Chemical peels are a popular and effective way to improve the appearance of your skin. Chemical peels are an effective way to improve the appearance of your skin, but they can leave your face feeling raw and sensitive for several days after treatment.
There are three types of chemical peels: superficial, medium and deep. A superficial peel removes only the top layer of dead skin cells and can be used safely up to once per week. A medium peel removes several layers of skin and is more likely to cause irritation than a superficial peel. A deep peel removes many layers of skin and is highly effective at treating wrinkles and acne scars, but it also causes more pain and may leave scars behind if care isn’t taken when healing from the procedure.
Read on to learn more about What To Know About Chemical Peel UK, How Much Do Chemical Peels Cost?
What To Know About Chemical Peel UK
What is a chemical peel, and why would you want one?
So, the word “chemical” instantly puts me off. I had never considered having a chemical peel before, and honestly didn’t really know what they were, or why you would want one. If you’ve found this article, maybe you’re considering a chemical peel and would like to know more, or maybe you’re just curious and like me up until recently, have no idea what a chemical peel actually is.
Simply put, chemical peels use acid (broad explanation as there are different types) to break down the top layer or layers of skin. This is to minimise the appearance of fine lines, wrinkles and uneven skin tone. Chemical peels can also be used to improve the appearance of fine scars, treat certain types of acne, and reduce age spots, freckles and dark patches.
Although they may sound scary to some, chemical peels have actually been around for a very long time.
A short history of the chemical peel
Upon doing a little bit of research, my first surprise was that chemical peels have actually been around for quite a while. As far back as records indicate, the first real mention of the chemical peel was by the ancient Egyptians. Ancient Egyptians used animal oils, salt, alabaster and sour milk to improve the texture of their skin. The sour milk contains lactic acid, which is known for skin rejuvenation and still used today.
Fast forward in time to Roman times. Roman people used fruit such as grapes to exfoliate their skin. The active ingredient in grapes is tartaric acid, and we use it today in many chemical peels. They also saw the benefits in using sulfur, mustard and limestone, and used these minerals to fade freckles and even their skin tone.
Moving through time, dermatologists around the world in the 1800’s used chemical peeling techniques to improve pigmentation conditions such as melasma, freckles and Addison’s disease and used chemicals such as salicylic acid, resorcinol, trichloroacetic acid (TCA) and phenol on the skin.
Skip ahead a bit to 1917 and during WWI, references to phenol under bandages for healing and “beautifying” the skin and to treat scarring. These types of peels are known today as a “deep” peel.
Chemical peels really started to gain popularity in the 1960s, and in the 70s and 80s, scientific work continued with the use of hydroxy acids (AHAs) to provide a more superficial treatment.
Back to the present day; what are the different types of chemical peel?
So, nowadays, after years of research, we have learned a number of best practices and can provide chemical peels to tackle a number of skin concerns. Chemical peels can be done at different depths depending on your desired results; light, medium and deep. Different types and depths of peel contain different chemical solutions.
Let me break this down into what you need to know when considering a type of chemical peel. It’s important first of all to choose which type you want to go for. Depending on the issues you’re addressing with the treatment, you’ll choose a chemical peel in one of three depths:
Light Chemical Peel
A light or superficial chemical peel removes the outer layer of your skin. This layer is called the epidermis. This peel is perfect for treating fine wrinkles, acne, uneven skin tone and dryness. You can have a light chemical peel as often as every two to five weeks depending on what you want to achieve.
Medium Chemical Peel
This type of chemical peel removes dead skin cells from the epidermis and from sections of the upper part of the middle layer of your skin. This layer is called the dermis. A medium depth chemical peel can also treat wrinkles, acne scars and uneven skin tone. You might repeat one of these after three to nine months to maintain your results.
