Chemical Peels: Indications and Special Considerations

for the Male Patient

Jeave Reserva, MD,* Amanda Champlain, MD,* Seaver L. Soon, MD,† and Rebecca Tung, MD*

BACKGROUND Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic
procedure performed in men.

OBJECTIVE To review the indications for chemical peels with an emphasis on performing this procedure in
male patients.

MATERIALS AND METHODS Review of the English PubMed/MEDLINE literature and specialty texts in cosmetic
dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men.

RESULTS Conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring,
rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction
scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic
procedures to optimize results. Male patients may require a greater number of treatments or higher concen-
tration of peeling agent due to increased sebaceous quality of skin and hair follicle density.

CONCLUSION Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and
medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men,
dermatologists should have an understanding of chemical peel applications and techniques to address the
concerns of male patients.

The authors have indicated no significant interest with commercial supporters.

A ccording to the American Society of

Dermatologic Surgery and the American Society
for Aesthetic Plastic Surgery, between 596,000 and
Materials and Methods

In addition to reviewing specialty texts in cosmetic

603,305 chemical peel procedures were performed in
2015, an increase of 25% compared with the previous
year.1,2 Among the total $379 million expenditures in
chemical peels in 2015, 7% were performed in men,
making it the sixth most common nonsurgical
cosmetic procedure performed in this group.1 Despite
their popularity in patients aged 65 years and above,1
increasing mainstream appeal,3 and men’s growing
interest in cosmetic procedures,4–7 the scientific
literature regarding chemical peels in male patients is
scant. In this study, the authors discuss the indications
for chemical peels and provide a practical approach
and special considerations when performing chemical
peels in male patients.
dermatology, oculoplastic, and facial aesthetic sur-
gery, the authors conducted a review of the English
PubMed/MEDLINE literature on sex-specific use of
chemical peels using the terms chemical peel, male, and
men.
Review
Chemical peels induce all 3 stages of tissue replace-
ment—destruction, elimination, and regeneration—
all under controlled inflammation.8 They are
commonly classified based on their histologic depth
of skin penetration.9 Superficial peels, subdivided
into very light and light peels, respectively, destroy
keratinocytes down to the level of stratum spinosum

*Division of Dermatology, Loyola University Medical Center, Maywood, Illinois; †Division of Dermatology &
Dermatologic Surgery, Scripps Clinic, La Jolla, California

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· ·
ISSN: 1076-0512 Dermatol Surg 2017;0:1–11 DOI: 10.1097/DSS.0000000000001281

