Postinflammatory hyperpigmentation salicylic acid peels

Joshi SS, Boone SL, Alam M et al (2009) Effictiveness, safety, and effect on quality of life of topical salicylic acid peels for treatment of postinflammatory hyperpigmentation in dark skin. Dermatol Surg 35 638-644... 

Indications for salicylic acid peels include acne vulgaris [inflammatory and noninflammatory lesions), acne rosacea, melasma, postinflammatory hyperpigmentation [PIH), freckles, lentigines, mild to moderate photodamage, and texturally rough skin (Figs 5.2-5.4). Salicylic acid peels are... 

Fig. 17.3 (a) Severe recalcitrant postinflammatory hyperpigmentation secondary to acne excorians. (b) After a series of four salicylic acid 20% and 30% peels and 10% hydroquinone cream... 

A large number of combination peels are in the market which combine various alpha-hydroxy acids and also with beta-hydroxy acids. There are other proprietary peels, the exact composition of which is not known. There are hardly any randomized controlled studies on these in Asian patients. There are concerns about their stability and efficacy. Some are made for home use. A comparative study on 44 Indian patients with acne which had two groups, one receiving 35% glycolic acid peels and the other 20% salicylic acid-10% mandelic acid peels for six sessions at 2-weekly intervals, found salicylic-mandelic peel more efficacious for active acne and postacne hyperpigmentation [24]. Mandelic acid penetrates less but in the combination with salicylic acid has a beneficial role in postinflammatory hyperpigmentation. 

Figure 5.6 Patient with pseudofolliculitis batbae and postinflammatory hyperpigmentation before (A) and after (B) a series of five salicylic acid chemical peels.

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