Complications in Chemical Peeling of the Dark-Skinned Patient

Abstract

Introduction: There are fundamental histologic and physiologic differences in the dark-skinned patient compared to the fair-skinned patient. These differences largely determine the variation in response to and the indications for chemical peeling. This study was designed to assess the incidence of complications after superficial and medium-depth peeling in dark-skinned patients. Materials and Methods: All patients treated for postinflammatory hyperpigmentation, acne vulgaris, scarring, and melasma were pretreated nightly with tretinoin 0.05% and hydroquinone 2% to the affected areas. Ten percent glycolic acid and SPF 17 sunblocking lotion was applied daily in all cases and to all anatomic units to be treated. The peel solutions used were 70% glycolic acid for a superficial peel and 70% glycolic acid with 35% trichloroacetic acid for a medium-depth peel. Four hundred patients were evaluated by 2 independent examiners for possible complications. Results: Clinically the combination of glycolic acid and trichloroacetic acid was safe and effective in peeling the dark-skinned patient. In this series of patients, 62% had a very satisfactory response; 25%, satisfactory; and 10%, unsatisfactory. A total of 3% were not reviewed. Complications included patchy hyperpigmentation (21%), prolonged erythema (2%), scarring (0.8%), milia (0.4%), and poor physician/patient rapport (0.4%). Conclusions: If melanocytic activity is modulated before and after peeling, the risk of complications in peeling the dark-skinned patient can be reduced. The risk of complications can also be reduced if the superficial peel is applied to the entire anatomic unit and followed by the medium-depth application in spots and patches only to the areas of severe pathology. The destroyed stratum corneum immediately following peeling allows deeper penetration of hydroquinone with better resolution of hyperpigmentation.