How To Treat Acne With A Chemical Peel

Chemical peels are special acid solutions applied to the face by a board-certified dermatologist or certified esthetician. When applied correctly, the acid solution damages and removes the top layer of dull skin over 2 weeks (or sometimes more). The peel reveals smooth, healthier skin underneath. Chemical peels have been around for several decades and treat a range of skin conditions. These include:

• Hyperpigmentation (dark spots), sun spots, age spots, and liver spots
• Uneven skin tone
• Melasma
• Fine lines and wrinkles
• Rough skin or a dull complexion
• Scars
• Acne

Chemical peels happen in several sessions and can treat even deep acne scars. Your dermatologist will use different types of peels to target different layers of your skin.

Our skin has different layers, namely the stratum corneum, epidermis, dermis, and subcutaneous tissue. As a result, different chemical peels impact our skin at different depths. There are three types of peels your dermatologist can perform.

1. A superficial or lunchtime peel targets the top layer or epidermis. These peels have minimal downtime and take just a few minutes (hence the name lunchtime peel since patients tend to do them on their lunch break). These are perfect for minor skin issues.
2. Medium-depth peel goes a bit deeper into the epidermis and impacts part of the dermis. This peel helps with deeper issues like wrinkles and scarring.
3. A deep chemical peel is a specific peel used for severe skin conditions. These peels impact the deeper layers of the dermis and require lengthy downtime. Deep peels happen under anesthesia and need extensive skincare before and after the procedure. Common reasons for deep peels include sun damage, scars, blotchy skin, and pre-cancerous growths.

Your dermatologist will use different types of acids for each peel at different concentrations. These peels also work well for the different types of acne. However, your dermatologist will perform an individual, detailed skin examination first to determine the right peel for you.

For the best results, your dermatologist will perform several peels over several weeks. Deep chemical peels happen once and require an extended healing period. After the full treatment, chemical peels remove damaged skin and clears up your acne. There are some hidden extras in your chemical peel too. For instance, your peel will improve the absorption of future topical treatments you’ll use to keep your acne at bay.

Chemical peels also reduce pore size and may decrease sebum production, the oil that causes acne. That means long-term, you’ll get fewer acne breakouts. And who wouldn’t love a fresh new face? In addition, clearing up your acne brings back your confidence in ways you did not think were possible.

After your initial consultation, we will decide on the type of peel that’s best to treat your acne. In the weeks leading up to your first chemical peel, you may be prescribed topical medication to prepare the skin for your peel. These could be a combination of hydroquinone and tretinoin, along with lower strength alpha-hydroxy acids. Follow all instructions before your peel, such as avoiding excess sun exposure, makeup, and exfoliating.

On the day of your treatment, your dermatologist or aesthetician will first cleanse your face. Then, the prepared chemical solution is placed on the face with an applicator, making sure to avoid your hair and eyes. After the peel stays on for a few minutes, the chemical is deactivated with a neutralizer to prevent burning. The total process takes less than 20 minutes. For deeper peels, the process can take a bit longer. For the best results, you will need a series of chemical peels over 2 to 3 months.

Your doctor will perform either a superficial or medium-depth peel to treat your acne. Superficial peels can help mild acne, improves your skin texture and tone. Medium peels will help moderate to severe acne scars, wrinkles, and hyperpigmentation. Your superficial peel can be one of the following:

• Glycolic acid: Belonging to a group of alpha-hydroxy acids, glycolic acid is perfect for superficial peels. It helps with exfoliation while increasing collagen production. Glycolic acid also reduces inflammation and works on all skin types. The superficial peel will start at 20% strength.
• Salicylic acid: This is a beta-hydroxy acid naturally sourced from willow tree bark that can provide deep exfoliation while treating acne. It can also improve hydration, keeping your pores clear for longer, which means fewer breakouts. 
• Jessner’s Solution: This is a combination of lactic acid (14%), salicylic acid (14%), and resorcinol (14%).
• Lactic Acid: Lactic acid is an alpha-hydroxy acid that provides a light peel of the epidermis. This acid can be combined with others for a more effective treatment.
• Mandelic Acid: This is another alpha-hydroxy acid that helps with exfoliation and is perfect for mild to moderate acne. Studies show that mandelic acid also contains antibacterial properties. In some cases, your dermatologist will combine mandelic acid with salicylic acid.
• Trichloroacetic acid (TCA): A specially made acid that can be used to perform peels at all levels.

Medium peels can fall under one of the following:

• TCA between 35% to 40%
• Glycolic acid at 35% or higher

Or a combination of acids to create a more effective solution.

Some patients are candidates for deep chemical peels. These candidates will have severe cystic acne or deep acne scars. Deep peels contain phenol or TCA beyond 50%. Phenol, in particular, is known for its ability to treat deep-seated acne and acne scars. If you’re a candidate for a deep peel, follow your doctor’s instructions for the best results.

Aftercare and possible side effects.

Your dermatologist will also provide aftercare treatment and instructions to support healing and accelerate results. These include:

• Applying sunscreen and moisturizers as often as possible.
• Your skin may appear a bit worse before it gets better.
• Using the prescribed topical treatments to maintain skin health.
• Avoid wearing makeup, tanning, or excess sun exposure for at least 48 hours.
• Avoid intense physical activity for at least 24 hours.
• You’ll feel tempted to pick or pull at your skin when it peels. Picking your skin can cause irritation or transfer dirt from your hands to your face.

We will recommend additional treatment for deep acne scars, which can include laser therapy, medication (steroid injections or retinol), microneedling, and much more.

Anyone who wants to get a brighter, even glowing complexion should get a peel. If you have a history of keloids or very sensitive skin, be sure to let your dermatologist know this.

Despite the effectiveness of chemical peels, the procedure is not for everyone. Based on your medical history, we’ll determine if this is the best route to deal with acne. Reasons you should not get a chemical peel include:

• A current or previous bacterial or fungal infection
• Taking medication to treat these infections
• Patients who’ve used a prescription medication to treat acne within the last year
• A history of irregular scarring, or keloids 
• Current immune-related diseases
• Patients who are pregnant or breastfeeding should avoid peels just to be safe.
• Patients with unrealistic expectations about the process may not be good candidates. You may need a holistic approach that includes multiple peels. For most patients, a completely acne-free face would not happen after one peel.

Make sure to raise any concerns before attempting a chemical peel. your dermatologist will advise you if the peel is right for you and provide alternatives if it’s not the right fit.

Regardless of your skin type or color, you can suffer from acne. When it comes to chemical peels, however, special considerations must be made for patients of color. There is a common misconception that darker skin tones should not get chemical peels. Because of the excess melanin production, some chemical peels expose these skin types to a condition called post-inflammatory hyperpigmentation.

Dermatologists are becoming more and more equipped to deal with skin of all shades. For darker skin types, we will stick to superficial peels. You’ll likely get one of the following peels:

• A glycolic acid peel at 20% concentration
• A salicylic acid peel at 20% concentration
• TCA between 10% and 30%
• Jessner’s solution
• A combination of other acids such as mandelic acid or lactic acid.

Dermatologists will start at the lowest concentrations possible, slowly working up to stronger peels to gauge the skin’s reaction. Patients with lighter skin tones can benefit from medium peels. However, deep peels are not suitable for dark skin. These peels can cause significant damage to the skin. Follow the advice of your dermatologist for the best acne treatment for dark skin.