Chemical skin peeling hypertrophic scars

Litton [284], one of the pioneer physicians in chemical skin peeling, ranaiked that almost all the scarring he had seen following chemical peels was due to TCA [284], A full-thickness injury and hypertrophic scarring may occur wheu the 50 % TCA solution is incorrectly prepared (50 g TCA in 50 mL distilled watCT rather than the correct 50 g TCA in 1(X) mL distilled water), resulting in a concentration much higher than 50 % [337]. 

It is important to obtain details regarding isotretinoin (Accutane, Roacutane) treatment and history of keloid or hypertrophic scar formation. Isotretinoin use necessitates a delay period of 6-12 months (depending on the skin thickness and oiliness) until chemical peel is performed. Active acne is not a contraindication for chemical peel. In these cases the peel is combined with systemic antibiotics for 2-3 weeks. It is always advisable to consider isotretinoin treatment after the peel to avoid acne flare and scar reappearance. 

In contrast, in persons with darker-colored skin, chemical peeling may be indicated for PIH, if care is taken to avoid irritation which can worsen PIH and predispose to other complications, including new areas of dyspigmentation, keloid formation, and hypertrophic scarring [342],... 

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