcinol.

Medium-strength peels use trichloroacetic acid (TCA) at 35% or above to smooth and soften fine surface wrinkles, restore a healthy complexion, and treat superficial blemishes and pigment problems. A very common practice is to combine a Jessner’s peel with TCA. A medium peel is the preferred treatment for more severe cases of melasma (the dark, blotchy lesions on cheeks due to pregnancy or oral contraceptive pills) and sun damage. However, as TCA peels affect the deeper skin structures and are more penetrating than superficial peels, TCA should be selected for only certain skin types, as TCA peels may produce unintended color changes (unnatural lightening or darkening) in the skin and involve significant prolonged redness and some crusting or peeling, sometimes for up to several weeks. 

Stronger chemical peels use phenol acid and generally take more recovery time than other peels. Peeling and crusting can be more pronounced. Deep chemical peels are recommended for coarse wrinkles; severely blotchy, sun-damaged skin; and precancerous growths. They can cause permanent darkening or lightening of the skin, and they are not recommended for darker skin tones. Deep peels can pose a pronounced risk for those with a family history of heart disease and usually involve anesthesia, which may have complications.

The vast majority of those who have chemical peels suffer no serious side effects and enjoy a gratifying outcome. So, putting first things first – including your fears – you need to be clear about the benefit and overall effect that you are looking for. Then, work with your dermatologist to learn everything you can about the best peel for you and what to expect afterward. Finally, assess your “fear level” from an informed viewpoint to make the best decision for you.

Published on 01/14/2010 | Last updated on 01/05/2017