Compounded Chemical Peels

September 1, 2023

With summer coming to an end, many patients will begin to notice sun damage and request treatment to erase or reduce signs of spots and discoloration. While there are a plethora of OTC options available to repair sun damage and other common skin conditions like acne, these rarely meet the needs of patients who may require higher or lower dosages or may even need combination chemical peels. Now more than ever, patients are demanding increasingly personalized skincare, but most commercially-available skincare options are meant to work for “everyone,” which means they are often ineffective for certain patient populations.

Given the number of factors that affect how a patient will respond to a chemical peel – including skin type, thickness, health, and more – the type and strength of the peel (superficial, medium-depth, and deep) may need to be adjusted for each individual patient. In some cases, it may even be appropriate to administer multiple peels to achieve desired results. Fortunately, a compounding pharmacy will be able to prepare chemical peels in a variety of strengths and combinations to help a patient meet their skincare goals.

Superficial Peels

Superficial peels are typically composed of alpha-hydroxy acids, such as glycolic acid and salicylic acid, and work by weakening the bonds between the keratinocytes of the stratum granulosum and causing abnormal skin cells to slough off. Because superficial peels are meant to provide more subtle improvements by targeting only the topmost layers of the skin, they should typically be neutralized by applying cold water within three to five minutes after application. This minimizes the likelihood of the active ingredients penetrating deeper into the skin, providing the patient with milder effects and shorter recovery times. In some cases, it may be necessary to neutralize them earlier if there are signs the patient is developing erythema, intolerable discomfort or excessive frosting.1 Many of these superficial chemical peels are suitable for at-home application by the patients.

Azelaic Acid Peel: Azelaic acid is a naturally-occurring acid derived from grains like barley and wheat. It has anti-inflammatory and antimicrobial properties, making it effective for treating acne and rosacea and for reducing pigmentation and melasma. Azelaic acid peels are generally considered safe for various skin types.
Glycolic Acid Peel: Glycolic acid is derived from sugarcane and is used for its exfoliating properties, promoting cell turnover and improving skin texture. It can help reduce fine lines, uneven skin tone, and mild sun damage and can also treat frictional dermal melanosis.1 Glycolic acid peels are effective for various skin types but may require caution for sensitive skin. It may be appropriate to use a concentration on the lower end of available strengths, something that a compounding pharmacy can create.
Salicylic Acid Peel: Salicylic acid penetrates oil glands and pores, helping remove debris and reduce breakouts. Salicylic acid peels are best for individuals with acne-prone or oily skin and are particularly effective for addressing blackheads, whiteheads, and mild to moderate acne.
Rebrighten Peel (Salicylic Acid 10%, Lactic Acid 7%, Mandelic Acid 8%): Rebrighten peels are designed to target pigmentation issues, such as melasma and sunspots, and can help reduce discoloration and improve overall skin tone. Rebrighten peels are ideal for individuals dealing with stubborn pigmentation concerns, such as melasma or sunspots, and those who desire little downtime.

Medium-Depth Peels

As the name implies, medium-depth chemical peels penetrate deeper into the skin than superficial peels. They are meant to address more significant skin concerns, such as moderate wrinkles, sun damage, and pigmentation issues. The depth of penetration can vary based on the individual’s skin characteristics, potentially making compounded preparations necessary to treat an individual patient’s needs.

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Modified Jessner’s Topical Solution (Salicylic Acid, Lactic Acid, Mandelic Acid): Jessner’s peel is a combination peel that provides a deeper exfoliation than single-acid peels and helps address more advanced skin concerns, including skin texture, moderate acne, and pigmentation issues.
Trichloroacetic Acid (TCA): When used at a concentration of 35 percent, TCA can help repair signs of photoaging.² A compounding pharmacy can also be reformulated into various strengths to achieve a superficial or deep peel or treat other concerns. For instance, 15 percent TCA has been shown to help treat frictional dermal melanosis.¹
VLS Peel (Ascorbic Acid, Phenol, Salicylic Acid, TCA, Vitamin A Palmitate, Glycolic Acid): This medium-depth peel is an option for patients who want fresh, healthy, and radiant skin. The combination of powerful ingredients addresses early signs of aging, sensitive skin, rough texture, and keratosis pilaris. It is most often administered in a series of three peels for maximum benefits.