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 CHEMICAL PEELS FOR MEN

and stratum basale.9 Medium peels penetrate into chemical peels as monotherapy or in combination
the upper reticular dermis, whereas deep peels with other noninvasive skin resurfacing modali-
wound to the level of the mid-reticular dermis.10 ties.14 The use of a physical modality such as solid
Classification of chemical peeling agents is described CO2 before the application of high strength tri-
in Table 1. chloroacetic acid (TCA) [50%] to the acne scar rims
has been described to improve acne scars.15 Simi-
larly, evidence exists supporting the use of micro-
Indications
needling, which creates wounds into the papillary
dermis, in conjunction with TCA [20%] in improv-
Acne Vulgaris and Scarring
ing post-acne atrophic scars, after 6 monthly treat-
Active acne lesions can be treated by a variety of ments in a cohort of 39 patients (15 males).16
superficial and medium peels (Table 2) (Figure 1).10–12 Compared with each technique as monotherapy,
When performed as combination therapy with microneedling promoted deeper penetration of TCA
pulsed dye laser, 3 treatments of salicylic acid [30%] at lower concentration, hence, minimizing the risk
at 3-week intervals improves moderate-to-severe of hyperpigmentation while fostering collagenesis.
acne compared with salicylic acid monotherapy.13 Moreover, alternating microneedling/TCA [20%]
With regard to improving facial acne scars, authors with the 1,540-nm nonablative fractional laser
of a recent Cochrane review were unable to find resulted in better acne scar improvement.16 In
sufficient evidence to support first-line use of another study involving a cohort of 20 patients (8
males), 4 sessions of microneedling/TCA [20%]
performed at 6-week intervals demonstrated results
TABLE 1. Classification of Chemical Peel
Agents10,11 comparable to one deep peel session using phenol
[60%] at 8-month follow-up.17 When used in higher
Superficial concentrations, superficial alpha-hydroxy acid
Very light
(AHA) peels (e.g., glycolic acid [70%]) have also
TCA (10%–20%)
Alpha-hydroxy acid (10%–50%)
been shown to be effective in treating atrophic acne
Beta-hydroxy acid (20%–30%) scars.18
Retinoic acid (1%–10%)
Light Pioneered by Lee and colleagues, the chemical
TCA (20%–30%) reconstruction of skin scars (CROSS) method uses
Jessner solution*
a sharpened wooden applicator to focally apply TCA
Glycolic acid (70%)
Salicylic acid (20%) + TCA (15%)
at high concentration (100%) to the depressed area
Medium depth of atrophic acne scars.19 In a cohort of 20 patients
TCA (35%–40%) (14 men), 2 sessions of the CROSS method 3 months
Pyruvic avid (40%) apart demonstrated similar effects on acne scars
Jessner solution-TCA (35%) (Monheit combination) compared with 3 sessions of 1,550-nm erbium:glass
Glycolic acid (70%)-TCA (35%) (Coleman
combination)
fractional laser at 1.5-month intervals.20 Leheta and
Solid CO2-TCA (35%) (Brody combination) colleagues17 recommended the CROSS method over
Phenol (88%) microneedling for the treatment of icepick and box-
Deep car acne scars, but suggested microneedling for
Baker-Gordon phenol–croton oil peel† ameliorating rolling acne scars and for patients at
Hetter phenol–croton oil peel
risk for postinflammatory pigmentary changes.
TCA (>50%)
CROSS using 50% TCA has also been shown to be
*Jessner solution: 14 g resorcinol, 14 g salicylic acid, 14 g lactic effective in improving acne scars while lowering peel
acid (85%), and 100 mL (quantity sufficient to make total)
ethanol (95%). complications such as scarring and dyspigmenta-
†Baker-Gordon phenol–croton oil peel: croton oil, phenol, tion.21,22 The need for further randomized control
hexachlorophene 0.25%, and distilled water.
trials for acne scar interventions is apparent, because

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 RESERVA ET AL

TABLE 2. Summary of Chemical Peel Indications for Men

Practical
Indication Example of Peel Selection Considerations
Acne vulgaris and scarring Treatments maybe
Comedonal and mild/moderate Salicylic acid (25%–30%) combined with other
inflammatory modalities:
Pyruvic acid (40%)
microneedling, pulsed
Glycolic acid (70%) dye laser, subcision,
Severe nodulo-cystic acne Pyruvic acid (40%) erbium:glass laser
Postacneic scar
Superficial Salicylic acid (25%) + TCA (25%–30%) gel
TCA (25%–50%)
Pyruvic acid (40%)
Medium/deep Phenol (45%–80%)
CROSS method TCA (50%–100%)
Solid CO2-TCA (35%)
Rosacea
Erythrosis Salicylic acid (15%–25%–30%) 1 application
Papulopustular Salicylic acid (25%–30%) 2–3 applications
Keratosis pilaris Glycolic acid (50%–70%) Daily maintenance
therapy with glycolic
acid lotion (12%–20%)
48-h after peel
Melasma, PIH Salicylic acid (25%–30%) 6 TCA (10%) gel Perform at 2-wk
Glycolic acid (50%–70%) intervals
TCA (10%–30%)
Phenol–croton oil peels (resistant cases)
AK Salicylic acid (25%) + TCA (25%–30%) gel May pretreat with 5-FU
Glycolic acid (70%) (5%) cream · 1 wk
Photoaging/periorbital rejuvenation For moderate-to-severe
WSRS #2 Jessner solution cases, 2 wk of
downtime, must avoid
Glycolic acid (70%)
sun exposure for 1–3
Salicylic acid (20%) +TCA (15%) mo
WSRS $2 Jessner-TCA (35%)
CO2-TCA (35%)
Glycolic acid (70%)-TCA (35%)
Stone phenol 2-d chemabrasion
PFB Salicylic acid (30%) Every 4 wk as needed
Glycolic acid (50%–70%)
Jessner solution