Deep Chemical Peel
A deep chemical peel removes dead skin cells from the epidermis, and from the mid to lower layer of your dermis. If you have deep wrinkles, scars or precancerous growths, a deep chemical peel could be the right course of action for you. You can only have a deep chemical peel once. This is because they affect the deeper layers of the skin, and the results are more permanent.
I’ve made it visual for you too, using cake. Why? Because cake is awesome and it also has layers.
Should I go for a chemical peel, or avoid one?
Generally, fair-skinned, light-haired people are better candidates for chemical peels. However, if you do not fall into this category, a chemical peel may still be the perfect solution for you. This will depend on the type of problem being treated. This is why it’s always best to have a consultation with an expert first, as they will be able to advise you as to if it’s the right treatment for you. If not, they can advise an alternative that will tackle the problems you are looking to address.
Are there any reasons why I might not be able to have a chemical peel?
There are a few reasons why going for a chemical peel might not be the perfect solution to your skin concerns. It is best not to go for a chemical peel if you have any of the following:
Active herpes simplex or warts in the area to be treated
A chemical peel could cause herpetic activation, so it’s best to avoid if you have either herpes simplex or warts.
Wounded or sunburned skin in the area to be treated
As the old and dead skin will be lifted from your face during a chemical peel, if the skin is already damaged, you run the risk of facial scarring or burns. It is not recommended to have a chemical peel just before or just after excessive sun exposure. So if a chemical peel is something you are looking to try, avoid booking around the time you go on your holidays.
Currently pregnant or breastfeeding
Pregnant or breastfeeding women should avoid a chemical peel. Salicylic acid is a chemical used in some chemical peels and it can be harmful during pregnancy. As there is a change salicylic acid may soak into your skin, it’s best to avoid this treatment until you have had your baby and are no longer breastfeeding.
History of radiation therapy in the area to be treated
Similarly, with wounded or sunburned skin, your skin could be compromised or damaged if treated with radiation so it is best to avoid a chemical peel in this circumstance.
A history of autoimmune diseases or those with weakened immune systems
As a chemical peel is revealing lower layers of your skin and inducing healing, people with weakened immune systems and diseases such as lupus or rheumatoid arthritis should avoid a chemical peel. This is because there is a risk of infection, although small, may be more of a risk if you have an autoimmune disorder or disease. It also avoids any unnecessary risk of infection, as an alternative treatment may be available to you for your skin concerns.
Vitiligo
If you have vitiligo, any type of skin trauma may initiate the spread of your condition. For this reason, it is worth consulting with your skincare expert to find out if you can have a chemical peel, or if a safer alternative may be available to treat your skin concern.
Choosing a clinic and chemical peel
Professional chemical peels are applied by trained skin therapists or medical practitioners. A responsible clinic or Medispa will advise you to have a consultation before your treatment and will advise you on whether they think the treatment is suitable for your skin.
You can ask the therapist about:
- Their experience and qualifications
- Any risks or side effects
- The type of chemical peel they would recommend for you, and why
- What aftercare and recommendations they provide
- What will happen if anything goes wrong
- Their insurance cover, if any
- If the clinic or Medispa is regulated by Healthcare Improvement Scotland. Find out more about Healthcare Improvement Scotland here
Are there any risks to having a chemical peel?
All in all, chemical peels are safe if they are done by an experienced and qualified skin therapist who has had the correct training.
However, as with all professional, clinical treatments, there are possible risks you need to be aware of.
These include;
- Darkening or lightening of the skin
- Cold sores returning if you have had them before
- Scarring or an infection – although this is extremely rare
Your skin will be more sensitive to the sun as it heals, so your skin therapist will recommend you use sunscreen for at least a month after the treatment. Find out more about the different types of sunscreen here
An experienced skin therapist will give you the appropriate advice on how to reduce the risks of side effects as much as possible and will provide you with an aftercare treatment plan with advice on at-home skincare products.
Will there be downtime?
