Chemical peels: Are they safe for cancer patients?

Chemical peels have been credited with everything from eliminating wrinkles and acne scars to stimulating cell growth and reversing sun damage. But is there any truth to those claims, and are chemical peels safe for cancer patients? 

To separate fact from fiction, we went to Valencia Thomas, M.D., a dermatologist who serves as director of MD Anderson’s Mohs Center. Here’s what she shared. 

What is a chemical peel?

A chemical peel is a form of controlled exfoliation in which an acid solution is used to remove the top layer(s) of skin.  

Human skin has three layers:  

• epidermis (top) 
• dermis (middle)  
• fat (bottom) 

A chemical peel at a spa or salon is normally only going to affect the dead cells on the outermost layer, or the outside of the epidermis. But doctors use chemical peels in a very controlled manner to affect living tissues further down and remove abnormal cells or pigment. 

What is the purpose of a chemical peel?

Out in the wider world, they’re used mostly by aestheticians to improve someone’s physical appearance. Chemical peels can even out skin tone and leave it looking smoother by removing the dead skin cells on top. They can also diminish the appearance of age spots, fine lines, wrinkles, acne scars and birthmarks. 

Here at MD Anderson, we use chemical peels primarily to treat a pre-cancerous skin growth called actinic keratosis. We also use them to treat skin disorders caused by cancer treatments, such as: 

• severe acne: seen with certain chemotherapy agents and newer targeted therapies, including epidermal growth factor inhibitors 
• melasma: a pigmentation change sometimes caused by chemotherapy 

Are there different types of chemical peels?

Yes. They’re normally categorized as superficial, medium or deep. 

A superficial peel is just removing dead skin cells from the surface of the epidermis to expose the living tissue underneath.  

A medium or deep peel goes past the living outer layer and into the deeper layers of skin. If you’ve ever skinned your knee and seen the white stuff there, that’s collagen. We perform chemical peels to reach down to that layer. Those chemical peels address the full thickness of the epidermis, and also begin to impact the dermis. 

Is it true that some chemical peels can “reverse” sun damage?

Not entirely. Depending on which chemicals you use, you might be able to remove sun-damaged cells and improve the appearance of sun-damaged skin by removing the top layers and stimulating new cell growth. But nothing’s ever going to reverse it completely.  

UV damage is cumulative, and it penetrates deeper than a chemical peel could ever go. So, all that’s being changed is the superficial. That’s why it’s so important to use sunscreen, wear protective clothing, avoid tanning beds, and seek shade when the sun’s rays are at their strongest, between the hours of 10 a.m. and 4 p.m. 

Does skin literally flake off after a chemical peel? Does it blister like a sunburn? What can I expect?

You should never get a blister from a chemical peel. If that happens, something is very wrong. 

A lot of times, people won’t notice any peeling or dry skin at all after a chemical peel. Others see true peeling, like you get sometimes with a bad sunburn. That normally happens about 3 to 4 days after a chemical peel. For some reason, it’s also usually most noticeable right around the nostrils. 

What types of acids are used in a chemical peel?

The two we use most frequently here at MD Anderson are salicylic acid for superficial peels and tricholoracetic acid for superficial and medium-depth peels. But a more complete list includes: 

• Glycolic acid: It is a plant-derived acid that’s available over the counter. 
• Salicylic acid: This is good for acne because it can dissolve blackheads.  
• Jessner’s solution: A proprietary combination of ethanol, resorcinol, salicylic acid and lactic acid, this one must be mixed by a pharmacist. 
• Lactic acid: It’s similar to glycolic acid. 
• Phenol: This is a component of embalming fluid that’s normally used for deep peels. It’s strongly associated with scarring and cardiac arrhythmia, though, so we don’t use it. 
• Tricholoracetic acid: This is not typically administered by aestheticians, because once it’s on the skin, there’s no way to neutralize it. 

Some of these are used more frequently with one kind of peel than another, but it’s really the concentration of chemical you use and the amount of time you leave it on the skin that determine a peel’s depth. 

Do dermatologists ever recommend chemical peels?

Yes, in the right clinical setting. Ours do either to treat primary skin disease or to treat secondary skin disease that results from cancer therapy. 

Are there any people who should not get a chemical peel?

People of any skin color can get a chemical peel. Issues usually only arise when people have certain underlying inflammatory disorders or the integrity of skin is already compromised.  

We would not perform a chemical peel, for instance, on someone who has visible tears or breaks in their skin, or whose skin is inflamed due to radiation therapy. 

What are the risks of chemical peels?

The most common side effects from chemical peels are: 

• tenderness/pain 
• scarring 
• blistering 
• pigmentary changes (undesired darkening or lightening of the skin) 
• increased sun sensitivity 

When performed by an expert, though, chemical peels are normally quite safe and effective. 

How should you care for your skin after a chemical peel?

It’s very important to protect your skin with sunscreen after a chemical peel. Once it’s been exfoliated, it’s very sensitive, like a baby’s.  

If you’re planning to have another cosmetic procedure, such as waxing, done to the same area, I’d advise waiting to do it until at least a week after the chemical peel.  

Also, if you’re using retinoids at home, stop one week before you get a chemical peel, and wait another week to restart them afterward. Otherwise, you risk burning your skin, and a burn can contribute to scarring. 

How long do the benefits of a chemical peel last? How often can you have one?

The benefits of a chemical peel depend on the depth of the peel. Over-the-counter peel products may require re-application weekly or every other week, as indicated by the product directions. Superficial, in-office peel benefits may last 1 or 2 months, while a medium-depth peel may last 2 or 3 months.  

Request an appointment at MD Anderson online or call 1-877-632-6789.