Deep Peels

Deep chemical peels are the most aggressive type of chemical peels and are meant to address more serious skincare concerns by penetrating deeper into the skin, reaching the reticular dermis. Due to their more aggressive nature, a longer downtime is typically necessary compared with medium-depth and superficial peels. They should only be administered in-office by a licensed medical professional or an expert.

Compounded Combination Peels

To achieve a patient’s individualized skincare goals and minimize the risk of scarring, it may be necessary to administer a different strength or a combination of the chemical peels listed above. One study showed that combination peels are more effective than individual peels at treating conditions like acne vulgaris.³ Combination peels can target multiple skin concerns simultaneously by combining different active ingredients and should be formulated by a licensed compounding pharmacy. Some combination chemical peels include:

Jessner’s Solution, followed by 35% TCA: Jessner’s solution penetrates the epidermis, and TCA is applied after Jessner’s solution has dried.
Glycolic Acid and 35% TCA: This combination penetrates slightly deeper than Jessner’s/TCA combination peel mentioned above.⁴
Salicylic Acid and Kojic Acid: This combination peel uses salicylic acid to address acne-prone skin by unclogging pores and reducing inflammation, while kojic acid (or even azelaic acid) targets hyperpigmentation and evens out skin tone.
Salicylic Acid and Niacinamide: This combination can address oily and acne-prone skin. Salicylic acid is used for oil control and pore refinement, while niacinamide regulates sebum production, reduces inflammation, and helps hydrate dry skin.
Jessner’s Topical Solution and Niacinamide 5%/Tranexamic Acid 3%/Kojic Acid 2%/Hydroquinone 2%: As shown by the photo below, this combination can help address a variety of issues to reveal bright, glowing skin. The patient in the photo completed a series of three Jessner’s peels (spaced four to six weeks apart), combined with a compounded topical cream of niacinamide 5%/tranexamic acid 3%/kojic acid 2%/hydroquinone 2% between treatments.

How a Compounding Pharmacy Can Help Prepare Chemical Peels

The appropriate ratio and strengths of any chemical peel will vary depending on the severity of the dermatological issue to be treated, as well as the individual patient’s skin characteristics. In addition to combination peels, any of the more standard peels mentioned previously may also need to be adjusted to meet a patient’s specific needs. This customization may involve:

Decreasing the strength (concentration) of the active ingredient, as is often appropriate for patients with sensitive skin. In contrast, increasing the strength of the active ingredient may be necessary to address some more severe skincare issues.
Developing a completely customized formulation to set your practice apart from competitors.
Developing formulations with or without specific ingredients that may irritate a patient’s skin. For example, niacinamide (vitamin B3) can be included in a topical cream to soothe and hydrate dry skin after a peel.

A licensed compounding pharmacy such as VLS Pharmacy & New Drug Loft can work with prescribers to prepare the optimal compounded chemical peel for a patient based on their specific needs, skin type, and skincare goals.

Please comment below with any thoughts or questions. Reach out to our team to learn about best practices and to partner with our experts about our other nutritional IV therapies for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

Want to learn even more? VLS Pharmacy, in partnership with Pharmacy Compounding Centers of America, presents an exclusive recording of the Dermatology Conference: Inspiration & Innovation to guide seasoned providers as well as those looking to get started.

References

Sacchidanand S, Shetty AB, Leelavathy B. Efficacy of 15% Trichloroacetic Acid and 50% Glycolic Acid Peel in the Treatment of Frictional Melanosis: A Comparative Study. J Cutan Aesthet Surg. 2015;8(1):37-41. doi:10.4103/0974-2077.155078
Starkman SJ, Mangat DS. Chemical Peels: Deep, Medium, and Light. Facial Plast Surg. 2019;35(3):239-247. doi:10.1055/s-0039-1688944
Nofal E, Nofal A, Gharib K, Nasr M, Abdelshafy A, Elsaid E. Combination chemical peels are more effective than single chemical peel in treatment of mild-to-moderate acne vulgaris: A split face comparative clinical trial. Journal of Cosmetic Dermatology. 2018;17(5):802-810. doi:10.1111/jocd.12763
Coleman WP, Futrell JM. The Glycolic Acid Trichloroacetic Acid Peel. The Journal of Dermatologic Surgery and Oncology. 1994;20(1):76-80. doi:10.1111/j.1524-4725.1994.tb03753.x