PIH, postinflammatory hyperpigmentation.

most studies, including those involving chemical
peels, are underpowered and did not use a validated
standardized improvement scale.14
Rosacea
Three to 4 sessions of salicylic acid peels [15% to
25%–30%] (one application) performed at 3-week
intervals is suggested for erythematotelangiectatic
rosacea, whereas salicylic acid peels [25%–30%]
(2–3 applications) is suggested for
papulopustular rosacea.23 In addition, despite
concerns about worsening the erythema in
rosacea, glycolic acid peels [25%–30%] pro-
gressively titrated to 50% to 70% over monthly
intervals can improve both eryth-
ematotelangiectatic and papulopustular
rosacea.24,25

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 CHEMICAL PEELS FOR MEN

Figure 1. Moderate inflammatory acne on the (A) face and (B) back with pseudofrosting is seen after application of salicylic
acid peel.

Keratosis Pilaris resistant cases.29,32 Glycolic acid peels, at concen-

Exfoliation of keratotic follicular debris and enhancing
the penetration of at home skin maintenance regimens are
the main goals of chemical peeling in keratosis pilaris
(KP).26 Keratosis pilaris can be initially treated by glycolic
acid [70%] for 5 to 7 minutes, titrated upward as toler-
ated, and neutralized with either water or sodium bicar-
bonate. Low to medium potency topical steroids may be
applied twice daily for 1 to 2 days if significant erythema
develops after chemical peel treatment. Maintenance
therapy after 48 hours using glycolic acid lotion [12%–
20%] is often recommended, as the condition often
recurs.25 Novel peels, such as the FCR (Illglobal Inc.,
Seoul, South Korea), a complex peel extracted from min-
eral-rich coral calcium and algae and reported to contain
niacinamide, papain, and a combination of mandelic
acid, lactic acid, citric acid and salicylic acid, have also
been shown to improve KP in a cohort of 16 Korean
subjects (4 men).27 In addition, Jessner solution has been
advocated in darker skin types for KP treatment.28
Melasma
Melasma is a systemic disorder, less prevalent in men
than women but equally bothersome for the patient.
Many superficial, medium, and deep agents have
been used successfully but not evaluated according to
modern standardized improvement scales. Recom-
mended superficial peels for melasma include TCA
[10%–30%] peel, twice monthly salicylic acid peels
[25%–30%], or a combined peel with salicylic acid
[25%] and TCA gel [10%].22,29–31 Monthly medium
peels using pyruvic acid [40%] can also be used for
this condition, as well as phenol–croton oil peels for
trations greater than 50%, performed at 2 week
intervals may also be effective for melasma in men.33–
35
The importance of vigilant photoprotection pre-
and post-peel treatment cannot be overstated when
treating melasma.
Actinic Keratosis
Combining topical 5-fluorouracil (5-FU) [5%] with
glycolic acid [70%] peel increases the efficacy for
treating actinic keratosis (AK).28 Comparable results
to treatment with topical 5-FU [5%] cream have been
reported when using Jessner-TCA [35%] in the treat-
ment of AK, with the added advantage of a single
procedure and reduced healing times (Figure 2).9,36
Other authors favor using salicylic acid [20%–30%]
for thin isolated lesions and TCA [10%–30%] for
multiple closely interspersed actinic keratoses.22
Annual reevaluation for potential need for retreatment
is recommended.36 In an atrophic bald scalp with
multiple AK, delayed reepithelialization of chemo-
exfoliated areas may be observed, which can be
a consequence of diminished adnexal structures or
actinically damaged skin itself.37 In these patients,
adherence to postoperative wound care should be
emphasized while maintaining a high index of suspi-
cion for factors that may contribute to delayed wound
healing, such as infection or erosive pustular derma-
tosis of the scalp. For hypertrophic AK, absorption of
the peeling solution may be facilitated by curettage of
the hyperkeratosis before application, with targeted
vigorous chemical peel reapplication using a cotton-
tipped applicator.38

