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In a study published in BMJ Open, researchers recently evaluated the currently available evidence on the effectiveness of chemical peels for acne.
Acne is a common skin disorder affecting many adolescents in most ethnic populations and can have a significant impact on an individual’s self-esteem. Acne can be classified as non-inflammatory or inflammatory. It can be treated with systemic therapies (i.e. oral antibiotics), topical therapies, and physical therapies (i.e. laser therapy and chemical peeling).
Chemical peels promote regeneration of new tissue
Chemical peeling is a process that causes injury to the skin thus promoting the regeneration of new skin tissue. Depending on the depth of the skin tissue injury, chemical peels are classified as either superficial, moderate or deep.
Superficial chemical peels are usually used for treating acne as they have antibacterial, anti-inflammatory, and skin peeling effects. They can also decrease the production of oily secretions that can contribute to acne development.
Despite the popularity of chemical peels for acne, the evidence supporting their use is limited. Current recommendations on chemical peels are based on limited past evidence, thus neglecting other potentially important data. Since evidence from newer trials have been published since the latest recommendations, researchers decided to compile and summarize the currently available data on the effectiveness of chemical peels for acne.
Reviewing previous studies on chemical peels
In a study published in BMJ Open, researchers in China performed a systematic review of the currently available data to summarize how effective chemical peels are for treating acne. The researchers searched the literature to find eligible trials that involved the use of chemical peels for acne in any study population. Two authors were involved in the selection, data extraction and bias assessment of the studies. Due to the significant differences found across the included studies, the researchers were unable to perform a meta-analysis of the data.
They included a 12 randomized controlled trials in the systematic review, which included a total of 387 participants. The reviews highlighted 11 different treatment comparisons of chemical peels for acne.
They identified eight different chemical peel treatments for the review:
- Trichloracetic acid (TCA)
- Salicylic acid (SA)
- Jessner’s solution
- Salicylic acid plus mandelic acid (MA)
- Glycolic acid (GA)
- Amino fruit acid (AFA)
- Pyruvic acid (PA)
- Lipohydroxy acid (LHA)
The comparisons were between different chemical peels, between a chemical peel and a physical therapy (such as phototherapy), or a chemical peel versus placebo.
Chemical peels are generally a positive method of acne treatment
They found that chemical peels are generally a positive method of acne treatment. Comparisons of varying combinations of the eight chemical peels identified demonstrated similar efficacy for acne treatment, with the finding that the combination of salicylic acid plus mandelic acid was more effective at peeling than glycolic acid alone.
In the previous studies, the participants tolerated all of the chemical peels well, with the most common side effects being temporary burning or stinging sensations, redness, scaling or dryness. Hyperpigmentation was a rare side effect.
The results of this data analysis and review are limited by the significant differences observed across the twelve included studies, with regards to participant skin types, treatment interventions (such as chemical peel concentrations and treatment durations), and outcome measurements.
The researchers identified that most of the included studies have a low to moderate quality for preventing bias. Further, the limited sample size from the studies means this study’s review is not sufficiently powered to identify all adverse effects, including any potential rare adverse effects. With that said, this is the first systematic review to evaluate chemical peels for acne.
Commonly used chemical peels for acne seem equivalent in treatment
Overall, the researchers conclude that the commonly used chemical peels appear relatively equivalent in treating mild to moderate acne and the choice of a chemical peel for acne treatment should be individualized to the patient. However, they could not draw firm conclusions on the superiority of the chemical peels. Future well-designed studies are needed to obtain higher quality evidence that can guide clinical practice on the optimal formulation and regimen of chemical peels for acne.
Written by Maggie Leung, PharmD
Reference: Chen X, Wang S, Yang M, et al. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open 2018;8:e019607. doi:10.1136/bmjopen-2017-019607