Ethnic Skin Considerations

When considering using chemical peels in ethnic skin, it is critical to identify the patient’s Fitzpatrick skin type as well as determine the patient’s ethnicity prior to selecting the peeling agent. Indications for chemical peeling in darker skin include acne vulgaris, PIH, melasma, scarring, photodamage, and pseudofolliculitis barbae. However, the primary indication for chemical peeling in skin types III–VI is for pigmentation dyschromias.

As a dermatologist treating ethnic/darker skinned patients, it is important to understand the different properties of the superficial chemical peeling agents in order to choose the most appropriate agent to address the patient’s dermatological needs. For example, glycolic acid and salicylic acid peels are excellent tools to treat acne in skin of color. In addition, salicylic acid in ethanol solutions is a great peeling agent for dark-skinned patients with melasma and PIH whereas glycolic acid is a less favorable agent to treat melasma and PIH because it may induce PIH in skin types V and VI. Trichloroacetic acid at low concentrations of 10–25% works well to treat acne scarring in skin of color, and when used in combination with 70% glycolic gel, it also rejuvenates uneven mottled facial pigmentation. Jessner’s solution may create depigmentation in patients with skin types V and VI but may be successful in spotpeeling for PIH in ethnic skin. In addition, TCA 25% and salicylic acid are important tools for spot-peeling for PIH.

Regarding the treatment of melasma with superficial peeling agents, Asian and Asian Americans respond well to serial glycolic peels maintained at the same concentration.Africans and darker African Americans (skin types V and VI) have better results with salicylic acid peels because the risk for PIH is higher with glycolic acid peels. Finally, serial glycolic acid peels and salicylic acid peels have been successful in improving the skin texture in patients with pseudofolliculitis barbae [22].

No matter which superficial agent is chosen in ethnic/dark skin, it is critical to start a prepeel regimen that includes the morning application of sunscreen with UVA/UVB SPF 30 and a moisturizer containing alpha-hydroxy acid as well as an evening combination including retinoid, hydroquinone, kojic acid, or azelaic acid and possibly at low-potency steroid. The duration of this pre- and postpeel regimen is similar in all skin types.