A Review of Chemical Peels for Acne Treatment

Common chemicals used to control acne include glycolic acid, benzoyl peroxide and salicylic acid. Benzoyl peroxide and salicylic acid are available without a prescription. Glycolic acid has recently been allowed for over-the-counter use and weaker solutions of glycolic acid are now available without a prescription.

Chemical peels work by chemically burning off the top layer of skin. This process kills bacteria associated with acne and is highly effective. There is no risk of increasing antibiotic resistance since these chemicals simply burn the bacteria. These chemical burns are the equivalent of unprotected sun exposure and increase UV penetration to the skin. This mode of action can lead to an increased risk of skin cancer similar to chronic sunburns. The Food and Drug Administration (FDA) has required that recommendation of sunblock or sun avoidance be printed clearly on packages to protect consumers of these risks.^[1] However, since this is not required by law, it is up to the manufacturer to place these warnings on the package. In addition, when chemicals are used improperly by consumers, chemical burns may result and often require addition medical attention to treat the chemical burn. Furthermore, chronic chemical burns to the face may lead to premature aging and skin cancer.

The 'tingling' that you feel when using acne control products that chemically remove a layer of skin is NOT simply "deep cleaning". It is the mild pain associated with chemically burning off a layer of living tissue. This layer of living tissue is the layer the contains cells that protect your skin from UV radiation, dehydration and block bacteria and environmental toxins from entering your skin and causing contact dermatitis, or acne symptoms. The mode of action is similar to unprotected sun exposure: a sunburn.

Benzoyl peroxide has been shown to be a tumor promoter and progression agent in mice, rats and hamsters. This may lead to a significant skin cancer risk considering the suggested use of benzoyl peroxide twice daily as a control for acne. According to this package insert for BenzaClin Topical Gel Safety Information, "Benzoyl peroxide has been shown to be a tumor promoter and progression agent in a number of animal studies. The clinical significance of this is unknown." "Benzoyl peroxide in acetone at doses of 5 and 10 mg administered twice per week induced skin tumors in transgenic Tg.AC mice in a study using 20 weeks of topical treatment."^[2] This study, Free radical generating agents lead to the rapid progression of benign skin tumors to carcinoma in iron-overloaded mice. states, "Inorganic peroxide (H(2)O(2))-mediated malignant transformation was also enhanced effectively by iron."^[3] Here is another study that shows a connection between benzoyl peroxide and skin cancer, Benzoyl peroxide promotes the formation of melanotic tumors in the skin of 7,12-dimethylbenz "Therefore, in addition to its known ability to promote papilloma and carcinoma formation in the back skin of mice, benzoyl peroxide is also able to promote the formation of melanotic tumors in the dermis of hamsters."^[4] In another study, benzoyl peroxide was shown to increase carcinogenesis, The function of benzol peroxide in the induction of Syrian golden hamster tongue carcinoma by chemical carcinogen "CONCLUSION: This study indicated that benzoyl peroxide could increase carcinogenesis of golden hamster tongue which induced by DMBA. Consideration of promoting agent should be taken in carcinogenesis as well as carcinogen." ^[5]And yet another study shows that benzoyl peroxide is a scientifically common tumor promoter, The treatment of skin carcinoma, induced by UV B radiation, using 1-oxo-5beta, 6beta-epoxy-witha-2-enolide, isolated from the roots of Withania somnifera, in a rat model. "...followed by topical treatment with benzoyl peroxide, a tumor promoter (20 mg/animal/0.2 ml acetone) twice a week for 1 month..."^[6]

