Problems after a Chemical Peel: Prolonged Redness, Dark Spots, Infection and Scarring — What to Do?

What is normal after a chemical peel?

In a chemical peel, controlled damage is applied to the skin, and a new layer forms on the surface as the skin repairs itself. This is why redness, burning, tightness, dryness and flaky peeling are expected symptoms. With medium and deep peels, swelling and the shedding of a darkened layer of skin are also part of healing.

The time considered normal depends on the depth of the peel: a few days for superficial peels, a few days to two weeks for medium-depth peels, and longer for deep peels. For a detailed healing timeline, see our article “Chemical Peels”. What really matters is that the symptoms decrease as the days pass; if they are increasing, healing may have departed from the expected course.

Why does redness last longer after a peel, and how long does it last?

Redness lasting longer than expected is called prolonged erythema. It is more common after deeper peels, in sensitive skin, in people with rosacea or eczema and in those who used retinoids or acid products before the procedure. Prolonged redness should be taken seriously because it can sometimes be an early sign of scarring.

So if redness lasts longer than expected or comes with thickening, firmness and itching, you need to see a physician. After assessing the skin, the physician may change your care routine or recommend treatments to reduce the redness.

Why do dark spots (darkening of the skin) occur after a peel?

Post-inflammatory hyperpigmentation, that is, darkening of the skin that develops as it heals, is one of the most frequently reported unwanted effects of peels. The risk is higher in darker skin, in skin that easily develops dark spots and in skin exposed to the sun after the procedure. It usually fades within weeks to months; however, the time varies from person to person.

Less commonly, the skin may remain lighter than its surroundings (hypopigmentation). This is seen particularly after deep peels and can last a long time. A visible colour boundary between the area that was peeled and the area that was not is also a known problem. For more information about dark spots, see our article “Dark Spots and Melasma”.

Can a peel trigger cold sores?

Yes. In people who have had cold sores before, a peel can reactivate the cold sore virus. This usually appears in the first days, around the mouth or in other parts of the face, as clusters of small fluid-filled blisters or painful sores. Because it can spread across peeling skin, it is important to have it assessed without delay.

In people with a history of cold sores, the physician may give preventive medication, especially before medium and deep peels. So be sure to mention your history of cold sores before the procedure.

How can infection after a peel be recognised?

Peeling, exposed skin can be an entry point for bacteria and fungi. Increasing pain, warmth, swelling, yellow crusting, yellow-green discharge, a bad smell and fever suggest a bacterial infection. A fungal infection, on the other hand, may appear mainly under occlusive dressings as an itchy rash with small blisters.

Infection delays healing and increases the risk of scarring. With these symptoms, the area needs to be seen by a physician; if necessary, a sample is taken and appropriate treatment is started. For general information, see our article “Infection after Aesthetic Treatments”.

Can a peel leave a scar?

Scarring is an uncommon but important problem. It is seen mainly after medium and deep peels, infection, cold sore flare-ups and picking off peeling skin. Some areas, such as the jawline and around the mouth, have been reported to be at higher risk. Prolonged and thickening redness can be the first sign of a developing scar.

When a tendency to scarring is noticed early, the physician can often intervene. So show any areas that are hardening, becoming raised or itching without waiting.

Itching and rash after a peel: could it be an allergy?

Contact dermatitis (skin irritation or an allergic reaction) can develop to the peel solution or to the skincare products used after the procedure. Intense itching and raised redness that extends beyond the treated area suggest this. Acne-like breakouts and small white cysts called milia may also appear. For allergic symptoms, see our article “Allergic Reactions in Aesthetic Treatments”.

Why are the risks of deep peels different?

Deep peels containing phenol can affect not only the skin but the body as a whole. This substance can be absorbed through the skin and affect heart rhythm, the kidneys and the liver. For this reason, deep peels should be carried out in selected people, after a detailed assessment, in a healthcare facility where heart rhythm can be monitored and emergency care is available. Detailed technical information is beyond the scope of this page.

Why is using high-strength acid at home or in a salon risky?

High-strength acid solutions sold online and treatments carried out without medical supervision can result in burns, long-lasting dark spots, infection and scarring. The content and strength of these products are not always the same as stated on the label. Steps such as the contact time, neutralisation and eye protection are also often unknown.

If, after such a treatment, the burning does not stop, the skin turns white, blisters or a wound opens, rinse off the product with plenty of water and see a physician. For more information, see our article “Counterfeit Products and Unlicensed Treatments”.

What should you do at home if there is a problem after a peel?

1. If solution has got into your eye, rinse the eye immediately with plenty of clean water and get medical help; if there is any change in vision, call 112.
2. If you have any of the warning signs, call the physician who performed the procedure the same day; take a photo of the area and say which peel was done, when, and which products you use.
3. Apart from the soothing skincare product your physician recommends, do not try any new product; keep the area gently clean.
4. Protect yourself strictly from the sun: with shade, a hat and clothing; once the skin has closed, with the sunscreen your physician recommends.
5. If you cannot reach your physician and you have a fever, rapidly spreading redness or severe pain, go to an emergency department.

What should you not do?

• Do not pull off peeling skin, pick off crusts or scratch.
• Do not apply steroid, antibiotic, antiviral (cold sore) or skin-lightening creams unless a physician recommends them; do not treat yourself with prescription medicines.
• Do not use home remedies such as toothpaste, lemon, vinegar, cologne or plant oils.
• Until the skin has healed, do not use make-up, retinoids or acid products, do not scrub with an exfoliating mitt, use steam or a sauna, or have a new peel.
• Do not sunbathe; remember that even brief sun exposure can make dark spots worse.

What are the treatment options? What can a physician do?

The physician first determines whether the problem is expected healing, an infection, a cold sore, an allergy or a developing scar. For infections and cold sores, appropriate medication can be started; for an allergy, the triggering product is stopped and treatments to soothe the skin can be planned. With prolonged redness and a tendency to scarring, early treatments aimed at reducing scar formation can be considered.

If a dark spot develops, the basic approach is sun protection and time; if necessary, the physician may recommend skin-lightening treatments. A new peel or light treatment on the same area is usually postponed until the skin has fully healed. For the general process, see our article “What Should You Do If a Complication Occurs after an Aesthetic Treatment”.

What can be done to reduce the risk?

• Decide on the type and depth of the peel together with a physician who assesses your skin type.
• Before the procedure, mention your history of cold sores, the medicines you take (especially oral vitamin A-derived acne medicines), retinoid and acid products, and any tendency to scarring.
• If your physician has recommended it, follow the pre-treatment skin preparation; stop the products that need to be stopped at the time you are told.
• Choose a period when you can protect yourself strictly from the sun before and after the procedure.
• Do not apply high-strength acid at home.
• Do not pick off skin during the peeling phase; follow your physician’s aftercare instructions.

Limits of the evidence: how often peel complications occur varies greatly depending on the substance used, its strength, the technique and the skin type; much of the available information is based on reviews and case series. For this reason, you cannot be given a personal risk figure. This page is for general information and does not replace an examination.