02 February 2016

The appeal of chemical peels: Considerations for skin of color

Procedures can provide effective treatment for hyperpigmentation, other conditions —

Schaumburg, Ill. 


People of color need to be extra careful when caring for their skin. They are prone to hyperpigmentation issues, and such problems may be triggered or exacerbated by treatments for other common skin conditions. In recent years, however, chemical peels have emerged as an effective treatment option for hyperpigmentation and other conditions in patients of color.



Information provided by board-certified dermatologist Seemal R. Desai, MD, FAAD, clinical assistant professor of dermatology, University of Texas Southwestern Medical Center, Dallas.



According to Dr. Desai, the most common dermatologic concerns among people of color are issues involving pigmentation, including darkening, lightening and complete loss of pigment. Although some of these conditions are not necessarily more prevalent in people of color than in the general population, he says, they can be more noticeable in these individuals. For example, vitiligo, which involves the complete loss of pigment, is more visible on darker skin, and melasma, a condition in which gray-brown patches appear on the skin, is more distinct in people of color because their skin contains more of the pigment melanin.


People of color are especially prone to postinflammatory hyperpigmentation (PIH), a condition in which dark spots appear on the skin in response to damage or trauma. While this condition can affect anyone, Dr. Desai says, it’s more pronounced in people of color because their skin contains more melanin.


Sun damage also may lead to hyperpigmentation, Dr. Desai says, and this may be a concern in people of color who mistakenly believe that they don’t need to protect themselves from the sun. “Contrary to what some people think, skin of color is not immune to the sun’s harmful ultraviolet rays,” Dr. Desai says. “Everyone, regardless of their skin color, needs to protect themselves from the sun by seeking shade, wearing protective clothing and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.”



In addition to pigmentation problems, people of color also may experience other skin conditions, including acne, psoriasis and eczema, Dr. Desai says; like pigmentation disorders, these conditions may appear differently in skin of color than in Caucasian skin. Acne, for example, is more likely to be accompanied by PIH in people of color, he says, and psoriasis may appear darker in these patients, making it difficult to differentiate from other disorders.

When people of color visit a dermatologist with pigmentation concerns, their top priority is likely achieving an even skin tone, Dr. Desai says. It’s also important, however, to determine whether another skin condition is causing the pigmentation problem, he says, because the dermatologist will need to treat the former in order to address the latter. Some treatments for common skin conditions may trigger or exacerbate pigmentation issues in people of color, he says, but a board-certified dermatologist who has experience treating these patients can prevent such problems or address them if they occur.



According to Dr. Desai, there’s a long-standing myth that chemical peels are not an appropriate treatment option for people of color, as they could cause burning or PIH in these patients. In reality, however, these complications are unlikely if the peel is applied by a dermatologist who understands how to treat skin of color, he says. “Because of the stigma surrounding chemical peels, they have remained an untapped resource for many years,” he says. “Now that dermatologists recognize how these procedures can be used safely in people of color, we have an additional option to provide these patients with effective treatment.”


Dr. Desai says the benefits of chemical peels may include increased collagen production, as well as reductions in pore size, excess surface oil and visible signs of aging. Most chemical peels, which involve the application of acid to remove dead skin cells, are brief procedures that require very little recovery time, although multiple treatments are usually necessary to achieve the best results. Many chemical peels use a combination of different acids tailored to treat the patient’s condition, he says, and these combination peels may also include antioxidants, which can better penetrate the skin after the acid has exfoliated it.


Chemical peels are an effective treatment for hyperpigmentation because they remove the top layer of damaged skin while also promoting the growth of new, healthy skin, Dr. Desai says. In patients of color, he says, chemical peels are an appropriate option for both pigmentation issues and other common skin conditions:

  • Salicylic acid peels can be used to treat both PIH and acne, so these peels are a good option for patients with acne-induced PIH.
  • Mandelic acid peels can be beneficial for patients with hyperpigmentation and melasma, as the acid is composed of large molecules that penetrate the skin evenly, altering its pigmentation with minimal damage.
  • Trichloroacetic acid (TCA) peels can be used to treat actinic keratoses, areas of skin that have been badly damaged by UV rays, without causing further trauma. Because TCA penetrates the skin more deeply than some other acids, a lower concentration should be used in patients of color. 
  • Toothpick peels are a treatment option for patients with scarring. In this procedure, the dermatologist uses a needle or toothpick to deliver TCA directly into the scar, where the acid breaks up the scar tissue.


Potential complications of a chemical peel may include burning, itching or swelling, and patients of color may experience PIH as the result of a peel that is not tailored to their skin type. Because the outcome of a chemical peel depends largely on the skill of the person applying it, patients should only receive these treatments in a dermatologist’s office, and people of color should see a dermatologist who has expertise in treating darker skin tones. Dr. Desai advises against using at-home chemical peels, even those with low acid concentrations, as they can cause serious problems if applied incorrectly.



In order to get the best results and avoid complications, patients should receive at least a month of pretreatment before getting a chemical peel, Dr. Desai says. This may involve the application of topical medication at home or, in the case of stronger peels like TCA, the administration of light chemical peels in the dermatologist’s office, gradually building up to the stronger formula. Chemical peel patients also should discontinue the use of topical retinols before the procedure, he says, as this may cause a reaction.


Chemical peel patients should take special care to protect themselves from the sun following the procedure, Dr. Desai says. He recommends sunscreens that contain physical blockers, like zinc oxide and titanium dioxide, and he also suggests seeking out formulas that contain niacinamide, a form of vitamin B that can help reduce inflammation and redness. To keep their skin from drying out after a chemical peel, patients also should use moisturizer as directed by their doctor.



“Chemical peels can be an effective treatment for hyperpigmentation and other skin conditions in people of color, but these procedures must be performed correctly in order to avoid complications,” Dr. Desai says. “A board-certified dermatologist can evaluate your skin and provide the treatment that’s best for you.”



Dermatology A to Z: Chemical peels


Jennifer Allyn       Nicole DiVito         Amanda Jacobs      Kara Jilek
(847) 240-1730    (847) 240-1746     (847) 240-1714     (847) 240-1701

Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 18,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or Follow the Academy on Facebook (American Academy of Dermatology), Twitter (@AADskin) or YouTube (AcademyofDermatology).