Chemical Peels for Acne Scars

From superficial to deep chemical peeling, you have to learn about your options…

In this article:

3 Types of Chemical Peels
Glycolic & Salicylic Acid
Jessner’s Chemical Peel
TCA Peel
Medium-Depth & Deep Chemical Peeling
What to Prepare
How Much Does It Cost?

How effective are chemical peels for acne scars? First of all, chemical peeling is actually a chemical exfoliation. It is one of the many skin resurfacing techniques that utilizes exfoliating chemical agents. Once these agents are applied to the skin surface, they will work by encouraging epidermal or dermal damage.

There are 3 types of chemical peels for acne scars:

Superficial chemical peels
Medium-depth chemical peels
Deep chemical peels

Superficial chemical peels work on superficial acne scarring (experts call it hyperpigmentation though) and the last 2 types of chemical peels (medium-depth and deep) show more promising results in treating acne scars.

Best results can be seen in rolling and boxcar scars. As for ice pick scars, chemical peeling has to be combined with another treatment such as punch excision. Another interesting fact is that chemical peels show better results in treating acne scars on older patients. This is due to the less-elastic condition of the skin in older individuals.

Superficial Chemical Peels

Just like the name describes, chemical peeling using superficial chemical peel agents is a superficial exfoliation that aims for the stratum corneum down to the papillary dermis of the skin. Several chemical peels that belong to this category are:

Jessner’s solution
Glycolic acid 40-70% (belongs to the AHAs group)
Trichloroacetic acid (TCA) 10-20%
Salicylic acid (belongs to the BHAs group)
Tretinoin

Note: Please read explanations about AHAs (Alpha Hydroxy Acids) and BHAs (Beta Hydroxy Acids) in our article about acne scar cream.

Each of these peels has its own qualities and method of peeling, with Jessner’s solution as the most inflammatory and TCA as the least inflammatory. Glycolic acid is considered as medium inflammatory and salicylic acid is completely non-inflammatory. All of these superficial peels are safe for dark-skinned individuals.

Glycolic Acid Chemical Peel

This is one of the most popular AHAs used as peeling agents. Others include: lactic acid, mandelic acid and pyruvic acid. All of them are natural ingredients. Patients can use these chemical peels for face and almost any area of the body. A 2 week interval is usually needed between treatments.

Salicylic Acid Chemical Peel

It is considered as the safest chemical peel for acne scars (hyperpigmentation) due to its anti-inflammatory and anti-microbial properties. It never shows any significant side effects nor complications. The peeling is performed at 2-4 week intervals with 3-6 treatments to achieve maximum results.

Jessner’s Chemical Peel

Jessner’s solution represents a combination of salicyclic acid, resorcinol and lactic acid.

TCA Peeling

TCA is the most flexible of all acne scars chemical peels. It is used in a variety of concentrations, starting from 10% to 50%. The higher the concentration is, the bigger the ablative injury, yet the greater the rejuvenative achievements.

TCA peels with concentrations greater than 30% can have an effect on the dermis and epidermis of the skin and therefore are classified as medium-depth or deep chemical peels.

In the past, 40-60% TCA peels was used for acne scarring treatments, but there were too many complications like scarring and post-inflammatory hyperpigmentaion. Consequently, these highly-concentrated TCA peels are not in use anymore.

Currently, most physicians combine 2 less-inflammatory chemical peels for acne scars; the first one is a superficial peeling agent and then followed with 35% TCA application. This can be done as a single procedure and the recovery time is normally 7-10 days.

Medium-depth Chemical Peels

Medium-depth chemical peels aim for the epidermis, papillary dermis, down to the upper reticular dermis of the skin. Unlike superficial chemical peeling, this kind of treatment should be used cautiously for dark-skinned individuals, because of the greater risk of post-inflammtory hyperpigmentation.

Acne scar chemical peels which belong to this category include:

TCA 30-50%
Glycolic acid 70% – applied 3-30 minutes
Glycolic acid 70% + 35% TCA
Jessner’s solution + 35% TCA
CO2 snow + 35% TCA
Phenol 88%

Deep Chemical Peels

Deep chemical peeling is a superb treatment for acne scarring – it can generate remarkable improvements within a single procedure that can last for a long time. However, this treatment is more aggressive and therefore has some inconveniences:

Requires a long time to heal
Uncomfortable conditions such as swelling, peeling, oozing and possible erythema for a minimum of 1 week
The skin appears sunburned for 2-3 months

Chemical peels in this category are:

Phenol 88%
Baker-Gordon phenol formula

Chemical Peeling for Acne Scars – Preparations & Post-Treatment Hints

Preparations depend on each patient’s health and scarring conditions
Patients who are on isotretinoin (Accutane, Roaccutane) are normally delayed for 6-12 months until chemical peeling is performed
Patients with a history of hypertrophic/keloid scar formation are normally treated carefully
The same goes for pregnant women and patients with heart disease
For combination treatments of acne scars, punch excision or elevations are usually performed 4-6 weeks before chemical peeling. Subcision is usually performed at the same session with the acne scars peel
Usage of topical retinoids (tretinoin, tazarotene, retinol formulations) can increase the penetration and depth of chemical peeling
Retinoic acid is commonly used in superficial and medium-depth chemical peeling, because it helps texture, tone and smooth the skin
After chemical peeling, sometimes topical bleaching agents such as azelaic acid, kojic acid, arbutin and licorice can be used
Sunscreen is a must for post-treatment application
After the peeling, use sunscreen daily and choose the right type of sunscreen, depending on the type of chemical peeling experienced and the type of the skin. Use UVA filters, UVB filters, or inorganic sunscreens
After experiencing chemical peeling for acne scars, isotretinoin may be needed to avoid acne flare and scar reformation