AHA peels are considered inferior to BHA for acne treatment. What is the available evidence for the use of AHA peels in acne?

1. Glycolic Acid Peel
for Acne:
Is it relevant?
Peter Nugraha Soekmadji
Department of Dermatovenereology
Faculty of Medicine
Maranatha Christian University
Bandung

2. Conflict of Interest Statement
• NO support or commercial funding for this
presentation or for any products mentioned
here

3. Acne Vulgaris

4. Acne Vulgaris
Fitzpatrick's Dermatology in General Medicine, 8th Ed

5. Acne Variants
Fitzpatrick's Dermatology in General Medicine, 8th Ed
• Acne conglobata
• Acne fulminans
• Acne mechanica
• Drug-induced acne
• Occupational acne
• Gram negative folliculitis
• Tropical acne

6. Chemical Peeling

7. Chemical Peels
• α-Hydroxy acids: glycolic acid, lactic acid,
mandelic acid, citric acid
• β-hydroxy acid: salicylic acid
• Jessner solution
• Trichloroacetic acid
• Phenol peel
• Various cocktail peels
Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
Fitzpatrick's Dermatology in General Medicine, 8th Ed

8. Fitzpatrick's Dermatology in General Medicine, 8th Ed

9. Possible Depths of Peels
Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

10. Glycolic Acid
• Fruit acids
• α-Hydoxy-acid
• pKa: 3.83

11. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

12. Mechanism of Action of Glycolic Acid

13. Glycolic Acid for Acne
• Disrupts corneocyte cohesion → works well
on comedonal acne

14. A 10% GA containing oil-in-water emulsion improves mild acne - a double-blind placebo-RCT

15. Glycolic Acid for Acne
• Disrupts corneocyte cohesion → works well
on comedonal acne
• What is the efficacy on inflammatory acne?

16. GA has bactericidal effects
on P. Acnes
Takenaka Y, Hayashi N, Takeda M, Ashikaga S, Kawashima M. Glycolic acid chemical peeling improves inflammatory acne eruptions
through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol. 2012 Apr;39(4):350-4. doi: 10.1111/j.1346-
8138.2011.01321.x. Epub 2011 Sep 28.

17. Takenaka Y, Hayashi N, Takeda M, Ashikaga S, Kawashima M. Glycolic acid chemical peeling improves inflammatory acne eruptions
through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol. 2012 Apr;39(4):350-4. doi: 10.1111/j.1346-
8138.2011.01321.x. Epub 2011 Sep 28.
pH 1.5 pH 3.5 pH 5.5

18. P. acnes colonies decrease after
GA peels
Takenaka Y, Hayashi N, Takeda M, Ashikaga S, Kawashima M. Glycolic acid chemical peeling improves inflammatory acne eruptions
through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol. 2012 Apr;39(4):350-4. doi: 10.1111/j.1346-
8138.2011.01321.x. Epub 2011 Sep 28.

19. Glycolic Acid Peel vs Placebo

20. Quality of Evidence
on GA Efficacy
de Vries FMC, Meulendijks AM, Driessen RJB, van Dooren AA, Tjin EPM, van de Kerkhof PCM. The efficacy and safety of non-
pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis. J Eur Acad
Dermatol Venereol. 2018 Jul;32(7):1195-1203. doi: 10.1111/jdv.14881.

21. GA vs Placebo
Kaminaka C, Uede M, Matsunaka H, Furukawa F, Yamomoto Y. Clinical evaluation of glycolic acid chemical peeling in patients with
acne vulgaris: a randomized, double-blind, placebo-controlled, split-face comparative study. Dermatol Surg. 2014 Mar;40(3):314-
22. doi: 10.1111/dsu.12417. Epub 2014 Jan 21.
GA
Placebo

22. • 25 patients
• Split-face comparison RCT
• 40% GA vs placebo, every 2 weeks, 5x
• GA significantly superior than placebo
• Flare-up of GA 12% (not statistically
significant)
GA vs Placebo: Comments
Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr
28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607.
Kaminaka C, Uede M, Matsunaka H, Furukawa F, Yamomoto Y. Clinical evaluation of glycolic acid chemical peeling in patients with acne vulgaris: a

23. Glycolic Acid Peel vs Other Peels

24. GA vs Salicylic Acid
Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of
mild to moderately severe facial acne vulgaris. Dermatol Surg. 2008 Jan;34(1):45-50; discussion 51. Epub 2007 Dec 5.

