Chemical peels, chosen for your skin type

In this region the governing consideration is Fitzpatrick type. Skin of type IV, V and VI has more active melanocytes that respond to inflammation by producing pigment. The same peel that leaves type II skin clear can leave type V skin with post-inflammatory hyperpigmentation that takes months to resolve and is, in the patient's eyes, considerably worse than what they came in with.

The response to that is not to avoid peeling darker skin. It is to peel it correctly: a slower agent, a lower concentration, shorter contact, more sessions, and priming beforehand. Skin is usually prepared for two to four weeks with a tyrosinase-inhibiting regimen and rigorous photoprotection before a peel is performed at all. That preparation is not an upsell; it is the part that determines whether the outcome is good.

Melasma deserves separating out. It is a chronic, relapsing condition driven by hormones, heat and ultraviolet light, not a stain to be removed. Peels have a role within a broader programme, but a peel given in isolation to melasma-prone skin frequently makes it worse. If that is your diagnosis, you will be told so and offered a programme rather than a procedure.

• Fitzpatrick type — determines agent, concentration, contact time and how much priming is needed.
• Diagnosis of the pigmentation — melasma, post-inflammatory change and solar lentigines behave differently and are not treated alike.
• History of post-inflammatory hyperpigmentation — previous episodes strongly predict future ones.
• Recent isotretinoin — peeling is deferred for six months after systemic retinoid treatment.
• Herpes simplex history — antiviral prophylaxis is prescribed before any medium-depth peel.
• Realistic sun behaviour — if daily photoprotection is not going to happen, a peel is not the right treatment.

1. Assessment and priming

   Skin type and diagnosis established, and a preparation regimen started. For most people this means two to four weeks of topical therapy and strict photoprotection before the first peel.

2. Patch test

   Where skin type or history warrants it, a test area is treated first and reviewed before proceeding.

3. The peel

   Skin is degreased and the agent applied in timed layers. You will feel warmth and stinging that builds and then eases; a fan is used. Contact time is decided by what your skin does, not by a fixed protocol.

4. Recovery and review

   Detailed written aftercare is given, since outcome depends heavily on it. Reviewed once peeling has completed, and the next session planned from how the skin responded to this one.

These are discussed with you individually before consent is taken. The list is not exhaustive, and it is not a substitute for that conversation.

• Redness, tightness and visible peeling — expected, and proportional to depth.
• Post-inflammatory hyperpigmentation, the principal risk in Fitzpatrick IV to VI, which may take months to resolve.
• Hypopigmentation, less common but more difficult to correct.
• Prolonged erythema after medium-depth peeling.
• Reactivation of herpes simplex, which is why prophylaxis is prescribed.
• Infection and, rarely, scarring — more likely if the skin is picked or peeled off manually during recovery.
• Under-treatment. Conservative peeling in pigmented skin trades a slower result for a much lower risk, deliberately.

When this treatment is not appropriate

• Pregnancy and breastfeeding for most agents.
• Systemic isotretinoin within the previous six months.
• Active infection, eczema, dermatitis or open skin in the treatment area.
• Recent significant sun exposure or sunburn.
• Known allergy to the agent, including aspirin allergy for salicylic acid.
• Keloid or hypertrophic scarring tendency for medium-depth peeling.
• Unwillingness or inability to maintain strict photoprotection afterwards.