Hyperpigmentation after glycolic acid peel

Fig. 16.4. a Post-inflammatory hyperpigmentation from unknown topical irritant, b Cleared after a series of two glycolic acid peels (20 and 35%)... 

PIH after a peel with 70% unbuffered glycolic acid neutralization with a sodium bicarbonate solution as soon as erythema appeared. There is no visible frosting. Postoperative developments were normal. On the 8th day, the patient consulted the doctor about the appearance of PIH 3 days before (a). Treatment consisted of tyrosinase inhibitors, topical antioxidants, sun avoidance and protection, (b) The patient after 5 weeks, (c) After 8 weeks. The hyperpigmentation has improved significantly. A telephone call revealed that the problem has cleared up completely after 3 months. 

We also utilize TCA in the treatment of xanthelasma. In mild to moderate photoaging, when 50-70% glycolic acid is ineffective, TCA 50% is the best choice for an all-over medium-depth peel. We tend to avoid the use of higher concentration TCA in darker skintypes. It is important to stress sun protection in all patients after treatment to avoid postpeel hyperpigmentation. 

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