This can depend on you and you face, and how your skin reacts to the treatment. It can also depend on whether you have chosen a superficial, medium peel or deep peel. With a superficial peel, your skin may feel tight for a short while after the treatment, and you may peel a little. This is because not every chemical peel causes your face to visually shed skin. With a medium depth peel, your skin may go red for a few days afterwards, and you will most likely have more visible peeling of the skin. It can take up to 6 weeks for your skin to return to normal, although usually, this is much faster. With a deep peel, the downtime could be much longer, but as mentioned above, this peel is usually only recommended for people with deep wrinkles, scars or precancerous growths.
How Much Do Chemical Peels Cost?
In the UK, chemical peels can cost anything from £60 to £500 for mild to medium peels. Deeper peels could cost more than £500. In Perthshire, prices also start from around £60 for a quality superficial chemical peel, although many clinics and beauty spas tend not to share their prices on their websites without locking their clients in for a consultation first. Many Perthshire clinics offer a consultation for £30, which is then redeemable against your chemical peel when you book.
It is also important to be aware that a professional chemical peel provider will map a skincare plan with you, to ensure you are having the right treatment and that you follow the appropriate aftercare. This may involve purchasing prep or aftercare products. You should ask your clinic to provide you with details of this if they do not clearly advise you from the beginning, as this could be an additional expenditure to you.
Prices at Tay MediSpa for a chemical peel
We offer clinically-proven, professional chemical peel treatments for our clients, with prices starting from £70. We use high-quality brands including Zo Skin Health [LINK] and iS Clinical [LINK] with both superficial and medium depth peels. Read more about our chemical peels by following the links below:
Zo Skin Health Stimulator Peel £70
Zo Skin Health Stimulator Peel with Deesse Pro LED Mask Treatment £95 (save £15)
iS Clinical’s Prodigy Peel P2 £245
iS Clinical’s Prodigy Peel P3 Pro £295
Book a complimentary consultation with us now to find out more, with no obligation to purchase or book a treatment
For a GP consultation to look into a deep peel, and any other more pressing skin conditions, you can make an appointment with Dr Julia here or with your local NHS GP to find out what options are available to you.
Finally…
After all this research and looking into the history of the chemical peel, my opinion quickly changed. If it’s good enough for Cleopatra, ruler and Queen of Ancient Egypt, then surely it’s good enough for me. The “chemicals” in a chemical peel often derive from natural sources, which instantly put me at ease. Over the last 5,000 years, we have the experts that have managed to make chemical peels the safest and most effective they can be. So I thought I would give one a go and let you know how it goes.
Chemical peel or laser for rosacea
If you’ve got rosacea, then you likely know that one of the last things you should do when it comes to skin care is overexfoliate. Since rosacea is a chronic inflammatory condition that results in a compromised skin barrier, it makes sense to want to avoid exfoliation all together – especially chemical peels – at all costs.
However, chemical peels in a clinic can be perfectly safe for those with rosacea (of course, depending on your specific condition, as everyone’s manifests differently). In fact, a gentler peel can have really great benefits for managing the condition along with other treatments – but only in a professional setting with someone who understands the complexities of rosacea.
We spoke with Spirithoula Koukoufikis, Skinfluencer skin clinic’s senior medical aesthetician to find out exactly how you can get the benefits of a chemical peel for rosacea without causing any adverse effects on your condition.
What Exactly Is Rosacea?
Rosacea is a chronic inflammatory skin condition, affecting one in 10 people in the UK, that presents in a number of ways. There are various “types” of rosacea, including erythematotelangiectatic rosacea (redness), papulopustular rosacea (acne rosacea), phymatous rosacea (thickening of the skin), and ocular rosacea (symptoms of the eyes). Each of the rosacea types can come in varying degrees of severity, and people can experience more than one. Symptoms can include facial redness and flushing, pimples and bumps, visible blood vessels, sensitivity, sore eyelids, and a burning or stinging feeling.
What Is a Chemical Peel?
