Skip to main content
SpringerLink
Log in

α-Hydroxy Acid-Based Cosmetic Procedures

Guidelines For Patient Management

  • Disease Management
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

α-Hydroxy acid (AHA) peels and home regimens have recently been recognized as important adjunctive therapy in a variety of conditions including photodamage, actinic damage, melasma, hyperpigmentation disorders, acne, and rosacea. Overall in our experience and in the literature, AHAs have a proven level of safety and efficacy in a variety of skin types. Although their exact mechanism of action is unknown, it has been demonstrated that AHAs improve these disorders by thinning the stratum corneum, promoting epidermolysis, dispersing basal layer melanin, and increasing collagen synthesis within the dermis.

In patients with photodamage, AHA peels and topical products are often combined with retinoids and other antioxidants for maximum benefit. Similarly, synergistic effects of fluorouracil and glycolic acid are observed in the treatment of diffuse actinic keratoses. For patients with melasma, AHA peels and combination products containing bleaching agents such as hydroquinone, kojic acid, and glycolic acid seem to have increased efficacy. Acne and rosacea patients can see improved results when standard regimens like antibacterials and topical retinoids are supplemented with AHA peels and lotions.

However, care should always be taken prior to commencing treatment with AHA peels and topical products. By obtaining a thorough history and physical examination, the physician will identify any specific factors like medications, prior procedures and medical conditions which can affect the outcome of the peel. During the interview, there should be open discussion of patient questions and concerns so that realistic expectations can be made. Pre- and post-peel regimens should also be reviewed in full as patient compliance is essential to ensure the success of a series of AHA peels.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Van Scott E.J., Liu R.J. Alpha hydroxy acids: procedures for use in clinical practice. Cutis 1989; 43: 222–228

    PubMed  Google Scholar 

  2. Bergfeld W., Tung R., Vidimos A., et al. Improving the appearance of photoaged skin with glycolic acid. J Am Acad Dermatol 1997; 36: 1011–1013

    Article  PubMed  CAS  Google Scholar 

  3. Stiller N.J., Bartolone, Stern R., et al. Topical 8% glycolic acid and 8% L-lactic acid creams for the treatment of photoaged skin. Arch Dermatol 1996; 132: 631–635

    Article  PubMed  CAS  Google Scholar 

  4. Perricone N.V., Dinardo J.C. Photoprotective and anti-inflammatory effects of topical glycolic acid. Dermatol Surg 1996; 22: 435–437

    Article  PubMed  CAS  Google Scholar 

  5. Clark C.P. Alpha hydroxy acids in skin care. Clin Plast Surg 1996; 23: 49–56

    PubMed  Google Scholar 

  6. Dinardo J.C., Grove G.L., Moy L.S.. Clinical and histological effects of glycolic acid at different concentrations and pH levels. Dermatol Surg 1996; 22: 421–424

    Article  PubMed  CAS  Google Scholar 

  7. Maddin S. Current review of alpha hydroxy acids. Skin Ther Lett 1998; 3: 1–2

    Google Scholar 

  8. Moy L.S., Howe K., Moy R.L.. Glycolic acid modulation of collagen production in human skin fibroblast cultures in vitro. Dermatol Surg 1996; 22: 439–441

    Article  PubMed  CAS  Google Scholar 

  9. Kim S.J., Park J.H., Kim D.H., et al. Increased in vivo collagen synthesis and in vitro cell collagen synthesis and in vitro cell proliferative effect of glycolic acid. Dermatol Surg 1998; 24: 1054–1058

    Article  PubMed  CAS  Google Scholar 

  10. Matarasso S.L., Hanke C.W., Alster T.S.. Cutaneous resurfacing. Dermatol Clin 1997; 135: 867–875

    Google Scholar 

  11. Gilchrist B.A. A review of skin ageing and its medical therapy. Br J Dermatol 1996; 135: 867–875

    Article  Google Scholar 

  12. Lewis A.B., Gendler E.C.. Resurfacing with topical agents. Semin Cutan Med Surg 1996; 15: 139–144

    Article  PubMed  CAS  Google Scholar 

  13. Newman N., Newman A., Moy L.S., et al. Clinical improvement of photoaged skin with 50% glycolic acid. Dermatol Surg 1996; 22: 455–460

    Article  PubMed  CAS  Google Scholar 

  14. Murad H.,. Shamban A.T., Premo P.S. The use of glycolic acid as a peeling agent. Dermatol Clin 1995; 13: 285–307

    PubMed  CAS  Google Scholar 

  15. Huilgol S.C., Carruthers A.,. Caruthers J.D. Raising eyebrows with botulinum toxin. Dermatol Surg 1999; 25: 373–375

    Article  PubMed  CAS  Google Scholar 

  16. Klein A.W., Wexler P.,. Carruthers A.,. et al. Treatment of facial furrows and rhytides. Dermatol Clin 1997; 15: 595–607