4 DERMATOLOGIC SURGERY

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Figure 2. Actinic keratoses treated with Jessner and spot
TCA (35%).
Photodamage and Reconstruction
Scar Resurfacing
Severity of photodamage may be classified using the
Glogau system.39 Other scoring systems such as the
Wrinkle Severity Rating Scale (WSRS)22 and Index of
Photoaging Skin40 can be used to quantify the severity
Figure 3. Prominent poikiloderma in a Glogau III patient (A) before and (B) 5 months after undergoing combined salicylic
acid (20%) and TCA (15%) peel.
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RESERVA ET AL
of photodamage and determine the appropriate
intervention. In the WSRS schema, those with scores
#2 may benefit from superficial peels such as Jessner
solution or glycolic acid [70%].22 Higher WSRS scores
may require salicylic acid [30%] or medium to deep
peels (Figure 3). Various combination medium-depth
peels use TCA [35%] in combination with other sub-
stances such as solid CO2 (Brody combination) or
glycolic acid [70%] (Coleman combination), with
Jessner-TCA [35%] peel (Monheit combination)
being the most commonly used.40,41 The success of
wrinkle removal in men with thicker dermis requires
penetration through the papillary dermis. This is the
mechanism of sequential medium-depth peeling in
removing wrinkles.42 However, for severe photo-
aging, Hetter phenol–croton oil peel continues to be
the treatment of choice.43,44 Varying the concentration
of the croton oil changes the depth of peel penetration
and effectiveness in treating rhytides. Additionally, the
application technique, such as the number of passes
over time, also plays a central role in the depth of
injury.44–46
Although not as commonly used as resurfacing lasers,
chemical peels continue to have a role in post-skin
cancer reconstruction scar resurfacing, with the goal
of optimizing the color blending with normal sur-
rounding tissues that have significant actinic dam-
age.47 Various superficial and medium-depth peels can
be used for this purpose, although a deep peel with
Baker-Gordon phenol–croton oil peel is known to
reliably resurface skin defects and is heavily favored by
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 CHEMICAL PEELS FOR MEN

