Are topical antibiotics or steroids prescribed after a chemical peel?

Topical Antibiotics and Steroids After Chemical Peel

Routine prophylactic topical antibiotics are not indicated after chemical peels, but antiviral prophylaxis with oral acyclovir is essential for all patients undergoing perioral peels regardless of herpes history; topical steroids are reserved only for managing inflammatory complications if they arise, not for routine post-peel care.

Antiviral Prophylaxis (Not Topical Antibiotics)

The primary antimicrobial concern after chemical peels is herpetic reactivation, not bacterial infection:

• All patients undergoing perioral chemical peels should receive high-dose oral acyclovir prophylaxis, regardless of whether they report a history of oral herpes 1
• Patients with no previous herpes history still developed postoperative herpetic infections in 6.6% of cases without prophylaxis 1
• In patients with a positive herpes history, the infection rate was 50% without prophylaxis versus 8.3% with standard acyclovir, and 0% with high-dose prophylaxis 1
• This represents systemic oral antiviral therapy, not topical antibiotics 1

Topical Antibiotics: Not Routinely Indicated

Topical antibiotics are not part of standard post-peel care protocols:

• Standard post-peel care consists of sunscreens and moisturizers, without mention of routine topical antibiotics 2
• While topical antibiotics reduce surgical site infections in wounds healing by primary intention (RR 0.61), chemical peels create controlled chemical wounds that heal differently than surgical incisions 3
• The evidence for topical antibiotics comes from surgical wound studies, not chemical peel literature 3

Reserve topical antibiotics only for suspected secondary bacterial infection:

• Signs include failure to heal appropriately, yellow crusting, purulent discharge, or painful lesions beyond expected post-peel discomfort 4
• If infection is suspected, obtain bacterial cultures and use systemic antibiotics based on sensitivities for at least 14 days 4

Topical Steroids: Only for Complications

Topical corticosteroids are not part of routine post-peel management but may be used for specific inflammatory complications:

When to Consider Topical Steroids:

• Severe inflammatory dermatitis developing post-peel with erythema and desquamation beyond expected healing 4
• Apply low-to-moderate potency steroids (prednicarbate cream 0.02% or hydrocortisone) to inflamed areas 4, 5
• Use oil-in-water creams or ointments, avoiding alcohol-containing preparations 4, 5

Important Caveats:

• Steroids should not be applied routinely as they can impair wound healing and increase infection risk 4
• If infection is suspected, steroids must be avoided or discontinued until infection is controlled 4
• Short-term use (2-4 weeks maximum) for acute inflammatory flares only 5

Standard Post-Peel Care Protocol

The evidence-based post-peel regimen focuses on barrier protection and healing support:

• Sunscreens (SPF 15 minimum, reapplied every 2 hours when outside) 4
• Moisturizers with urea 5-10% or glycerin, applied liberally and frequently 4, 5
• Avoid hot water, mechanical stress, and chemical irritants 4
• Soap-free cleansers to avoid barrier disruption 5

Clinical Pitfalls to Avoid

• Do not confuse post-peel erythema with infection requiring antibiotics—expected inflammation is part of controlled chemical injury 2
• Do not apply topical steroids prophylactically—they offer no benefit and may delay healing 4
• Do not skip antiviral prophylaxis even in patients denying herpes history—subclinical carriers can reactivate 1
• Do not use topical antibiotics as a substitute for proper patient selection, adequate priming (2-4 weeks with sunscreen, hydroquinone, tretinoin), and appropriate peel depth selection 2, 6