Factors That Enhance Efficacy of AHA Peels on Acne

Factors influencing the effectiveness of alpha hydroxy acid (AHA) peels for the treatment of acne are identified.

Alpha hydroxy acid (AHA) peels are sometimes recommended to patients with acne who are intolerant to first-line therapies such as isotretinoin or topical or oral antibiotics, but there is currently a lack of evidence-based knowledge regarding the factors associated with AHA peel satisfaction and efficacy for acne management. According to study findings published in Dermatologic Therapy, patients with acne who are satisfied with AHA peels are more often older and have better compliance to the therapy.

The study was a retrospective analysis of consecutive patients with acne who had a lack of satisfactory response to first-line therapies. Patients, all of whom were treated at a Beijing hospital from 2017 to 2019, received AHA peels. Demographic variables such as age and gender as well as post-treatment efficacy rates were collected.

Significant improvements in acne were defined by 2 points on an efficacy score, and 1 point represented mild improvement. A score of 0 was indicative of no improvement. In addition, the investigators defined an efficacy score of 2 points as “satisfactory,” while patients who scored less than 2 were classified in an “unmet effect” group.

A higher percentage of patients in the satisfactory group were older (47.4% vs 29.5%; P =.046) and showed significantly better compliance to AHA peels (88.7% vs 54.5%; P =.001) than patients classified in the unmet effect group. An additional multivariate analysis confirmed an association between the unmet effect of AHA peels on acne with younger age (odds ratio [OR], 2.70; 95% CI, 1.15-6.34; P =.022) and poor compliance (OR, 2.74; 95% CI, 1.74-4.32; P =.001).

Limitations of the study included its retrospective nature as well as the recruitment of only East Asian patients, which may reduce the generalizability of the findings.

The investigators noted that hormone imbalance in the younger patients may ultimately reduce the effects AHA peels have on acne. They wrote the findings were an “interesting phenomenon” and “indicated that younger patients could benefit from AHA peels but the effects were difficult to maintain due to pulses of hormones during puberty.”


Tang J, Yang J, Zhang C, et al. The factors influencing the unmet effects of alpha hydroxy acid peels on acne vulgaris: A single tertiary center experience. Dermatol Ther.  Published online April 11, 2021. doi:10.1111/dth.14956