25. GA vs Salicylic Acid
Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of
mild to moderately severe facial acne vulgaris. Dermatol Surg. 2008 Jan;34(1):45-50; discussion 51. Epub 2007 Dec 5.

26. GA vs Salicylic Acid: Comments
Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr
28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607.
Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to
• 20 patients
• Split-face comparison RCT
• 30% GA vs 30% SA, every 2 weeks, 6x
• Total number of lesions & patients’ preference
was comparable
• After 2-month follow-up, mean number of
lesions was higher on GA-treated side

27. Comparison of AHA vs BHA
AHA BHA
Lipophilic - +
Inhibits arachidonic acid - +
Anesthetic properties - +
Antiinflammatory
properties
± +
Increase collagen + -
Ease of use
(neutralization,
time dependent)
+ +++
Use in pregnancy + -
Cosmetic Dermatology - Principles & Practice, 2nd Ed

28. AG vs SA+Mandelic Acid
El Refaei, Asmaa M.; Abdel Salam, Hany A.; Sorour, Neveen E. Salicylic–mandelic acid versus glycolic acid peels in Egyptian patients
with acne vulgaris. Journal of the Egyptian Women's Dermatologic Society, Volume 12, Number 3, September 2015, pp. 196-
202(7). DOI: 10.1097/01.EWX.0000464740.18592.42
GA SA+MA

29. AG vs SA+Mandelic Acid
El Refaei, Asmaa M.; Abdel Salam, Hany A.; Sorour, Neveen E. Salicylic–mandelic acid versus glycolic acid peels in Egyptian patients
with acne vulgaris. Journal of the Egyptian Women's Dermatologic Society, Volume 12, Number 3, September 2015, pp. 196-
202(7). DOI: 10.1097/01.EWX.0000464740.18592.42

30. AG vs SA+MA: Comments
Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr
28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607.
El Refaei, Asmaa M.; Abdel Salam, Hany A.; Sorour, Neveen E. Salicylic–mandelic acid versus glycolic acid peels in Egyptian patients with acne
• 40 patients
• RCT
• 35% GA vs 20% SA + 10% MA, every 2 weeks,
6x
• SA+MA was superior in all aspects, except in
improvement on scars
• Side effects was comparable

31. GA vs Jessner
Kim SW, Moon SE, Kim JA, Eun HC. Glycolic acid versus Jessner's solution: which is better for facial acne patients? A randomized
prospective clinical trial of split-face model therapy. Dermatol Surg. 1999 Apr;25(4):270-3.

32. GA vs Jessner: Comments
Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr
28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607.
• 25 patients
• Split-face comparison RCT
• 70% GA vs JS, every 2 weeks, 3x
• Efficacy & patient’s preference was
comparable
• JS-induced scaling negatively affect patient’s
daily activities (0 vs 36%)

33. GA vs Amino Acid
Ilknur T, Demirtaşoğlu M, Biçak MU, Ozkan S.. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther. 2010
Oct;12(5):242-5. doi: 10.3109/14764172.2010.514919.
baseline 3 month 6 month
AA GA

34. GA vs Amino Acid: Comments
Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr
28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607.
Ilknur T, Demirtaşoğlu M, Biçak MU, Ozkan S.. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther. 2010 Oct;12(5):242-
• 30 patients
• Split-face comparison RCT
• 20-70% GA vs 20-60% AA, every 2 weeks, 12x
• Efficacy & patient’s preference was
comparable
• Discomfort was more common on GA

35. Glycolic Acid Peel:
Clinical Pearls

36. Kontochristopoulos G, Platsidaki E. Chemical peels in active acne and acne scars. Clin Dermatol. 2017 Mar - Apr;35(2):179-182.
doi: 10.1016/j.clindermatol.2016.10.011. Epub 2016 Oct 27.

37. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

38. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

39. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

40. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

41. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed

42. Glycolic Acid Peel:
Conclusion

43. GA Peel For Acne
• Good treatment modalities for comedonal
acne
• Inferior to salicylic acid for inflammatory acne
• Great options if patients can not tolerate side
effects of other peels (desquamation, etc)
• Useful if patients are able to adhere to long-
term and 2x/month treatment plan