Chemical Peel Protocol for Facial Treatment
For facial chemical peels, use glycolic acid 30-50% for very superficial peels applied for 1-2 minutes, or salicylic acid 20-30% applied for 2-4 minutes, with mandatory screening for isotretinoin use within 6 months and active infections as absolute contraindications. 1, 2
Pre-Treatment Requirements
Mandatory Screening for Absolute Contraindications
- Isotretinoin therapy within the last 6 months - this is an absolute contraindication that must be ruled out 2, 1
- Active infection or open wounds (herpes simplex, excoriations, or open acne cysts) 2
- Lack of psychological stability and mental preparedness or unrealistic expectations 2, 1
- Poor general health and nutritional status 2, 1
Screen for Relative Contraindications
- History of abnormal scar formation or delayed wound healing 2, 1
- History of therapeutic radiation exposure 2, 1
- Active inflammatory dermatoses: rosacea, seborrheic dermatitis, atopic dermatitis, psoriasis, vitiligo, or active retinoid dermatitis 2, 1
- For medium and deep peels: medium-depth or deep resurfacing procedure within the last 3-12 months 2, 1
- For medium and deep peels: recent facial surgery involving extensive undermining 2, 1
Pre-Peel Skin Preparation
- Perform prepeel priming with sunscreens, hydroquinone, and tretinoin for 2-4 weeks before the procedure 3
Peel Selection and Application Protocol
Glycolic Acid Peels (Preferred for Most Patients)
Very Superficial Peels:
- Use 30-50% glycolic acid applied for 1-2 minutes 1
- Neutralize after predetermined duration (usually 3 minutes) with 10-15% sodium bicarbonate solution 3
- Critical endpoint: If erythema or epidermolysis (grayish white appearance or small blisters) occurs, neutralize immediately regardless of duration 3
Superficial Peels:
- Use 50-70% glycolic acid applied for 2-5 minutes 1
- Follow same neutralization protocol as very superficial peels 3
Medium-Depth Peels:
- Use 70% glycolic acid applied for 3-15 minutes 1
- These require greater caution in darker skin types 3
Salicylic Acid Peels (Alternative Option)
For Comedonal Acne:
- Very superficial: 20% salicylic acid 2
- Superficial: 30% salicylic acid 2
- Apply for 2-4 minutes depending on intensity of clinical response 2
- Endpoint: Pseudofrost formation when salicylic acid crystallizes 3
- Apply 1-3 coats to achieve even frost, then wash with water after 3-5 minutes once burning subsides 3
Post-Procedure Care
Immediate Management
- Apply sunscreens and moisturizers 3
- Monitor for expected adverse effects: mild stinging, burning, erythema, and mild to intense exfoliation 2
Serious Complications to Monitor
- Postinflammatory hyperpigmentation - the most common serious complication 2, 1
- Erosive blisters and scarring - requires immediate intervention 2, 1
Treatment Schedule
- Repeat peels weekly, fortnightly, or monthly depending on type and depth 3
- The American Academy of Dermatology recommends applying peels every 15 days for 4-6 months for optimal results 1
- Multiple treatments are needed as results are not long-lasting 2
Critical Safety Considerations
Skin Type Considerations
- Superficial peels are considered safe in Indian patients and darker skin types 3
- Medium-depth peels should be performed with great caution in dark-skinned patients 3
- Deep peels are not recommended for Indian skin or darker skin types 3
Common Pitfalls to Avoid
- Do not confuse clinical peel concentrations (20-70%) with home-use formulations (5-15%), which serve different purposes 1, 4
- Home-use products are designed for daily maintenance, not clinical peeling 1, 4
- Excessive repeated application will not increase therapeutic benefit but could result in increased local intolerance 5