While salicylic acid isn't actively used to promote skin cancer in lab animals, it also has risks in addition to the FDA required sunblock protection warning. Salicylic acid is also called Willow bark extract, Oxybenzoic acid,Ortho-oxybenzoic acid, salix alba, and more - some of which are derivatives of wintergreen. According to the International Programme on Chemical Safety, Salicylic acid is a derivative of aspirin that is readily absorbed through the skin. This documentation also includes that dermal absorption can lead to salicylism, an allergic response to aspirin. "Chronic usage of salicylic acid and or methyl salicylate in skin and rheumatic diseases may cause intoxication through percutaneous absorption."^[7] Symptoms of salicylism include: Some of the indications of aspirin sensitivity include: itchy and watery eyes, itchy rashes, nasal congestion, hives, worsening asthma, rashes around the mouth, cough and wheezing, and anaphylaxis - a severe, potentially fatal reaction including hives, difficulty breathing and a drop in blood pressure; fortunately rare in aspirin sensitivity. Unlike the FDA requirement for aspirin warnings on oral medications, there is no requirement for this information to be disclosed to consumers on cosmetic products with the same risks. In addition, considering the fact that salicylic acid is absorbed through the skin, there is the same risk of Reye's Syndrome, a lethal liver and brain disorder, from topical products that contain salicylic acid. According to the National Reye's Syndrome Foundation, ""While these products are not ingested through the mouth, certain ingredients may be absorbed through the skin and therefore a potential risk where Reye's Syndrome is concerned."

Of the three, glycolic acid appears to be the least harmful to the human body. It is not used to promote or induce skin cancer in lab animals, cannot cause an allergic response to aspirin, and most likely does increase your risk of Reye's Syndrome. However, it is a potent photosensitizing agent, removes a layer of skin and strips the skin of oils - just like a sunburn.

Chemical peels dry out the skin and often lead to excessive dryness, peeling, flaking and redness. The dry skin itself leads to clogged pores and results in acne symptoms within days of stopping treatments. Conventional moisturizers, lotions and creams often contain ingredients that are contact allergens, increasing the risk that acne will be more severe if treatment is stopped than it was prior to starting treatment.

Acne symptoms that are an allergic response to contact allergens, environmental pollution and dioxins, as noted in "What Causes Acne?", cannot be controlled with chemical peels. While the bacteria associated with acne are controlled effectively during treatment, if contact allergens, environmental pollution and dioxins that contribute to acne symptoms are not removed, the acne will return within days of stopping treatment.

The costs associated include regular purchases of the desired chemical solution, which can be quite expensive. Often the cost to the consumer is well over $50 per month. The increased risk of skin cancer has the potential to be of social consideration as skin cancer is often a life-long disease and treatment is extremely expensive. The increased risks with salicylic acid of allergic response to aspirin and worsening asthma symtoms should be considered as well as the increased risk of Reye's Syndrome. These risks have the potential to increase health care cost for privately insured and increase taxation to cover medical expenses for those who are under insured or have no insurance.

Summary

Chemical peels are much more costly than holistic controls and come with a lot of potential risks that can add to increased insurance premium and social taxes for under-insured or un-insured, and risk of life-time maintenance of skin cancer add to social burden. Environmental fate of these chemicals remains unknown at this time. I was not able to find any studies to evaluate if these chemicals survive the disinfection process at waste treatment facilities and there is the potential that these chemicals may be returned to the consumer in their drinking water.

To learn other treatment options for your acne, such as antibiotic treatment, isotretinoin treatment and holistic treatment please visit: http://www.sunflowernaturals.com.

Resources:

1. Food and Drug Administration, http://vm.cfsan.fda.gov/~dms/cos-bha.html

2. BenzaClin Topical Gel Safety Information, http://www.fda.gov/medwatch/SAFETY/2005/APR_PI/BenzaClin_PI.pdf

3. Free radical generating agents lead to the rapid progression of benign skin tumors to carcinoma in iron-overloaded mice., http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=14647977&ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

4. Benzoyl peroxide promotes the formation of melanotic tumors in the skin of 7,12-dimethylbenzhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3102100&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

5. The function of benzol peroxide in the induction of Syrian golden hamster tongue carcinoma by chemical carcinogen, http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12539642&ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

6. The treatment of skin carcinoma, induced by UV B radiation, using 1-oxo-5beta, 6beta-epoxy-witha-2-enolide, isolated from the roots of Withania somnifera, in a rat model., http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15330502&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

7. International Programme on Chemical Safety, http://www.inchem.org/documents/pims/pharm/pim642.htm8. National Reye's Syndrome Foundation, http://www.reyessyndrome.org/aspirin.htm#TOPICAL