A professional chemical peel is a treatment done at a clinic (not at home) in which a practitioner will apply a solution made up of different types of acids in various pH levels to your face. Peels come in three depths – superficial, medium, and deep – each with varying outcomes and aftercare instruction. The aim of a chemical peel is to deeply exfoliate the skin and improve the overall skin texture, tone, and appearance, depending on your goals. It’s important to visit a trained professional who can take into account your skin type and skin tone to find a treatment plan best suited to your individual needs.
What Professional Peels Work Well For Someone With Rosacea?
When it comes to chemical peels for rosacea, Koukoufikis explains that it’s not so much “which acid but more a case of the pH of the acid peel chosen”. For a condition like rosacea, only a superficial peel “that does not have an excessively low pH” should be used, as “you only want to remove the surface of the dead skin, before proceeding with laser treatments to manage and improve the appearance of the condition.”
Benefits of Chemical Peels For Rosacea
When it comes to rosacea, chemical peels can help manage redness and breakouts, and reduce inflammation. However, Koukoufikis says they should be used as part of a bigger-picture treatment plan. “I really believe they should only be used to prep the skin before you tackle the rosacea with laser-based treatments.”
How Often Can Someone With Rosacea Get Chemical Peels?
Koukoufikis says you should only have a peel every four to eight weeks, but for a laser treatment, she recommends every four to six weeks because “the vascular network is so dense and needs to be targeted in a specific way.” Once this course has been completed, you’ll likely only need maintenance treatments once or twice a year.
What to Avoid When It Comes to Chemical Peels and Rosacea
Avoid over-resurfacing the skin. “Remember, in the case of rosacea, the skin’s surface is already compromised,” Koukoufikis says. “By using acid peels too often, the skin is unable to heal and repair. In fact, it is highly likely that you will just create more inflammation and enhance the skin’s sensitivity, which will lead to itching. The skin won’t be able to heal fast enough, and this could lead to other skin conditions such as hyperpigmentation and acne, to name but two.”
What Other Treatments Can Be Used With Chemical Peels For Rosacea?
As Koukoufikis mentioned, she believes the best treatments for rosacea are peels combined with lasers. “Laser treatments that are specifically designed to target vascularity are great for rosacea. Over the years, rosacea will bring more vascularity to the surface of the skin, resulting in the appearance of thread veins or an overall blush/redness, depending on what’s happening beneath the skin,” she says. “You can never take away rosacea, you can only treat it so the appearance of it is improved. The gold-standard treatment protocol for rosacea is laser, and with its advanced technology, Cutera’s Excel V+ is the current industry leader. Excel V+ has been designed to target the excess haemoglobin that manifests as red veins or blushing.”
For that reason, Koukoufikis always recommends a course of laser treatments to “chip away at that dense vascular network, which will improve the overall tone and texture of the skin.” Of course, all of this needs to be in addition to proper skin care at home, curated with you and for you by a skin specialist.
“Rosacea is a complicated skin condition, and really you need a professional to assess and analyse the skin, determine the severity of the rosacea, and prescribe a programme that includes treatments and products to ensure you get the best possible outcome,” Koukoufikis adds.
Final Thoughts on Chemical Peels and Rosacea
In-clinic acid peels can have a wonderful outcome on those with rosacea but are typically best when used in conjunction with other treatments. “They should only be used to prep the skin before you tackle the rosacea with laser-based treatments,” Koukoufikis says.
