Safety of Chemical Peels in Pregnancy

Chemical peels are commonly used treatments to keep skin looking fresh and healthy. Additionally, they are helpful in treating a variety of dermatologic conditions including acne, rosacea, and melasma among others. Because they are relatively easy to utilize and there are many options to choose from, pregnant women may consider using them for facial rejuvenation. However, the safety of these treatments during pregnancy is difficult to assess due to the lack of formalized studies. Here, we give an overview of what chemical peels are, the types that exist, and what we know about their safety during pregnancy.

What Are Chemical Peels?

Chemical peels usually consist of a substance that causes localized destruction of skin cells (keratinocytes) and the connections between those cells when applied to the skin. The exfoliation of old, damaged and/or existing skin cells makes way for new, regenerating skin cells with increased protein (collagen and glycosaminoglycans) deposition which gives the skin a healthier, firmer appearance.^[1] This is known as skin resurfacing and results in epidermal thickening and an increase in dermal volume. The overall goal of a chemical peel can be to improve the quantity and quality of acne scars, reduce inflammation and dyspigmentation, and/or for more youthful appearing skin.^[2] 

Different types of peels are classified based on their depth of penetration of the skin. Superficial peels cause controlled wounding of the epidermis, the top layer of the skin. These peels are used to treat mild dyspigmentation/sun damage and minor fine lines on the skin. Milder alpha-hydroxy acids such as 20-70% glycolic acid peels and lactic acid peels, and other acids such as 10-20% trichloroacetic acid peels and salicylic acid peels are typically used.^[3]

Medium-depth peels go deeper into or through the papillary dermis, the second layer of the skin. These peels are used to treat wrinkling, moderate sun damage, melasma, pre-cancerous skin lesions (actinic keratoses) and superficial scarring. These agents include TCA 35-70% peels alone or in combination with other substances, and Jessner’s solution, a combination of alpha hydroxy acids and resorcinol.^[1]

Deeper scarring, more severe pigmentary changes, and large amounts of sun damage can be treated with higher concentrations of TCA (>50%) or the specialized Baker-Gordon formula containing phenol.^[3]

General Side Effects

Side effects of chemical peels vary with the type of peels used. Stronger concentration and deeply penetrating peels have a greater likelihood of causing adverse effects. Mild redness, stinging, burning, pain, and itching is common immediately after treatment. Blistering and skin color changes (either lightening or darkening of certain skin areas) can also occur. Most of these symptoms resolve over time. However, skin color changes may last longer or be permanent in some individuals.^[4] It is important to consider patient skin tone when choosing the type of peel, as darker skin tone patients have a greater chance of developing post-inflammatory hyperpigmentation (darkening of skin) with stronger peels. Therefore, peels in darker skin types are to be used with highest caution.

Safety of Chemical Peels During Pregnancy

Although we have limited long-term safety data on chemical peel use during pregnancy, we will review what we do know about some of the most commonly used peels. This information is summarized in the table below.

Alpha-hydroxy peels

Glycolic acid peels and lactic acid peels are two of the most commonly used alpha-hydroxy peels used for skin treatment. These peels are considered to be generally safe since they do not seem to significantly penetrate the deeper skin layers where blood vessels exist.^[6] Glycolic acid peels remove the outer layer of the skin and induce desquamation.^[7] Lactic acid peels have also been safely used in pregnant patients for gestational acne with no reported negative effects to the pregnancy or fetus.^[8]

Beta-hydroxy peels

A commonly used beta-hydroxy peel, salicylic acid (SA), has an uncertain pregnancy safety profile, so this product should be used with caution or avoided in pregnant patients. SA peels have been shown to have greater penetration of deeper skin levels when used in large areas or under occlusion. Therefore, if these peels are used in pregnancy, they should be limited to small areas of the body.^[8]

Other peels

Jessner’s peel is a combination peel which consists of lactic acid, salicylic acid, and resorcinol (a skin-lightening agent). It is considered to exhibit moderate penetration of the skin layers. This product contains SA and should therefore be avoided or used with caution in pregnancy.

TCA peels have been used safely in pregnant patients to treat genital warts on a case-by-case basis.^[9] One study published in 2013, associated high urine TCA levels in mothers with fetal growth retardation. These women were not, however, treated with TCA products prior to urine measurements and a direct causative effect between TCA product use and fetal birth weights was not established.^[10] TCA can also be easily absorbed from mucosal surfaces (mouth and genitalia) and surfaces around the eyes. Therefore, this peel should be used with caution in pregnant patients and is not recommended as a first-line peel.^[8]

Key Takeaways

• The uncertainty surrounding the safety of cosmetic procedures, such as chemical peels, during pregnancy should be addressed to ensure proper patient education about the reported and theoretical risks
• Glycolic acid and lactic acid peels are considered safe during pregnancy
• Whenever possible, however, it is safest to delay unessential chemical peel procedures until at least the second trimester of pregnancy