Is chemical peeling compatible with vitiligo?

Key points to remember.

It is possible for individuals with vitiligo to undertake gentle chemical peels at home every three weeks.
Salon-administered peels using potent exfoliating agents should be avoided for people with vitiligo, as they are too strong and staff may not be adequately trained.
Phenol peels may be considered to even out vitiligo-affected skin, but they must be performed by a qualified professional.

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Are there any risks associated with undergoing a chemical peel in patients with vitiligo?

Vitiligo is a skin condition characterised by the gradual loss of melanocytes, the cells responsible for skin pigmentation. It appears as depigmented patches, often symmetrical, and may affect various areas of the body. Although painless and non-contagious, vitiligo can have a substantial psychological impact due to its visibility and chronic nature. The exact causes are not fully elucidated, but it involves an autoimmune process whereby the immune system gradually destroys melanocytes.

Many individuals living with vitiligo wonder whether they can undergo a peel without exacerbating their depigmentation. Carrying out a peel or a mild exfoliation is possible, but must be done with caution. According to the French Vitiligo Association, a light exfoliation can be carried out every three weeks, provided that overly harsh products are avoided and the particular sensitivity of depigmented skin is respected. The goal is to avoid inducing microtrauma that could trigger a Koebner phenomenon, that is, the emergence of new vitiligo patches at sites of irritation. Among the gentlest exfoliants, one can notably mention the gluconolactone, belonging to the polyhydroxy acid (PHA) family.

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

Peeling and vitiligo: a feasible therapeutic option?

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

However, some studies suggest that phenol may have potential only in a very specific context. This chemical peel, which is particularly deep, penetrates as far as the reticular dermis and acts as a cytotoxic agent, causing the destruction of melanocytes. The aim is not to stimulate repigmentation, but rather to reduce the contrast between pigmented and depigmented areas to even out the appearance of the skin. This approach may be considered in patients with generalised, stable vitiligo, in order to mitigate the psychological impact of the remaining patches and create an appearance of uniform skin tone. It is therefore a targeted cosmetic option to be used under strict medical supervision and only after a thorough assessment 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 patient who had suffered from vitiligo since childhood and exhibited residual pigmented areas on the face, chest and shoulders. The patient was seeking an alternative depigmenting approach, as previous treatments had not produced satisfactory results. An 88% aqueous phenol solution was applied selectively to the pigmented regions of the face. The application was accompanied by cold compresses to mitigate the discomfort associated with exfoliation. After four applications to the same area, a complete depigmentation was achieved, then the same protocol was applied to the other pigmented areas, yielding a uniform outcome and no repigmentation observed over one year, while the patient adhered to strict photoprotection.

Avant/après quatre séances de peeling au phénol 88%. — Before and 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 rely 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 attenuate pigmentary demarcations caused by vitiligo must be strictly reserved for professionals, and stringent sun protection is essential to prevent any repigmentation.