Glycolic peel rosacea
Each year, we have more choices in our arsenal for effectively treating acne and rosacea patients. This past year was no exception. At the Cleveland Clinic, we’ve had much success with a number of treatments for treating patients who have acne and rosacea. Therapeutic Approaches for Acne Many patients with recalcitrant acne are already on comprehensive treatment regimens. To enhance the effectiveness of their acne medications, we’re increasingly turning to glycolic or salicylic acid peels. We can use a regimen of superficial peels to hasten the response of acne to treatment by reducing follicular corneacyte adhesion and promoting epidermolysis. At higher concentrations, glycolic acid can unroof pustules and penetrate the follicular epithelium to the level of the sebaceous glands. Also, glycolic acid products enhance penetration of topical medications by thinning the stratum corneum. We typically perform the glycolic peels for acne patients every 2 to 4 weeks. These in-office peels take only about 3 to 5 minutes to complete. Because patients usually experience some mild stinging, we give them a hand-held fan to help increase their comfort level. With glycolic acid peels, the patient washes with a glycolic acid cleanser. Then the facial skin is wiped with acetone, followed by application of the glycolic acid solution. The acid is neutralized with tap water after 3 to 5 minutes. For a few hours, the peeled skin is pink. The patient’s skin peels slowly and subtly for the next 3 to 5 days. We’ll do a series of four to eight peels over several weeks. Adding superficial peels to a regimen of an oral antibiotic and topical retinoid/topical antibiotic often prevents the need for isotretinoin in recalcitrant cases. Salicylic acid has been used as a keratolytic in dermatology for many years, and has been employed in topical preparations and soaps to treat acne. More recently, pure salicylic acid peels have been used in a series to treat acne patients, with the advantage of enhanced penetration into oil-clogged pores. Treating Acne Scarring Acne scars have a variety of morphologies, so scar revision must be individualized. Options include scar excision, punch grafting, punch elevation, soft tissue augmentation, subcision, dermabrasion, chemical peels, microdermabrasion, nonablative lasers and laserabrasion with carbon dioxide or erbium lasers. The best candidates for medium to deep resurfacing procedures are lighter skinned patients. Many patients require a staged, multimodality approach to acne scar revision for optimal results. The carbon dioxide laser can ablate thin layers of skin as well as cause contraction of collagen fibers, which can promote enhanced overall acne scar improvement. The erbium laser ablates thinner layers of skin and generates less heat, thereby causing less collagen tightening, faster healing, and less pronounced and less long-lasting erythema compared to the carbon dioxide laser. Most recently, nonablative lasers have been employed in a series of treatments to improve the contour of acne scars, and have the advantage of minimal to no down time and the ability to safely treat darker skin types. Therapies for Rosacea Treating rosacea includes avoiding known exacerbating dietary, environmental and emotional factors that may cause flare-ups. Sun protection measures such as broad spectrum sunscreens or sunblocks, protective clothing and hats, and sun avoidance are essential. Medical therapy includes oral and topical antibiotics. We may also use glycolic acid peels to hasten control of rosacea. Peels are performed every 2 to 4 weeks and may be used in combination with low concentration glycolic acid washes and creams. In general, we’ll use lower concentrations of the peeling agent (20% to 40%) to prevent excessive irritation. Topical rosacea treatments are resumed in 3 to 4 days. In addition to controlling the papules and pustules, patients often note overall improvement in prominent pores and skin texture. The telangiectasias associated with rosacea don’t respond to topical and oral therapy. Facial erythema may be camouflaged with green-based make-ups and moisturizers. Also, patients should choose cosmetics that are fragrance-free, alcohol-free, water-based, and nonabrasive. Vascular lasers and intense pulsed light sources may be used to ablate the ectatic vessels, reducing overall facial redness. The treatments take 15 to 30 minutes and are performed at 6- to 12-week intervals. Patients may initially require two to four treatments, and may return on a yearly basis as needed for treatment of new blood vessels. The newer vascular lasers don’t produce purpura, but rather cause redness and minimal swelling which lasts about 24 hours. Sun protection is essential after laser treatments. Risks of vascular laser treatments include dyspigmentation and scarring (<1%). Patients must be continued to minimize the risk of flare-ups and new telangiectasia formation. Rhinophyma typically occurs in men older than 40 and involves hypertrophy of the nasal skin. In advanced cases, collapse of the nares may occur, causing obstruction of breathing. Treatment is mainly surgical and includes CO2 laser vaporization and or excision, erbium laser vaporization, dermabrasion or electrosurgery to sculpt the nose to a more normal shape. These are outpatient procedures performed under local anesthesia. Healing usually takes 7 to 10 days. Making Progress Treatment options for acne and rosacea continue to expand. Careful use of superficial peels can enhance treatment of acne and rosacea patients. Also, the ever-changing field of cutaneous lasers continues to offer improved care, and acne scar patients can benefit from both ablative and nonablative laser technology. Vascular lasers and intense pulsed light have proven to be significant tools in the treatment of the sometimes symptomatic and cosmetically disfiguring telangiectasias of rosacea. The significant psychological benefit derived from improved acne and rosacea control, fewer scars, and less-prominent facial vessels will continue to encourage advances in both medical and surgical arenas. n Dr. Vidimos is a staff member with the Dept. of Dermatology, Section of Dermatologic Surgery and Oncology at the Cleveland Clinic Foundation.
