Ethnic Skin Considerations

In Fitzpatrick skin types IV–VI,medium-depth peels can be used for many of the same indications for which superficial peels are employed in this group (Table 4.2). The lesions requiring this form of therapy in white skin, however, may be less prevalent in ethnic skin by virtue of the latter’s response to and extent of sun damage. The medium-depth peeling agents used in patients with darker skin are the same as those used in their white counterparts. The chemical percentage, combinations, and even the vehicle chosen, however, may be different. Roberts describes a technique of using glycolic acid 70% gel in place of solution before applying TCA 25% solution for the treatment of acne scars in darker skin. Although the glycolic acid enhances the effect of the TCA, the gel vehicle limits the harshness of this second product, allowing for more control of the peeling process [22]. This author also emphasized that the TCA should not be allowed to frost completely but, rather, be neutralized with 10% sodium bicarbonate after 2–4 min, depending on the lesion being treated. For areas of postinflammatory hyperpigmentation, Roberts recommended “spot peel,” using TCA 25% salicylic acid or Jessner’s solution on discreet areas in combination with or without full-face peeling. Attempts at treating dermal pigment should be avoided because of the inherent risk of permanent depigmentation and hypertrophic scarring in this class of patients. Stringent control of peel depth is basic to achieving a successful outcome in skin types IV–VI because in this population, the treatment of pigmentary and scarring disorders can lead to results worse than the original problem.