Adverse Effects

Superficial peels are generally well tolerated. The majority of patients will experience mild stinging and burning during the application of the wounding agent, which is an expected sensation and is not considered a procedural complication. Although the adverse reactions associated with superficial peels are much less than with the deeper peels, the risks are not negligible.

Pigmentary changes in the form of both hypopigmentation and hyperpigmentation are possible complications. The risk of hyperpigmentation is greater in patients with darker skin types. Typically, hypopigmentation resolves with in several months after the peel.Hyperpigmentation can be treated effectively with hydroquinone regimens.

Prolonged erythema, milia, pustulocystic acne, reactivation of latent herpes simplex infection, and superficial bacterial infection are all potential complications postpeel [20]. The incidence with superficial peels is significantly less than with deeper peels although not negligible. Patients with a history of herpes should be treated prophylactically with acyclovir, valacyclovir, or famciclovir beginning on the day of the peel and complete a course of 10–14 days at therapeutic doses. Prolonged erythema may be treated with a low-dose topical steroid such as hydrocortisone or with desonide 0.05% lotion twice daily for 2–3 days. Milia or acne that occurs after the peel may be aggravated by thick ointments applied to the treated area. An irritant reaction due to pooling of the acid in the skin creases (e.g., oral commissures, lateral and medial canthi) are best avoided by applying petrolatum ointment prior to beginning the procedure.

The risk of hypertrophic scarring is less than 1% with superficial peels [7]. The rate of scaring may be increased with a history of recent isotretinoin use or poor patient selection. If hypertrophic scaring does occur, treatments include dilute triamcinolone injections into the scar, topical or tape-impregnated glucocorticoids, silicone gel sheeting, or the 585-nm flashlamp- pumped pulse dye laser [21].