some authors.43,47 However, the Baker-Gordon
phenol–croton oil peel with a croton oil concentration
of 2.1% is more likely to produce undesired hypo-
pigmentation in men. The Hetter formulas with less
croton oil concentration, 1.2% and lower, can remove
wrinkles without the pigmentary loss that is difficult to
camouflage in men.45
Periorbital Rejuvenation
The periorbital area is the first part of the face to show
signs of aging and, hence, is considered an aging
barometer of the face.48 Age-related changes in the
periorbital area, specifically crow’s feet and tear
troughs, are of most significant concern for aestheti-
cally oriented men.5 Periorbital peels can provide sig-
nificant improvement and tightening of the anterior
lamella for younger patients who show only textural
changes and mild fat protrusion and are not yet seek-
ing surgical interventions.48 TCA [35%] alone or
preceded by solid CO2, Jessner solution, or glycolic
acid [70%] can be repeated every 12 weeks if neces-
sary.42 A deep phenol–croton oil-based peel can be
a first-line therapeutic option for treating blephar-
ochalasis and can be repeated after 6 months for fur-
ther skin tightening.48 The authors do not tape occlude
the eyelids after the procedure. In micropunch ble-
pharopeeling, straight phenol [89%] is applied to the
area between the upper eyelid’s superior tarsal plate
border and the eyebrow’s inferior border, as well as
within 1 to 2 mm of the lower eyelid margin; imme-
diately after frosting, multiple (between 5 and 20) 3- to
5-mm snip excisions arranged in a random grid-like
pattern are performed on the centrolateral areas of the
upper eyelid, which are allowed to heal by secondary
intention.32,49 This procedure has shown excellent
aesthetic outcomes in treating periocular rhytides
without the associated volume loss and linear scarring
seen in conventional surgical blepharoplasty.32,49
Combining chemical peels with other resurfacing
modalities continues to be common practice.50,51 A
retrospective review of 114 patients (39 men) with
predominantly rolling acne scars treated with a single
session combining TCA [20%], extensive subcision,
and fractional CO2 laser demonstrated significant scar
improvement and high patient satisfaction with
treatment results.52 Other reports have suggested that
prepeel treatment with botulinum toxin and/or hya-
luronic acid filler has a synergistic effect in the
treatment of rhytides.53,54 After performing a medium-
depth peel, blending the sharp demarcations along the
hairline and neck can be achieved using laser resur-
facing or mechanical sanding.50,55,56
Contraindications
General absolute contraindications to chemical peels
in men include active infection and allergic contact
dermatitis to peel ingredient(s). Relative contra-
indications include smoking, regular indoor or out-
door tanning, history of postinflammatory
hyperpigmentation, history of poor wound healing,
history of high-dose iatrogenic immunosuppression
(e.g., for treatment of autoimmune disease or trans-
plant rejection), active inflammatory dermatoses,
cardiac, renal, or hepatic disease (for phenol-based
peels), and habitual excoriation. Absolute contra-
indications to phenol-based peels include history of
hypertrophic scarring or keloid formation, Fitzpatrick
skin Type VI, and recent surgical rhytidectomy, as
vascular compromise and scar formation can occur
when deep peel is applied to recently undermined
skin.57 Ideal peel candidates should be both willing
and actually adherent to postpeel care regimens,
including strict photoprotection. Men who work or
regularly exercise outdoors may present a relative
contraindication depending on the patient’s ability
and/or willingness to avoid sun exposure to the treated
area postpeel. Although there are no absolute con-
traindications for periorbital peeling, unless corrected
before the chemical peel, preexisting ectropion or
moderate-to-severe lower lid laxity are relative con-
traindications for lower eyelid peeling.48
Skin of Color
Ethnic skin, which traditionally includes Fitzpatrick
skin Type IV to VI, is prone to postinflammatory
pigmentary changes. Although deep peels should
generally be avoided or reserved for special circum-
stances, superficial and medium-depth peels can still
be reliably used in this population.58,59 Among chem-
ical peels, superficial peels, such as salicylic acid
[20%–30%], are among the safest to use on ethnic
skin patients.58,60,61 Salicylic acid [30%] is favored by