    Article  PubMed  CAS  Google Scholar 

  17. Bolognia J.L. Dermatologic and cosmetic concerns of the older woman. Clin Geriatr Med 1993; 9: 209–229

    PubMed  CAS  Google Scholar 

  18. Marks R. Solar keratoses. Br J Dermatol 190; 122 Suppl. 35: 49-60

  19. Marrero G.M., Katz B.E. The new fluor-hydroxy pulse peel. Dermatol Surg 1998; 24: 973–978

    Article  PubMed  CAS  Google Scholar 

  20. Winton G.B., Lewis C.W. Dermatoses of pregnancy. J Am Acad Dermatol 1982; 66: 977–998

    Article  Google Scholar 

  21. Garcia A.,. Fulton J.E. The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg 1996; 22: 443–447

    Article  PubMed  CAS  Google Scholar 

  22. Lim J.T.E., Tham S.N. Glycolic acid peels in the treatment of melasma among asian women. Dermatol Surg 1997; 23: 177–179

    Article  PubMed  CAS  Google Scholar 

  23. Van Scott E.J., Yu R.J. Alpha hydroxy acids: therapeutic potentials. Can J Dermatol1989; 1: 108–112

    Google Scholar 

  24. Webster G.F. Acne and rosacea. Med Clin North Am 1998; 82: 1145–1154

    Article  PubMed  CAS  Google Scholar 

  25. Goulden V.,. Clark S.M., Cunliffe W.J. Post-adolescent acne: review of clinical features.Br J Dermatol 1997; 136: 66–70

    Article  PubMed  CAS  Google Scholar 

  26. Sperling L.,. Hermer W. Androgen biology as a basis for the diagnosis and treatment of androgenic disorders in women. J Am Acad Dermatol 1993; 28: 669–683

    Article  PubMed  CAS  Google Scholar 

  27. Shaw J.C. Antiandrogen and hormonal treatment of acne. Dermatol Clin 1996; 14:803–811

    Article  PubMed  CAS  Google Scholar 

  28. Lucky A.W., Henderson T.A., Olson W.H., et al. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris. J Am Acad Dermatol. 1997; 37: 746–754

    Article  PubMed  CAS  Google Scholar 

  29. Plewig G., Jansen T. Rosacea. In: Freedberg I.M., Eisen A.Z., Wolff K., et al., editors. Fitzpatrick’s dermatology in general medicine. New York: McGraw-Hill, 1999: 785–794

    Google Scholar 

  30. Bonnar E.,. Eustace P., Powell FC. Demodex mite population in rosacea. J Am Acad Dermatol 1993; 28: 443–448

    Article  PubMed  CAS  Google Scholar 

  31. Utas U.,. Ozbakin O.,. Turasan A., et al. Helicobacter pylori eradication treatment reduces severity of rosacea. J Am Acad Dermatol 1999; 40: 433–435

    Article  PubMed  CAS  Google Scholar 

  32. Bergfeld W.F., Remzi B.K., Green B., et al. Evaluation of gluconolactone sensitive skin care products [poster]. American Academy of Dermatology Meeting. 1998; Orlando (FL)

    Google Scholar 

  33. Dahl M.V. Optimal strategies for the treatment of rosacea. Skin Aging 1999; 7: 44–48

    Google Scholar 

  34. Wang C.-M., Huang C.-L., Hu C.-T.S., et al. The effect of glycolic acid on the treatment of acne in asian skin. Dermatol Surg 1997; 23: 23–29

    Article  PubMed  CAS  Google Scholar 

  35. Duffy D.M. Alpha hydroxy acids / trichloroacetic acids risk / benefit strategies.Dermatol Surg 1998; 24: 181–189

    Article  PubMed  CAS  Google Scholar 

  36. Slavin J.W. Considerations in alpha hydroxy acid peels. Clin Plast Surg 1998; 25: 45–52

    PubMed  CAS  Google Scholar 

  37. Kripke M. Ozone, photodamage, and photoprotection. Presented at the American Academy of Dermatology. 1998 Jul 31; Chicago (IL)

    Google Scholar 

  38. McLean D.I., Gallagher R. Sunscreens-use and misuse. Dermatol Clin 1998; 16: 219–226

    Article  PubMed  CAS  Google Scholar 

  39. Naylor M.F., Boyd A., Smith D.W., et al. High sun protection factor sunscreens in suppresion of actinic neoplasia. Arch Dermatol 1995; 131: 170–175

    Article  PubMed  CAS  Google Scholar 

  40. Bergfeld W.F., Fiume M.Z., Andersen F.A. Safety assessment of alpha hydroxy acid ingredients used in cosmetic products. Cleveland (OH): Cleveland Clinic Foundation, 1999

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, The Cleveland Clinic Foundation, 9500 Euclid Avenue (A61), Cleveland, Ohio, 44122, USA

    Rebecca C. Tung,  Wilma F. Bergfeld, Allison T. Vidimos & Berna K. Remzi

Authors
  1. Rebecca C. Tung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilma F. Bergfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allison T. Vidimos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Berna K. Remzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wilma F. Bergfeld.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tung, R.C., Bergfeld, W.F., Vidimos, A.T. et al. α-Hydroxy Acid-Based Cosmetic Procedures. Am J Clin Dermatol 1, 81–88 (2000). https://doi.org/10.2165/00128071-200001020-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128071-200001020-00002

Keywords

Search

Navigation