Evaluating Clinical, Confocal, and Microbial Changes in Facial Skin After a Professional Chemical Peel

Chemical peeling is a popular cutaneous resurfacing procedure for photoaging, fine lines, scarring, pigmentary disorders, wrinkles, and inflammatory dermatoses. We conducted a clinical pilot study with 18 subjects, involving initial screening, two peeling sessions, and a postpeel assessment. We used a combination peel containing 10% TCA and 24% lactic acid, with a pH ranging from 0.15 to 1.15. Subjects underwent clinic visits for cheek swabbing for microbial analysis, dermatologist assessment, VISIA imaging, and confocal microscopy at 4‐week intervals. Results: The score for global appearance, abnormal pigmentation, and fine and coarse wrinkling were assessed on a scale ranging from 0 ( absent ) to 9 ( severe ), with the following subscales: 1–3: mild, 4–6: moderate, and 7–9: severe. The average score for global appearance improved from 5 to 3.5, wrinkles from 4.5 to 3.5, and uneven pigmentation from 4.75 to 3.5. VISIA analysis showed an improvement in spots, brown spots, texture, pores, and red areas. Confocal microscopy showed a decrease in melanin and an increase in collagen. Microbial analysis indicated no imbalance in the microflora of the facial skin; counterintuitively, there was a trend showing an increase in species diversity after each peeling session as seen in Shannon diversity, Hill1 diversity, and observed taxonomic units. The facial peel was well tolerated and was effective in improving overall global appearance, uneven pigmentation, and wrinkles.