Efficacy of Compound Acid Chemical Peeling in Patients with Moderate Acne: A Prospective Study with Comprehensive Facial Evaluation

Summary

This study evaluates compound acid chemical peeling in patients with moderate acne vulgaris. In the split-face trial of 30 patients, treatment reduced Global Acne Grading System scores, skin redness, porphyrins, and expression of IL-1α, IL-6, IL-17, TGF-β, and TLR2. Skin microbiome diversity decreased, especially Staphylococcus, with no adverse events reported during follow-up.

Abstract

Compound acid chemical peeling is widely used to treat acne vulgaris (AV), but the biological mechanisms underlying its clinical effects remain incompletely understood. We hypothesized that compound acid chemical peeling would improve acne severity and would be associated with changes in the skin microbiome and a reduction in local inflammatory responses in patients with moderate AV. This study aimed to investigate the clinical, microbiological, and inflammatory effects of compound acid peeling in this population. We carried out a prospective, split‑face, randomized trial enrolling 30 patients with moderate AV. One hemiface received compound acid peeling twice weekly for 3 weeks (6 total sessions), followed by a 9‑week observation period. The contralateral hemiface received no treatment for the first 3 weeks and then underwent the same peeling protocol for 3 weeks, with a 6‑week follow‑up. Outcome measures included the Global Acne Grading System (GAGS), patient self‑assessment, standardized facial imaging, skin biopsy with immunohistochemistry, bacterial DNA extraction, PCR amplification, and 16S rRNA gene sequencing. Patients showed a statistically significant improvement in GAGS scores (P < 0.001). Facial imaging analysis revealed reductions in redness and porphyrin readings. Immunohistochemical staining for interleukin (IL)-1α, IL-6, IL-17, transforming growth factor-β (TGF-β), and toll-like receptor 2 (TLR2) was reduced. Skin microbiome alpha diversity decreased, with a notable decrease in the relative abundance of Staphylococcus (P < 0.05). Throughout the study, no adverse events were reported. Compound acid peeling was effective and well-tolerated during the observation period and was associated with changes in the skin microbiome and local inflammatory marker staining.

Introduction

Acne vulgaris (AV), commonly known as acne, is a chronic inflammatory skin disorder primarily affecting hair follicles and sebaceous glands. It is characterized by the development of papules, pustules, nodules, and cysts, predominantly on the face, chest, and back. While acne mostly affects teenagers and young adults, it can arise at any age, with a global prevalence estimated to be between 70% and 87% among individuals aged 12 to 24 years^1,2. Notably, acne can persist into adulthood, especially in females, with an increasing incidence observed in individuals aged 25 years and older. The development of acne is....

Protocol

The study protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (No. 2024-020-01). The study was prospectively registered with the National Medical Research Registry, China (registration number: MR-50-24-036087; registration date: September 6, 2024). Written informed consent was obtained from all participants before enrollment, including consent for the publication of de-identified facial photographs. The study was conducted in accordance with the Declaration of Helsinki.

Study design
This was a 12‑week, split‑face, randomized, prospecti....

Results

Baseline patient characteristics
Thirty patients were enrolled and completed all study procedures. Baseline demographic and clinical characteristics were summarized in Table 1.

VISIA skin analysis
Treatment with compound acid peeling led to visible improvement in acne lesions on both hemifaces. VISIA analysis confirmed meaningful reductions in erythema and porphyrin levels at week 12 follow-up. The red area score fell from 32.34 ± 6.32.......

Discussion

Our findings offer novel insights into the therapeutic effects of compound acid peeling treatment in the management of moderate AV. After the treatment, patients showed a notable improvement in their GAGS scores. Improvements were also noted in the VISIA scores, specifically for the red area and porphyrin. Additionally, the expression levels of key inflammatory markers, including IL-1α, IL-6, IL-17, TGF-β, and toll-like receptor 2, were reduced in the skin tissue following treatment. Moreover, there was a decli.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Agilent 2100 Bioanalyzer	Agilent, USA
AMPure XP beads	Beckman Coulter Genomics, Danvers, MA, USA
Biopsy punch			2 mm
Compound acid peel	XIMEIEN	A363	Alpha-hydroxy acid 4%, salicylic acid 2%, and azelaic acid 1.5%; total nominal active-acid concentration approximately 7.5%; PH: 3.6, 12 g
cutadapt (v1.9)			removing sequencing primers
DADA2			denoising and generating amplicon sequence variants
DNA cleanup beads	Vazyme		VAHTS DNA Clean Beads; used to purify PCR products
DNA extraction kit	TIANGEN	DP302-02	DNA Kit for skin tissue
DNA quantification assay kit	Invitrogen		Quant-iT PicoGreen dsDNA Assay Kit
Facial imaging system			VISIA system; model/version not supplied
FLASH (v1.2.8)			merging paired-end reads
fqtrim (v0.94)			trimming reads containing >5% N records
llumina library quantitative kits	Kapa Biosciences, Woburn, MA, USA
Immunohistochemistry antibodies	Proteintech; Youpin Biology	66148-1-Ig; YP-Ab-01185; YP-Ab-04780; YP-Ab-16022; YP-Ab-01522; YP-Ab-15931	Supplied descriptions: IL-17A monoclonal antibody; TLR2 polyclonal antibody; TGF-β mouse monoclonal antibody (1F12); IL-6 polyclonal antibody; IL-1α polyclonal antibody
Iodophor	Lierkang, Shandong, China		Used to disinfect biopsy sites
KF-PRO-120 digital scanner	Jiangfeng Bio
Light microscope			Used to examine immunohistochemistry sections
nsegata-lefse			LDA effect size
NT-16S			alignment database
Paired-end sequencing platform	Illumina (LC-Bio Technology Co., Ltd., Hangzhou, China)	NovaSeq 6000 SP Reagent Kit	Paired-end 250-bp sequencing
Paraffin			Used to embed biopsy samples
Paraformaldehyde			4% solution used to fix biopsy samples
PCR primers 338F and 806R			338F: 5′-ACTCCTACGGGAGGCAGCA-3′; 806R: 5′-GGACTACHVGGGTWTCTAAT-3′
Post-peel mask	XIMEIEN	C85Y	Soothing and moisturizing mask; 28 mL × 6 pieces
QIIME2			sequence alignment of species annotation
Qubit	Invitrogen, USA		DNA quantification
Sequencing reagent kit	Illumina	NovaSeq 6000 SP Reagent Kit	Used for paired-end sequencing
SILV A			alignment database
Software, graphing	Origin Software Inc.	Origin 2021	Graphing software
Software, statistical	IBM	SPSS 27.0	Statistical analysis software
Vsearch software (v2.3.4)			filtering chimeric sequences