What is the recommended protocol for a glycolic acid (GA) micropeel treatment?

Glycolic Acid Micropeel Protocol

For optimal results and safety, glycolic acid micropeels should be administered at concentrations of 20-70% by a trained professional every 2-3 weeks for a period of 4-6 months, with treatment times ranging from 1-5 minutes depending on concentration and skin sensitivity. 1

Concentration Guidelines

• Very superficial peel: 30-50% glycolic acid applied for 1-2 minutes
• Superficial peel: 50-70% glycolic acid applied for 2-5 minutes
• Medium depth peel: 70% glycolic acid applied for 3-15 minutes

Treatment Protocol

Pre-Treatment Phase

1. Patient Assessment:

   • Evaluate skin type, condition, and sensitivity
   • Check for contraindications: active infections, open wounds, isotretinoin use within past 6 months, psychological instability 1
   • Note relative contraindications: history of abnormal scarring, radiation exposure, rosacea, seborrheic dermatitis, atopic dermatitis, psoriasis, or vitiligo 1

2. Skin Preparation:

   • Begin home use of lower concentration glycolic acid (10-15%) for 2-4 weeks before professional treatment
   • Consider topical retinoid preparation if appropriate for patient's skin condition

Treatment Phase

1. Cleansing:

   • Thoroughly cleanse skin with a mild cleanser
   • Degrease the skin with alcohol or acetone solution

2. Application:

   • Apply glycolic acid solution evenly using a brush, gauze, or cotton applicator
   • Begin timing immediately upon application
   • Monitor skin reaction closely for signs of erythema, frosting, or discomfort
   • Treatment duration: 1-5 minutes based on concentration and desired depth 2, 3

3. Neutralization:

   • Apply neutralizing solution (typically sodium bicarbonate solution) when appropriate time has elapsed
   • Ensure complete neutralization to prevent continued acid activity 4
   • Rinse thoroughly with cool water

Post-Treatment Phase

1. Immediate Care:

   • Apply soothing, hydrating mask or moisturizer
   • Apply broad-spectrum sunscreen (SPF 30+)

2. Home Care Instructions:

   • Use gentle cleanser for 3-7 days
   • Apply moisturizer regularly
   • Avoid sun exposure and use SPF 30+ daily
   • Avoid exfoliants, retinoids, and other potentially irritating products for 3-7 days
   • Resume home use of lower concentration glycolic acid (10-15%) after 7-10 days

3. Follow-up Treatment Schedule:

   • Schedule next treatment in 2-3 weeks
   • Complete series of 4-8 treatments for optimal results 1, 5

Important Considerations

• pH Matters: Solutions with pH below 2 demonstrate greater potential for tissue damage and necrosis than partially neutralized solutions with pH above 2 4

• Adverse Effects: Monitor for post-inflammatory hyperpigmentation, erosive blisters, increased sun sensitivity, stinging, discomfort, and erythema 1

• Combination Therapy: Glycolic acid peels can be effectively combined with other treatments:

  • For acne: Combine with topical retinoids and benzoyl peroxide 1
  • For pigmentation issues: Consider combination with hydroquinone for melasma 5

• Treatment Progression: Start with lower concentrations (30-50%) and shorter application times (1-2 minutes), gradually increasing both as tolerated in subsequent sessions

• Skin Type Considerations: While generally safe for Fitzpatrick skin types I-IV, darker skin types require more cautious approach with lower concentrations to minimize risk of post-inflammatory hyperpigmentation 6

By following this structured protocol, glycolic acid micropeels can effectively address various skin concerns including fine lines, photoaging, acne, and pigmentation issues with minimal downtime and risk of complications.