Is a chemical peel compatible with vitiligo?

The essential points to remember.

It is feasible for individuals with vitiligo to perform mild chemical peels at home every three weeks.
In-salon chemical peels performed with potent exfoliating agents should be avoided for individuals with vitiligo, as they are too strong and staff may not be adequately trained.
Phenol peels may be considered to even out skin affected by vitiligo, but they must be performed by a qualified professional.

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Are there any risks associated with undergoing a chemical peel when you have vitiligo?

The vitiligo is a skin condition characterized by the progressive disappearance of melanocytes, the cells responsible for skin pigmentation. It manifests as the appearance of depigmented patches, often symmetrical, and may affect different areas of the body. Although neither painful nor contagious, the vitiligo can have a significant psychological impact due to its visibility and chronic nature. The exact causes of the disease are not fully understood, but it is an autoimmune process in which the immune system gradually destroys melanocytes.

Many people with vitiligo wonder whether they can undergo a chemical peel without exacerbating their depigmentation. Performing a peel or a mild scrub is possible, but should be done with caution. According to the French Vitiligo Association, a mild scrub can be performed every three weeks, provided that overly harsh products are avoided and that the particular sensitivity of depigmented skin is respected. The goal is to avoid causing microtrauma that could induce a Koebner phenomenon—that is, the emergence of new vitiligo patches at the sites of irritation. Among the gentlest exfoliants, one can specifically cite the gluconolactone, which belongs to the polyhydroxy acid (PHA) family.

However, it is advisable to avoid chemical peels performed in beauty salons, as estheticians are not necessarily trained to treat individuals with vitiligo, and the peels used in these facilities are often too harsh for depigmented skin.

Chemical peels and vitiligo: a viable therapeutic option?

Chemical peeling is not among the standard therapies used for the treatment of vitiligo.

However, some studies suggest that phenol may be of interest in a very specific context. This particularly deep chemical peel penetrates down to the reticular dermis and acts as a cytotoxic agent, causing melanocyte destruction. The objective is not to stimulate repigmentation but rather to reduce the contrast between pigmented and depigmented areas to even out the skin’s appearance. This approach can be considered in patients with stable, generalized vitiligo to limit the psychological impact of remaining patches and create the impression of a more uniform complexion. Therefore, it is a targeted cosmetic option to be used under strict medical supervision and only after a comprehensive evaluation of the skin and the type of vitiligo.

To illustrate the potential effects of phenol in the context of vitiligo, a case study was conducted on a 67-year-old woman who had suffered from vitiligo since childhood and still exhibited residual pigmented areas on her face, chest, and shoulders. The patient sought an alternative depigmenting approach because previous treatments had not produced satisfactory results. An 88% aqueous phenol solution was applied selectively to the pigmented regions of the face. The procedure was accompanied by cold compresses to mitigate the discomfort associated with exfoliation. After four applications to the same area, a complete depigmentation was achieved, and the same protocol was then extended to the other pigmented zones. The outcome was uniformly depigmented skin with no repigmentation observed over the course of one year, provided the patient maintained strict photoprotection.

Avant/après quatre séances de peeling au phénol 88%. — Before/after four sessions of 88% phenol peel.
Source: BITTENCOURT F. & al. Residual pigment islands treated with 88% phenol peeling in a woman with universal vitiligo. Actas Dermo Sifilliograficas (2021).

The depigmenting effects of phenol are based on a complex mechanism: this compound acts as a tyrosine analogue, interfering with the melanogenesis pathway and generating free radicals that lead to melanocyte destruction. It can also trigger a local immune response that contributes to depigmentation. Despite its efficacy, phenol carries risks, including scarring, dyschromias, or infections.

The use of phenol to reduce pigmentary demarcations in vitiligo should be strictly limited to professionals, and diligent sun protection is essential to prevent any repigmentation.