Each year, we have more choices in our arsenal for effectively treating acne and rosacea patients. This past year was no exception. At the Cleveland Clinic, we’ve had much success with a number of treatments for treating patients who have acne and rosacea. Therapeutic Approaches for Acne Many patients with recalcitrant acne are already on comprehensive treatment regimens. To enhance the effectiveness of their acne medications, we’re increasingly turning to glycolic or salicylic acid peels. We can use a regimen of superficial peels to hasten the response of acne to treatment by reducing follicular corneacyte adhesion and promoting epidermolysis. At higher concentrations, glycolic acid can unroof pustules and penetrate the follicular epithelium to the level of the sebaceous glands. Also, glycolic acid products enhance penetration of topical medications by thinning the stratum corneum. We typically perform the glycolic peels for acne patients every 2 to 4 weeks. These in-office peels take only about 3 to 5 minutes to complete. Because patients usually experience some mild stinging, we give them a hand-held fan to help increase their comfort level. With glycolic acid peels, the patient washes with a glycolic acid cleanser. Then the facial skin is wiped with acetone, followed by application of the glycolic acid solution. The acid is neutralized with tap water after 3 to 5 minutes. For a few hours, the peeled skin is pink. The patient’s skin peels slowly and subtly for the next 3 to 5 days. We’ll do a series of four to eight peels over several weeks. Adding superficial peels to a regimen of an oral antibiotic and topical retinoid/topical antibiotic often prevents the need for isotretinoin in recalcitrant cases. Salicylic acid has been used as a keratolytic in dermatology for many years, and has been employed in topical preparations and soaps to treat acne. More recently, pure salicylic acid peels have been used in a series to treat acne patients, with the advantage of enhanced penetration into oil-clogged pores. Treating Acne Scarring Acne scars have a variety of morphologies, so scar revision must be individualized. Options include scar excision, punch grafting, punch elevation, soft tissue augmentation, subcision, dermabrasion, chemical peels, microdermabrasion, nonablative lasers and laserabrasion with carbon dioxide or erbium lasers. The best candidates for medium to deep resurfacing procedures are lighter skinned patients. Many patients require a staged, multimodality approach to acne scar revision for optimal results. The carbon dioxide laser can ablate thin layers of skin as well as cause contraction of collagen fibers, which can promote enhanced overall acne scar improvement. The erbium laser ablates thinner layers of skin and generates less heat, thereby causing less collagen tightening, faster healing, and less pronounced and less long-lasting erythema compared to the carbon dioxide laser. Most recently, nonablative lasers have been employed in a series of treatments to improve the contour of acne scars, and have the advantage of minimal to no down time and the ability to safely treat darker skin types. Therapies for Rosacea Treating rosacea includes avoiding known exacerbating dietary, environmental and emotional factors that may cause flare-ups. Sun protection measures such as broad spectrum sunscreens or sunblocks, protective clothing and hats, and sun avoidance are essential. Medical therapy includes oral and topical antibiotics. We may also use glycolic acid peels to hasten control of rosacea. Peels are performed every 2 to 4 weeks and may be used in combination with low concentration glycolic acid washes and creams. In general, we’ll use lower concentrations of the peeling agent (20% to 40%) to prevent excessive irritation. Topical rosacea treatments are resumed in 3 to 4 days. In addition to controlling the papules and pustules, patients often note overall improvement in prominent pores and skin texture. The telangiectasias associated with rosacea don’t respond to topical and oral therapy. Facial erythema may be camouflaged with green-based make-ups