Chemical Peeling

A chemical peel is when your dermatologist applies an acid to your skin, causing the top layer to come off. Often, this procedure is done for cosmetic reasons.1 Chemical peeling can also be done to remove actinic keratoses. Chemical peeling works as well as fluorouracil for treating actinic keratosis and can be done in a single-treatment.2,3

How is chemical peeling performed?

Chemical peels are classified by how deep into the skin they go:1

  • Superficial peel: removes top layer only
  • Medium peel: penetrates the top and middle layer of skin
  • Deep peel: penetrates deep into the middle layer of skin

Preparation and recovery are very different depending on the depth of the peel. To remove actinic keratosis, a medium peel is typically needed.1,4

Medium peel is an office-based procedure. It should be performed by a dermatologist. The acids used for medium peels are trichloroacetic acid, Jessner’s solution, or glycolic acid.1,4 These chemicals may be used alone or in combination.5 You may be given a mild sedative and anti-inflammatory medications to take before the procedure.5 After the skin is thoroughly cleaned and dried, the chemical solution is brushed onto your skin.6 It is left in place for a few minutes and then removed.7 Your skin will be treated with a cool compress and lotion.7 You will be instructed on how to care for your skin during the recovery period.

For what types of lesions is chemical peeling used?

Chemical peeling is an option for treating actinic keratosis. Actinic keratosis is a precancer, which forms when cells in the epidermis begin to grow abnormally. Up to 10% of actinic keratoses become squamous cell carcinoma.8 For this reason, your doctor might recommend treating actinic keratosis.

Chemical peels also are done for cosmetic reasons, including:

  • Reducing lines and wrinkles
  • Even skin color
  • Brighter complexion
  • Smoother skin
  • Removing age spots

Who should not have a chemical peel?

Chemical peels are not for everyone. You may not be a candidate if:6

  • You have a history of abnormal scarring or changes in skin color (pigmentation).
  • You used certain acne treatments within the past year.
  • You have facial warts.

Chemical peels can cause permanent pigment problems. Therefore, people with dark skin tones should see a dermatologist with experience performing chemical peel on darker skin.7

What should I expect before, during, and after the procedure?

If you are considering a chemical peel, you will need to meet with your doctor to decide whether you are a good candidate for this procedure. Ask how the risks and benefits of chemical peel compares with other treatments for actinic keratosis. Discuss the type of peel that you would need to remove the actinic keratoses. Preparation and recovery are very different, depending on the depth of the peel.

Recovery from a medium peel takes 7 to 14 days.7 Your skin will be red and swollen. It may blister. You will need to soak your skin and apply ointment regularly. You must avoid the sun while your skin recovers.7 Chemical peeling may reactivate the herpes simplex virus, causing cold sores to return. If you have a history of cold sores, your doctor may give you an antiviral medication to take before the procedure.7

What are the risks of chemical peeling?

Your skin will be red after the procedure. Redness can last for up to a month after a medium peel.5 Chemical peel can cause changes in skin coloration.7 Your skin may darken or lighten. These changes may be temporary or permanent.6

Scarring is rare when an experienced dermatologist performs the procedure.7 Other possible risks include:5

  • Infection
  • Delayed healing
  • Reactivation of the herpes simplex virus, causing cold sores to return

Your doctor will instruct you on how to care for your skin to avoid scarring or infection.

What questions should I ask before having a chemical peel?

  • Are you a dermatologist? Are you a plastic surgeon?
  • Am I a good candidate for chemical peel?
  • How often do you perform chemical peels? How often do you perform chemical peels on dark skin?
  • What are the benefits of having a chemical peel to treat actinic keratosis?
  • How do the risks of a chemical peel compare with the risks of other treatments for actinic keratosis?
  • How will you do the peel?
  • What will the recovery be like? When can I return to normal activities?
  • How often should I have follow-up skin exams to check for skin cancer?
Written by: Sarah O'Brien | Last reviewed: May 2017.
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