Chemical peels for hyperpigmentation, melasma and dark spots, are they worth it?

Table of Content:
What is a chemical peel? | Are they used for hyperpigmentation? | Best chemical peels for hyperpigmentation? | Price of chemical peels in the US | Topical medication as an alternative to chemical peels | Get a prescription for topical medicine | FAQ about chemical peels

So, what is a chemical peel?

A chemical peel (also known as chemical exfoliation) is a type of ablative resurfacing method that can penetrate a particular depth of skin depending upon the type of chemical used and its concentration. As a result, depending on the depth of penetration, one can see various benefits regarding improved texture, pigmentation, and overall a more youthful appearance.

Are chemical peels used for dark spots (hyperpigmentation)? 

Yes, chemical peels can be used to treat dark spots, particularly those caused by sun damage (such as lentigines) and other hyperpigmentary disorders such as melasma¹.

The treatment of melasma and hyperpigmentation can be quite challenging due to the presence of melanin at varying depths in the epidermis and dermis. However, since chemical peels remove melanin and improve skin tone and texture, they are commonly used in treating this condition. Patients with darker skin types (Fitzpatrick III and above) who are seeking chemical peels for melasma, and are considering a deep peel should be careful because this increases the risk of unwanted side effects such as paradoxical hyperpigmentation (skin darkens more instead of becoming lighter) or even scarring.

The best treatment for melasma tends to be a combination of methods are used such as sun protection with tinted sunscreens, topical agents such as hydroquinone or tranexamic acid, and an experienced dermatologist provider to curate an individualized plan regarding chemical peels or laser therapy.

Best chemical peels for hyperpigmentation

Glycolic acid peels

Glycolic acid peels are the most common type of alpha hydroxy acid peels. They are typically used in strengths of 30-70% and are one of the few peels that require neutralization with a basic solution such as sodium bicarbonate. These are excellent peels when one’s desired target in the skin is rather superficial and can even reach medium depth when used in combination with other peeling agents., ultimately leading to improved skin texture and appearance. These peels are commonly used in skincare routines and dermatological treatments to address various skin concerns and at the appropriate depth, can achieve collagen stimulation. Superficial exfoliation typically occurs within 7 to 10 days².

TCA peels

Trichloroacetic acid peels (TCA peels) are a great option for medium-depth chemical peels, commonly used to treat wrinkles, sun damage, and skin discoloration. However, with superior efficacy due to its depth of penetration also runs the risk of greater side effects such as: scarring and bacterial infections. TCA peels are generally used in concentrations < 50% and in combination with other chemical peels to achieve greater depth of penetration. A popular peel for the treatment of ice pick acne scars utilizes a 90% spot treatment of TCA that is referred to as TCA cross³.

Salicylic acid peels

Salicylic acid is a beta hydroxy acid (BHA) that can be effective for treating hyperpigmentation associated with acne and other skin conditions. It can penetrate oil-filled pores, making it useful for addressing both active breakouts and their associated pigmentation⁴.

Mild chemical peels

Lactic acid and mandelic acid peels are mild chemical peels for individuals with sensitive skin, although they are less popular treatments as most people opt in for deeper peels that produce more dramatic results.

Lactic acid peels

Lactic acid peels are (alpha hydroxy acid peels) effective for treating very superficial issues (more superficial than glycolic) like sun damage, skin discoloration, and fine lines / wrinkles, similar to glycolic acid peels. The same as with glycolic acid, exfoliation occurs between 7 to 10 days⁵. 

Mandelic acid peels

Similar to Lactic acid peels, this is another type of alpha hydroxy acid peel that is more mild in nature. It acts very superficially and is good for sensitive skin types. Mandelic acid dissolves in both water and organic solutions, making it easy to penetrate the skin evenly. It is effective for the treatment of skin discoloration, and reduces skin oil production. Mandelic acid peels give more subtle results than glycolic acid peels but also have fewer side effects and shorter recovery times. Patients usually experience minimal skin shedding, and healing is typically complete in 3 to 5 days⁶. 

What is the price of a chemical peel in the United States?

Although the price will greatly vary depending on the state you live in and the type of chemical peel you are getting, the average price for a chemical peel treatment is $500. However the price can range from $200 up to $5,000.

Do I need more than one treatment?

According to Dr. Ben Williams, Dermatology Resident Physician, in many cases, yes, you will need more than one treatment; however it depends on the type of problem you have. A dermatologist in your area would be able to determine the type of treatment and the number of sessions you will need to achieve your desired cosmetic result. 

Are chemical peels for dark spots worth the money?

Dr. Williams says that it really depends on the severity of your condition, your skin tone / type, and other individual factors related to your personal medical history, but there are other options that can be as or even more efficient in terms of skin lightening  than chemical peels performed by an experienced dermatologic provider.

Is there a more affordable alternative to reduce hyperpigmentation?

Dr. Williams says that topical prescription medications can be effective as well (depending on the severity of your condition) and may be a more affordable solution to treat dark spots. 

 If you have a limited budget, it may be advisable for you to have a consultation with a dermatologist to get a prescription for topical treatment for hyperpigmentation. Read our dermatologist’s guide on the best treatments for melasma.