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some authors62 for improving pseudofolliculitis bar-
bae (PFB) in men, although serial glycolic acid [50%–
70%] peels and Jessner solution can also be effective
for PFB.63–65 Newer peels such as b-lipohydroxy acid
(a salicylic acid derivative), salicylic-mandelic acid (an
AHA), and amino fruit acids have shown some
promise in treating acne and dyschromias in skin of
color.58
Similar superficial and medium-depth peels can be
used in skin of color patients with some caveats. For
example, the Grade II white frost heralding the end
point for TCA peels in lighter-skinned individuals
should be avoided in darker phototypes to diminish
the risk of dyschromia and scarring.59 Furthermore,
predictable response and common complications from
TCA treatment can be anticipated by classifying skin
of color patients into a genetico-racial skin classifica-
tion system (Table 3).66 Ethnic skin patients should
also be instructed to avoid retinoids and other exfo-
liants at least 7 days before a peel to reduce risk of
greater peel penetration and potential post-
inflammatory pigmentary changes. Some experts also
suggest a prepeel regimen that includes bleaching
agents, such as hydroquinone, to mitigate induction of
dyschromias.40,43,64,67
Practical Considerations
A prepeel consultation is of utmost importance to
ensure that both the physician and patient have com-
municated their expectations and risks and benefits are
appropriately discussed. A thorough history should be
obtained that includes assessment of the history of
recurrent herpes simplex virus infection and anabolic
steroid use, in which acne can be recalcitrant and
associated with aberrant scarring. Medium to deep
chemical peels may be contraindicated in patients who
have undergone oral isotretinoin therapy within the
past year.22 Normal healing can be observed in
patients with acne despite undergoing Jessner-TCA
[35%] peel and manual sandpaper abrasion within 1
to 3 months of taking oral isotretinoin; however, each
patient is unique.68 Depending on the planned chem-
ical peel to be used and area to be treated, a prepeel
skin regimen involving daily topical retinoid may be
warranted, especially for hyperkeratotic or sebaceous
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RESERVA ET AL
lesions.22 Physicians must emphasize the need for
work and social downtime, as well as the importance
of photoprotection before and after the peel
to minimize background pigmentation.
Men may require more treatments or higher concen-
trations of peeling agents than do women because of
the higher proportion of sebaceous skin and higher
density of hair follicles.6 In the authors’ experience,
men tolerate more aggressive degreasing, greater vol-
ume of peeling agents, and more aggressive clinical
pressure when applying the peeling solution, which
correlate with a deeper and more effective chemical
peel. To minimize the line of demarcation, it is
important to feather the peeling solution into the
hairline, or into the scalp in patients with androgenetic
alopecia. Segmental combination peels using different
strength peels on different parts of the same face are
especially valuable for male patients who do not use
makeup so as not to compromise less sun-damaged
skin with the chance of pigmentary change. When
applying a medium-depth peel to the face, one author
(S.S.) ends the medium-depth peel at the mandibular
border and then applies a superficial peeling agent
(such as Jessner solution or TCA [15%–20%]) on the
neck to the clavicle, which in his experience provides
more visually continuous skin rejuvenation. It is
important to note that medium-depth peels have
unpredictable penetration of skin on the neck and have
been associated with scarring.29 The authors use gauze
or cotton-tipped applicators for delivery of superficial
and medium-depth peeling agents. Cotton-tipped
applicators are advised for phenol–croton oil peels or
application of any peeling agent to the eyelids. Post-
procedure care does not differ between men and
women, and willingness to adhere to postoperative
care should be considered during prepeel consultation.
The authors recommend male patients avoid shaving
of the treated area until reepithelialized, approxi-
mately 1 week. Postprocedure erythema may be
addressed with green-tinted cosmetic products or
topical a-adrenergic receptor agonists, though in one
author’s [S.S.] experience, effectiveness is unpredict-
able in the latter.
In medium-depth peels, herpes simplex virus pro-
phylaxis (e.g., valaciclovir 1 g daily) is
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8
DERMATOLOGIC SURGERY

CHEMICAL PEELS FOR MEN

TABLE 3. Genetico-Racial Skin Classification Categories and TCA* Peel Outcomes66

Mid-
Southern Caucasians/ Northern, Central, and Northern Southern Europeans/ Europeans (e.
Indo-Pakistanis (e.g., Southern Asians (e.g., Europeans/Nordics Mediterraneans (e.g., g., French,
Central and Indian, Egyptian, or Chinese, Japanese, or (e.g., Scandinavian, Spanish, Greek, Italian, German, or
Southern Africans Saudi Arabian) Filipino) Irish, or Scottish) or Turkish) English)
Geographic Origin Central and Southern Northern Africa and Eastern Asia Northern Europe Southern Europe, Central Europe
Africa Western Asia Northern Africa, and
Western Asia
Facial Features Large Moderately large Moderately large Fine Slightly large Medium
Skin Thick, with black to Thick, with a deep tan to Thick, with light medium Thin, white with a pink Slightly thick, with Average
Characteristics deep black dark brown or dark brown element a medium tan thickness,
white or light
tan
TCA Peel Acceptable (with Acceptable to good (with Good (with light and Good (with light to Good to very good (with Excellent (with
Outcomes very light peels) light peels) medium peels) medium peels) medium and deep peels) all peels)
Hyperpigmentation +++ +++ ++ +/2 ++ +
Hypopigmentation If deep peel If deep peel Rare with deep peel 2 2 2
Erythema +/2 +/2 ++ (later turns into +++ ++ +
hyperpigmentation)

*Very light peels with TCA is less than 30%; light is 30% to 35%; medium is 35% to 40%; and deep is 40% to 45%.

