What chemical peels are safe for individuals with sensitive or reactive skin?

From the Guidelines

For individuals with sensitive or reactive skin, the safest chemical peels are those with mild concentrations of alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs), such as lactic acid (10-20%), mandelic acid (20-30%), or low-concentration glycolic acid (10-20%). These peels are generally well tolerated and work by removing dead skin cells and promoting cell turnover without triggering significant inflammation 1. Enzyme peels containing papain, bromelain, or pumpkin enzymes are also excellent options as they work more gently than traditional acid peels. PHA (polyhydroxy acid) peels, such as gluconolactone or lactobionic acid at 10-20% concentrations, are particularly suitable because they have larger molecular structures that penetrate more slowly and cause less irritation.

When getting a professional peel, it is essential to start with the mildest option and have a patch test performed 24-48 hours before the full treatment. For at-home use, begin with the lowest available concentration and use only once every 2-3 weeks, gradually increasing frequency as tolerated. These gentler peels improve skin texture and tone while minimizing the risk of adverse reactions that stronger peels might cause in sensitive skin. It is also important to note that the use of chemical peels, such as ALA-red light PDT, has been shown to be effective in treating actinic keratosis, with minimal harms and low risk of scarring 1. However, the specific guidelines for the management of actinic keratosis may not be directly applicable to the treatment of sensitive or reactive skin.

Some key points to consider when using chemical peels on sensitive or reactive skin include:

• Starting with mild concentrations and gradually increasing as tolerated
• Performing a patch test before the full treatment
• Using enzyme peels or PHA peels as gentler alternatives
• Avoiding the use of harsh or high-concentration peels
• Following a consistent skincare routine to minimize irritation and promote skin health

Overall, the use of mild chemical peels, such as those containing AHAs or BHAs, can be a safe and effective way to improve skin texture and tone in individuals with sensitive or reactive skin, as long as proper precautions and guidelines are followed 1.

From the FDA Drug Label

Warnings For external use only Do not use if you have very sensitive skin or known allergy to aspirin CAUTION: For external use only. Avoid Eye area. If product gets in your eyes, rinse thoroughly

The glycolic acid chemical peel may not be safe for individuals with sensitive or reactive skin, as the label warns against using the product if you have very sensitive skin 2. It is recommended to stop use and ask a doctor if excessive itching, dryness, redness, burning or swelling occurs 2.

• Key considerations for use in sensitive skin:
  • Avoid eye area
  • Rinse thoroughly if product gets in eyes
  • Reduce application if bothersome dryness or peeling occurs 2

From the Research

Chemical Peels for Sensitive or Reactive Skin

• Salicylic acid peels are considered safe for individuals with sensitive skin, as they have distinct advantages for resurfacing moderately photodamaged facial skin 3
• Lactic acid peels have been found to be effective and safe in the treatment of melasma, with no side effects recorded in all treated patients 4
• Glycolic acid peels and salicylic-mandelic acid peels are both equally efficacious and safe treatment modalities for melasma in Indian skin, and are more effective than phytic acid peels 5
• Buffered 50% glycolic acid (pH 3.0) + 0.5% salicylic acid solution has been found to be as effective and convenient as Jessner's solution in the treatment of acne vulgaris, with fewer adverse events 6

Precautions and Considerations

• It is essential to do prepeel priming of the patient's skin with sunscreens, hydroquinone, and tretinoin for 2-4 weeks 7
• Medium depth peels should be performed with great caution, especially in dark-skinned patients 7
• Deep peels are not recommended for Indian skin 7
• The physician performing chemical peeling should have completed postgraduate training in dermatology and have adequate knowledge of the different peeling agents used, the process of wound healing, the technique, as well as the identification and management of complications 7