Typical ingredients prescribed to treat dark spots

• Hydroquinone
• Tretinoin
• Glycolic acid
• Salicylic acid
• Lactic acid
• Niacinamide
• Azelaic acid
• Kojic acid 
• Vitamin C

It is very often that your dermatologists recommends combination therapy to address the melasma for effectively, so it is very likely that you get prescribe tretinoin and hydroquinone, tretinoin and niacinamide, or tretinoin and azelaic acid.

Dr. Chacon talks about the ingredients that dermatologists use the most commonly to treat hyperpigmentation. Read our article Best ingredients to treat hyperpigmentation.

What is the difference between doing a chemical peel vs getting a prescription medication for hyperpigmentation?

According to Dr. Williams, you can get very similar results with both options, but it all depends. The main differences rely on the price of the treatment and the time it will take you to see the results.

The price of chemical peels done at the dermatologist’s office generally will be more expensive than applying a topical treatment, on the other hand, you may see faster results with a chemical peel than you would using a topical medication (which may take 6 to 12 weeks to see results).

How can I get  a prescription for hyperpigmentation?

You need to have a photo-consultation with a dermatologist, which starts at $59. You will be asked to answer some questions about your condition and upload some photos of your skin. 

After your dermatologist reviews your case, they will write you a prescription for a customized formula that will include some of the ingredients listed above. This formula will vary depending on the severity of your condition and the type of skin you have. 

Benefits of chemical peels

• Improve skin texture and tone
• Stimulate the production of dermal collagen 
• Reduce the appearance of acne scars
• Enhance the effects of other treatments
• Reduce signs of aging
• Reduce pore size⁷

Common side effects of chemical peels

Chemical peels carry certain potential side effects so it is essential to familiarize yourself with these potential side effects before the procedure

• Skin redness and swelling
• Sensations of itching or burning on the skin
• Skin peeling or flaking
• Alterations in skin pigmentation, which may involve lightening or darkening of the skin
• Occasional blisters or scabs in the treated area
• Rare instances of scarring or infection

How deep should a chemical peel for dark spots go?

Usually light or medium chemical peels are used for hyperpigmentation, unless your condition is rather severe. 

Superficial peels

Superficial peels, such as glycolic acid or salicylic acid peels, work on the top layer of the skin. They can be effective for treating mild dark spots, like sunspots or minor pigmentation irregularities. These peels exfoliate the skin, helping to reduce the appearance of dark spots and improve overall skin texture. These chemical peels have minimal downtime and are generally well-tolerated⁸.

Medium depth peels

Medium depth peels, like trichloroacetic acid (TCA) peels or combination with highly concentrated glycolic acid penetrate a bit deeper into the dermal layer of the skin where collagen is present. They are used to address deeper pigmentary disorders and more significant sun damage⁹. Medium peels can target pigment irregularities more effectively than superficial peels but may require some downtime for recovery.

Who is a good candidate to get chemical peels for hyperpigmentation?

Dr. Williams says that individuals with fair to medium skin tones and mild to moderate hyperpigmentation concerns, such as sunspots, age spots, freckles, and post-inflammatory hyperpigmentation (PIH) from conditions like acne may be good candidates for chemical peels. For patients with darker skin types, an experienced dermatologic provider is paramount in order to choose a non-inflammatory peel type as well as address their exact concerns. 

As a general rule, people should have generally healthy skin without active infections, open wounds, or other skin conditions that may contraindicate chemical peel treatment.

People undergoing this type of treatment should avoid excessive sun exposure before and after chemical peel treatments to minimize the risk of post-inflammatory hyperpigmentation. Sun protection is essential using zinc based sunscreens that are SPF 30 or higher and broad-spectrum. We also prefer tinted over non-tinted sunscreens as iron oxide particles offer better protection against blue light.

The successful outcome of the treatment relies on proper post-treatment care, including diligent sun protection, moisturization, and avoidance of harsh skincare products. 

Are chemical peels used for anything else besides hyperpigmentation?

Besides dark spots, chemical peels are also commonly used to treat other skin concerns such as acne, acne scars, and wrinkles.

What are the best chemical peels for dark skin?

For all of these peels, the name of the game here is primarily a superficial depth of penetration to prevent the paradoxical hyperpigmentation that can occur from peels that generate a lot of deeper inflammation. 

Glycolic Acid (GA) Peels: Glycolic acid peels are relatively gentle and can be effective for mild hyperpigmentation and skin texture concerns.

Salicylic Acid (SA) Peels: SA peels are well-tolerated by many skin types and can help with acne-related hyperpigmentation.

Lactic Acid (LHA) Peels: Lactic acid is another mild option suitable for dark skin. It can improve skin texture and hydration.

The takeaway

Still unsure whether chemical peels are adequate for you? You can always try a prescription topical treatment first since it is more affordable and if you do not experience the dramatic results you had hoped for, you can find a dermatologist in your area and book an in-person consultation. 

References:
https://www.ncbi.nlm.nih.gov/books/NBK547752/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3875240/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122508/
https://www.ncbi.nlm.nih.gov/books/NBK547752/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921757/

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