Aesthetic Dermatology MCQ - Chemical peeling contraindications

A 26-year-old woman presents requesting a chemical peel for treatment of acne and post-inflammatory hyperpigmentation. On further history, she reveals that she has been taking oral isotretinoin for the last 3 months for nodulocystic acne. Which of the following statements BEST represents the recommended management?

A. Proceed with a medium-depth TCA peel, as isotretinoin use does not affect healing
B. Perform a deep phenol peel with strict sun protection afterward
C. Delay chemical peeling for at least 6–12 months after discontinuing isotretinoin
D. Proceed with a superficial glycolic acid peel since it does not affect dermal healing
E. Chemical peels are absolutely contraindicated in all patients with a history of acne

Correct Answer:
C. Delay chemical peeling for at least 6–12 months after discontinuing isotretinoin

Explanation:
Contraindications for chemical peeling include:

Absolute:

• Recent oral isotretinoin use (within 6–12 months) → risk of delayed wound healing, hypertrophic scarring, and keloids

• Active bacterial, viral (e.g., herpes simplex), or fungal infection

• Known allergy to peeling agent

Relative:

• History of hypertrophic scarring/keloids

• Pregnancy and lactation (for some peeling agents like salicylic acid, phenol)

• Unrealistic expectations or poor compliance with post-procedure care

• Darker skin types (risk of PIH) → relative, requires careful agent selection

Other options explained:

• A & B: Performing medium/deep peels while on isotretinoin carries a high risk of scarring.

• D: Even superficial peels should be avoided until isotretinoin has been stopped long enough for normal wound healing to resume.

• E: History of acne is an indication for peels, not a contraindication.

Key Point:
Chemical peeling should be avoided for 6–12 months after isotretinoin therapy due to risk of hypertrophic scarring and poor wound healing.