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Chemical peels for acne vulgaris: a systematic review of randomised controlled trials
  1. Xiaomei Chen1,
  2. Sheng Wang1,
  3. Ming Yang2,
  4. Li Li1
  1. 1 Department of Dermatology & Venereology, West China Hospital, Sichuan University, Chengdu, China
  2. 2 The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
  1. Correspondence to Dr Li Li; hxskincos2017{at}


Objective We evaluated current evidence from randomised controlled trials (RCTs) regarding the effectiveness of chemical peeling for treating acne vulgaris.

Methods Standard Cochrane methodological procedures were used. We searched MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE via OvidSP through April 2017. Reviewers independently assessed eligibility, risk of bias and extracted data.

Results Twelve RCTs (387 participants) were included. Effectiveness was not significantly different: trichloroacetic acid versus salicylic acid (SA) (percentage of total improvement: risk ratio (RR) 0.89; 95% CI 0.73 to 1.10), glycolic acid (GA) versus amino fruit acid (the reduction of inflammatory lesions: mean difference (MD), 0.20; 95% CI −3.03 to 3.43), SA versus pyruvic acid (excellent or good improvement: RR 1.11; 95% CI 0.73 to 1.69), GA versus SA (good or fair improvement: RR 1.00; 95% CI 0.85 to 1.18), GA versus Jessner’s solution (JS) (self-reported improvements: RR 1.00; 95% CI 0.44 to 2.26), and lipohydroxy acid versus SA (reduction of non-inflammatory lesions: 55.6%vs48.5%, p=0.878). Combined SA and mandelic acid peeling was superior to GA peeling (percentage of improvement in total acne score: 85.3%vs68.5%, p<0.001). GA peeling was superior to placebo (excellent or good improvement: RR 2.30; 95% CI 1.40 to 3.77). SA peeling may be superior to JS peeling for comedones (reduction of comedones: 53.4%vs26.3%, p=0.001) but less effective than phototherapy for pustules (number of pustules: MD −7.00; 95% CI −10.84 to −3.16).

Limitations The methodological quality of the included RCTs was very low to moderate. Meta-analysis was not possible due to the significant clinical heterogeneity across studies.

Conclusion Commonly used chemical peels appear to be similarly effective for mild-to-moderate acne vulgaris and well tolerated. However, based on current limited evidence, a robust conclusion cannot be drawn regarding any definitive superiority or equality among the currently used chemical peels. Well-designed RCTs are needed to identify optimal regimens.

  • chemical peeling
  • acne vulgaris
  • systematic review
  • treatment
  • comedone
  • papule

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  • Contributors XC and LL designed the protocol. XC and MY searched the literature, extracted the data and analysed the data. XC, SW, MY and LL interpreted the data and revised the manuscript. All authors read and approved the publication of this work.

  • Funding This review was supported by a grant from the Sichuan Provincial Science and Technology Department (Grant number: 2017JY0277).

  • Disclaimer The funder had no role in study design, data collection, data analysis, data interpretation or writing of the report.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.