Can chemical peels be used for active acne to reduce clogged pores and treat PIH? (photo)

Glad that doxycycline has helped improve your acne, and sorry to hear that you're still struggling with comedonal acne.

Can chemical peels be used for active acne to reduce clogged pores and treat PIH?

Chemical peels can be used for active acne to reduce clogged pores and treat PIH.

Chemical peeling is defined as the application of chemical agents, of variable strength, on the skin that results in the controlled destruction of the epidermis and dermis. The induced exfoliation is followed by dermal and epidermal regeneration from adjacent epithelium and skin adnexa, which results in improved surface texture and appearance of the skin.

Chemical peels target most of the pathophysiological factors involved in acne vulgaris. They:

• break down corneosomes with subsequent exfoliation
• induce keratolysis
• have comedolytic effects
• decrease sebum production and pore size
• have anti-inflammatory and anti-bacterial properties
• promote the penetration and absorption of other topical therapies by reducing the barrier effect of the stratum corneum

Common options include trichloroacetic acid, salicylic acid, glycolic acid and Jessner's Peel. Based on studies, the effect of each chemical peel is approximately equivalent. Some physicians feel that salicylic acid, being lipophilic, may be better at penetrating pores. Personally, I favour trichloroacetic acid as it is easier to control the peel depth.

Chemical peels do help with post-inflammatory hyperpigmentation (PIH) as well, by speeding up the removal of pigmentation through exfoliation. However, I prefer to treat PIH with picosecond or ruby laser which produce a much faster resolution of pigmentation.

Chemical peels start from around $150-200, and I usually recommend 4-6 sessions.

Based on the photograph you have sent, you have inflammatory and comedonal acne as well as significant PIH and dilated pores.

You may wish to consider adding on a topical vitamin A/retinoid such as Differin which would help unblock the pores and prevent further clogging. Fractional lasers or fractional microneedle radiofrequency would also help. Recalcitrant acne may benefit from a course of isotretinoin.

Hope this helps!

Warmest regards,

Dr Wan Chee Kwang

References

1. Castillo et al. Chemical peels in the treatment of acne: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018; 11: 365–372.
2. Chen et al. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open 2018;8:e019607.
3. Hassanain Al-Talib et al. Efficacy and safety of superficial chemical peeling in treatment of active acne vulgaris . An Bras Dermatol. 2017 Mar-Apr; 92(2): 212–216

Depending on the type, strength and depth of the chemical peel, chemical peels can be used for active acne to reduce clogged pores and PIH. Chemical peels result in accelerated exfoliation of the skin induced by the peel acids.

This in turn signals the cells within the skin to regenerate faster, resulting in increased cell turnover, improved skin texture, reduction in pigmentation and prevent pores from being clogged.

For acne-prone and oily skin types, superficial chemical peels like Alpha Hydroxy Acids (AHAs) are useful in increasing cell turnover to achieve a brighter complexion, reducing PIH and clogged pores. Beta Hydroxy Acids like salicylic acid peels are also very useful for oily, congested, acne-prone skin as they tend to penetrate slightly deeper in oily skin due to its lipophilic nature.

Jessner's peel, which combines a few different types of acids and comes in different strengths, is also useful as it combines the strengths and benefits of different acids.

Chemical peels start generally from $150 onwards per session. There are other modalities of treatments that you can consider for treatment of acne and PIH marks, such as topical creams, oral supplements, LED light therapy and lasers.

Thank you for your close-up photo.

Yes, chemical peels can be used for active acne to reduce clogged pores and treat PIH (post-inflammatory hyperpigmentation).

Glycolic acid and salicylic acid peels are the best chemical peels for active acne. They also help to fade PIH.

Chemical peels which are better for PIH are Jessner's peel. This is a chemical peel that combines several types of acids to lighten pigmentation.

Expected cost of each chemical peel: range from $150 upwards.

Minimum number of sessions: 3-5 sessions.

Hope that this helps!