Aesthetic Dermatology MCQ - Indications of peeling

A 30-year-old woman presents with mild acne, post-inflammatory hyperpigmentation, and melasma. She asks about chemical peeling as a treatment option. Which of the following is NOT a recognized indication for chemical peeling?

A. Acne vulgaris (comedonal and inflammatory)
B. Epidermal melasma
C. Post-inflammatory hyperpigmentation
D. Hypertrophic scars and keloids
E. Fine rhytides

Correct Answer:
D. Hypertrophic scars and keloids

Explanation:
Indications for chemical peeling (superficial/medium/deep) include:

• Pigmentary disorders: melasma (epidermal > dermal), post-inflammatory hyperpigmentation, freckles, solar lentigines

• Acne vulgaris: comedonal acne, superficial inflammatory acne

• Acne sequelae: mild superficial scars, PIH

• Photoaging: fine wrinkles, actinic keratoses, mottled pigmentation

• Texture improvement: roughness, enlarged pores

Not an indication:

• Hypertrophic scars/keloids: Peels are ineffective and may worsen scarring risk due to dermal injury and abnormal wound healing response. These lesions are better treated with intralesional corticosteroids, silicone sheeting, laser, or surgery.

Key Point:
Chemical peeling is indicated for epidermal-level disorders and mild dermal changes, but not for hypertrophic scars or keloids. In fact, such lesions are a relative contraindication for medium-to-deep peels.