Combination Superficial Peels With Salicylic Acid and Post-Peel Retinoids

April 2016 | Volume 15 | Issue 4 | Original Article | 442 | Copyright © April 2016

Douglas E. Kligman MD PhDa and Zoe D. Draelos MDb

aDepartment of Medicine, Chestnut Hill Hospital, Philadelphia, PA
bDepartment of Dermatology, Duke University School of Medicine, Durham, NC

BACKGROUND: Salicylic acid (SA) and retinoids, tretinoin (all-trans retinoic acid [ATRA]), and retinol (all-trans retinol) are widely used as topical agents for the improvement of photodamage and acne vulgaris. They can be used in daily take-home products or as part of an in-office procedure, combining the benefits of a keratolytic (SA) and a retinoid.
OBJECTIVE: The objective of this research was to compare the efficacy for ameliorating photodamage of topical tretinoin (0.25%) and retinol (0.25%) to baseline and with each other when applied after a 30% salicylic acid peel on human facial skin.
METHODS: Twenty female subjects received a full face 30% SA peel followed by the overnight application of tretinoin to a 1 randomized half-face and retinol to the opposite side (split-face study). The identical procedure was repeated at week 2. Double-blinded subject and investigator assessments of the results were captured at weeks 2 and 4.
RESULTS: By investigator evaluation, both peeling regimens were effective in improving photodamage parameters compared to baseline. (ATRA P-values at week 4 were: P=.00008 texture, P=.00013 roughness, P=.00221 pores, P=.00098 dryness, P=.02770 erythema, and P=.00008 overall appearance. Retinol P-values at week 4 were: P=.00019 texture, P=.00053 roughness, P=.00221 pores, P=.00147 dryness, P=.02770 erythema, and P=.0043 overall appearance.) By subject self-assessment compared with baseline, both tretinoin and retinol were effective in improving overall appearance (ATRA P=.0229 and retinol P=.0190). By investigator evaluation comparing tretinoin with retinol, tretinoin was slightly better than retinol at week 4 in improving texture P=.00506, roughness P=.01171, and overall appearance P=.00506. By subject self-assessment comparing tretinoin with retinol, there was no difference in overall appearance (ATRA P=.2367 and retinol P=.3613).
CONCLUSION: Either topical tretinoin (0.25%) or retinol (0.25%) can be used safely and effectively when applied in office immediately after SA peeling to ameliorate signs of photoaging.

J Drugs Dermatol. 2016;15(4):442-450.


Patients desiring antiaging treatments are looking for efficacious procedures that yield rapid results with minimal downtime. Delivering these results can be challenging with a single modality. We have previously described a technique for achieving superficial chemical peels in an office setting using salicylic acid (SA) for the treatment of photoaging and acne vulgaris (AV).1 In addition, we have described a technique for rapid retinization of facial skin using high-strength tretinoin (all-trans retinoic acid) applied nightly for 1 month in an outpatient population.2
This research was conducted to determine if cumulative benefit could be achieved by combining an in-office 30% SA peel with a post-peel topical retinoid solution, consisting of either 0.25% tretinoin or 0.25% retinol. Neither of these retinoids, when used alone as a single application peeling agent, achieved the sought-after results of rapid patient-perceived improvement. After first peeling the stratum corneum (SC) barrier with a 30% SA peel, and then applying tretinoin or retinol, the penetration of these retinoids into the deeper layers of the epidermis was enhanced. The aim of the current study was to compare 0.25% tretinoin and 0.25% retinol as post-SA peel topical treatments both to baseline and with each other.


Twenty female subjects aged 18 years or older were enrolled with mild to moderate photodamage, enlarged pores, rough skin texture, AV, and hyperpigmentation in a single-site, double-blinded study evaluating the efficacy of the combination superficial chemical peel using 30% SA followed by a retinoid solution. The patient’s face was first cleansed with an alcoholic preparation pad. The 30% SA peel (SA prepared in 95% ethanol/5% water) was applied to the face of the study subjects with a sponge, followed by rinsing with water. Then either 0.25% all-trans retinoic-acid (tretinoin) or 0.25% all-trans retinol (retinol) solution, prepared in 50% ethanol and 50% polyethylene glycol 400, were applied to either the