TABLE 4. Tips and Pearls for Management of Adverse Reactions and Complications66,67
Sequelae Pearls
Hypertrophic  Early signs of scar formation include
scarring persistent erythema, induration, pruritus,
and delayed healing
 Initiate treatment at earliest recognition of
scarring
PIH  Fitzpatrick skin Types III–VI at highest risk
 Consider performing test spot in at risk
patients
 Initiate treatment once reepithelialized
Allergic contact  Most commonly due to resorcinol
dermatitis
Pustule  Bacterial or Candida infection
formation
Painful erosions  Painful skin lesions occurring postpeel
or ulcerations should be treated as herpetic infection
Acneiform  Associated with medium-depth peels
eruption
PIH, postinflammatory hyperpigmentation; PDL, pulsed dye laser; po, by mouth; bid, twice daily; tid, three times daily.
recommended until the treated area has fully ree-
pithelialized (Table 4). 12,69 For full face peel or
periorbital rejuvenation, systemic corticosteroids,
such as a methylprednisolone dose pack, may be
considered to reduce postpeel inflammation. As
with most cosmetic procedures, standard baseline
and posttreatment photography is critical to ensure
accurate documentation and allow for evaluation
of improvement. For medium-depth and deep
peels, a follow-up in-office clinic visit with pho-
tography at 1 week after the procedure allows the
physician to assess wound-healing progress
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RESERVA ET AL
Management Tips
 Scar massage
 Silicone gel sheeting
 Topical, intralesional, or oral steroids
Class I topical steroid bid
Intralesional triamcinolone acetonide injections (10–
20 mg/mL tailored to scar thickness) performed
monthly
 PDL
 5-FU injections may be used in combination with
intralesional steroids and/or PDL treatments
 Sunscreen with physical blocking ingredient
(titanium dioxide or zinc oxide)
 Hydroquinone 4% or higher bid
6 topical retinoid and low potency steroid (or
combination product with hydroquinone/retinoid/
steroid)
 Topical immunomodulator (tacrolimus 0.1%
ointment) may be added to treat residual
inflammation
 Glycolic acid peels (10%–30%) every other wk
 Topical steroids
 If severe/persistent: methylprednisolone dose pack
 Swab for gram stain, culture, and sensitivities
 Empiric fluconazole 150 mg po · 1 dose; Consider
addition of oral antibiotic, such as doxycycline, while
awaiting culture results
 Direct fluorescent antibody test and/or viral culture
for herpes simplex virus or varicella-zoster virus
 Empiric valacyclovir 1 g tid · 10 d
 Unroof pustules
 Tetracycline class oral antibiotic · 2 wk
 Intralesional triamcinolone acetonide injection (2.5
mg/mL)
and make any adjustments in the postpeel care
regimen.
Conclusion
The growing interest of men in minimally invasive
aesthetic procedures behooves dermatologists to have
a working knowledge of chemical peels and their
potential to improve aesthetic concerns of the male
patient. Either as monotherapy or when combined
with other noninvasive skin rejuvenation modalities,
chemical peels are excellent options for the
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 CHEMICAL PEELS FOR MEN
contemporary man seeking cost-effective treatment
with reliable results and minimal downtime and
adverse effects.
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Address correspondence and reprint requests to: Rebecca
Tung, MD, Division of Dermatology, Loyola University
Medical Center, Building 54, Room 101, 2160 S. First
Avenue, Maywood, IL 60153, or e-mail: rtung@lumc.edu
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