and moisturizers. Also, patients should choose cosmetics that are fragrance-free, alcohol-free, water-based, and nonabrasive. Vascular lasers and intense pulsed light sources may be used to ablate the ectatic vessels, reducing overall facial redness. The treatments take 15 to 30 minutes and are performed at 6- to 12-week intervals. Patients may initially require two to four treatments, and may return on a yearly basis as needed for treatment of new blood vessels. The newer vascular lasers don’t produce purpura, but rather cause redness and minimal swelling which lasts about 24 hours. Sun protection is essential after laser treatments. Risks of vascular laser treatments include dyspigmentation and scarring (<1%). Patients must be continued to minimize the risk of flare-ups and new telangiectasia formation. Rhinophyma typically occurs in men older than 40 and involves hypertrophy of the nasal skin. In advanced cases, collapse of the nares may occur, causing obstruction of breathing. Treatment is mainly surgical and includes CO2 laser vaporization and or excision, erbium laser vaporization, dermabrasion or electrosurgery to sculpt the nose to a more normal shape. These are outpatient procedures performed under local anesthesia. Healing usually takes 7 to 10 days. Making Progress Treatment options for acne and rosacea continue to expand. Careful use of superficial peels can enhance treatment of acne and rosacea patients. Also, the ever-changing field of cutaneous lasers continues to offer improved care, and acne scar patients can benefit from both ablative and nonablative laser technology. Vascular lasers and intense pulsed light have proven to be significant tools in the treatment of the sometimes symptomatic and cosmetically disfiguring telangiectasias of rosacea. The significant psychological benefit derived from improved acne and rosacea control, fewer scars, and less-prominent facial vessels will continue to encourage advances in both medical and surgical arenas. n Dr. Vidimos is a staff member with the Dept. of Dermatology, Section of Dermatologic Surgery and Oncology at the Cleveland Clinic Foundation.
Each year, we have more choices in our arsenal for effectively treating acne and rosacea patients. This past year was no exception. At the Cleveland Clinic, we’ve had much success with a number of treatments for treating patients who have acne and rosacea. Therapeutic Approaches for Acne Many patients with recalcitrant acne are already on comprehensive treatment regimens. To enhance the effectiveness of their acne medications, we’re increasingly turning to glycolic or salicylic acid peels. We can use a regimen of superficial peels to hasten the response of acne to treatment by reducing follicular corneacyte adhesion and promoting epidermolysis. At higher concentrations, glycolic acid can unroof pustules and penetrate the follicular epithelium to the level of the sebaceous glands. Also, glycolic acid products enhance penetration of topical medications by thinning the stratum corneum. We typically perform the glycolic peels for acne patients every 2 to 4 weeks. These in-office peels take only about 3 to 5 minutes to complete. Because patients usually experience some mild stinging, we give them a hand-held fan to help increase their comfort level. With glycolic acid peels, the patient washes with a glycolic acid cleanser. Then the facial skin is wiped with acetone, followed by application of the glycolic acid solution. The acid is neutralized with tap water after 3 to 5 minutes. For a few hours, the peeled skin is pink. The patient’s skin peels slowly and subtly for the next 3 to 5 days. We’ll do a series of four to eight peels over several weeks. Adding superficial peels to a regimen of an oral antibiotic and topical retinoid/topical antibiotic often prevents the need for isotretinoin in recalcitrant cases. Salicylic acid has been used as a keratolytic in dermatology for many years, and has been employed in topical preparations and soaps to treat acne. More recently, pure salicylic acid peels have been used in a series to treat acne patients, with the advantage of enhanced penetration into oil-clogged pores. Treating Acne Scarring Acne scars have a variety of morphologies, so scar revision must be individualized. Options include scar excision, punch grafting, punch elevation, soft tissue augmentation, subcision, dermabrasion, chemical peels, microdermabrasion, nonablative lasers and laserabrasion with carbon dioxide or erbium lasers. The best candidates for medium to deep resurfacing procedures are lighter skinned patients. Many patients require a staged, multimodality approach to acne scar revision for optimal results. The carbon dioxide laser can ablate thin layers of skin as well as cause contraction of collagen fibers, which can promote enhanced overall acne scar improvement. The erbium laser ablates thinner layers of skin and generates less heat, thereby causing less collagen tightening, faster healing, and less pronounced and less long-lasting erythema compared to the carbon dioxide laser. Most recently, nonablative lasers have been employed in a series of treatments to improve the contour of acne scars, and have the advantage of minimal to no down time and the ability to safely treat darker skin types. Therapies for Rosacea Treating rosacea includes avoiding known exacerbating dietary, environmental and emotional factors that may cause flare-ups. Sun protection measures such as broad spectrum sunscreens or sunblocks, protective clothing and hats, and sun avoidance are essential. Medical therapy includes oral and topical antibiotics. We may also use glycolic acid peels to hasten control of rosacea. Peels are performed every 2 to 4 weeks and may be used in combination with low concentration glycolic acid washes and creams. In general, we’ll use lower concentrations of the peeling agent (20% to 40%) to prevent excessive irritation. Topical rosacea treatments are resumed in 3 to 4 days. In addition to controlling the papules and pustules, patients often note overall improvement in prominent pores and skin texture. The telangiectasias associated with rosacea don’t respond to topical and oral therapy. Facial erythema may be camouflaged with green-based make-ups and moisturizers. Also, patients should choose cosmetics that are fragrance-free, alcohol-free, water-based, and nonabrasive. Vascular lasers and intense pulsed light sources may be used to ablate the ectatic vessels, reducing overall facial redness. The treatments take 15 to 30 minutes and are performed at 6- to 12-week intervals. Patients may initially require two to four treatments, and may return on a yearly basis as needed for treatment of new blood vessels. The newer vascular lasers don’t produce purpura, but rather cause redness and minimal swelling which lasts about 24 hours. Sun protection is essential after laser treatments. Risks of vascular laser treatments include dyspigmentation and scarring (<1%). Patients must be continued to minimize the risk of flare-ups and new telangiectasia formation. Rhinophyma typically occurs in men older than 40 and involves hypertrophy of the nasal skin. In advanced cases, collapse of the nares may occur, causing obstruction of breathing. Treatment is mainly surgical and includes CO2 laser vaporization and or excision, erbium laser vaporization, dermabrasion or electrosurgery to sculpt the nose to a more normal shape. These are outpatient procedures performed under local anesthesia. Healing usually takes 7 to 10 days. Making Progress Treatment options for acne and rosacea continue to expand. Careful use of superficial peels can enhance treatment of acne and rosacea patients. Also, the ever-changing field of cutaneous lasers continues to offer improved care, and acne scar patients can benefit from both ablative and nonablative laser technology. Vascular lasers and intense pulsed light have proven to be significant tools in the treatment of the sometimes symptomatic and cosmetically disfiguring telangiectasias of rosacea. The significant psychological benefit derived from improved acne and rosacea control, fewer scars, and less-prominent facial vessels will continue to encourage advances in both medical and surgical arenas.