A-26-years old unmarried female came with complaints of raised lesions and pigmentation over the face for 6 months. On evaluation patient was diagnosed as acne vulgaris grade-2 with Post inflammatory hyperpigmentation (PIH) (Figure – 1a, b). She was treated outside with oral and topical medications for the above complaints with minimal response. Patient was concerned about pigmentation over face and was counselled for chemical peel regarding both acne and PIH. Two sittings of 4% Retinol peel were done two weeks apart along with photoprotection. The retinol peel was applied evenly over face and allowed to stay for 8 hours, then cleansed off gently. We witnessed a drastic improvement not just with acne part but also with PIH over face, thus highlighting the role of retinol peel in PIH.  (Figure – 1c, d).

PIH being a challenge to dermatologists have multiple modalities of treatment such as topicals (hydroquinone, retinoids, kojic acid, azelic acid), chemical peels like (glycolic acid (35%), salicylic acid (30%), mandalic acid, jessner solution) and lasers (Co2 laser, Q-switched Nd:YAG laser, Pico laser).3

Chemical peeling a cost-effective, quick and safer method for treating PIH is becoming popular now.1,2 Chemical peels for acne has already been established as a well-known treatment modality with proven results and is a routine procedure. From our case it’s noticeable that retinol peel has a dramatic effect with near normal resolution of PIH along with acne and gives even tone and improves texture, even in individuals with Fitzpatrick – type 4 skin which was not well discussed in literature. Another advantage of chemical peels are relatively less adverse effects compared to other modalities of treatment. On conclusion, retinol peel can be opted as routine option to treat PIH over face with better outcome compared to other modalities even with individuals of skin type (Fitzpatrick 3-5).Acne induced post inflammatory hyperpigmentation is routinely treated with lasers and other superficial and deep peels which is costly and requires multiple sessions and has considerable side effects with acne being treated separately, comparatively retinol peel is cost-efficient, requires only two sessions with minimal side effects. We suggest to consider using retinol peel as a routine option for treating acne along with post inflammatory hyperpigmentation over face with excellent results.

Figure 1 (a, b): multiple, discrete, hyperpigmented and skin coloured papules and hyperpigmentation’s (black circle) present over b/l cheeks, temporal, mandibular regions - baseline. (c, d): Lesions showing near normal resolution of papules and pigmentation with improved texture after 4 weeks.

1. Callender VD, Baldwin H, Cook-Bolden FE, Alexis AF, Stein Gold L, Guenin E. Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice. Am J Clin Dermatol. 2022; 23: 69-81.
2. Green B, Gostomski J, Edison B, Chua D, Sadick N. Advanced, physician-strength retinol peel improves the appearance of fine lines, wrinkles, skin firmness, and overall complexion brightness. In Journal of the American Academy of Dermatology 2017; 76: B36-AB36.
3. Moolla S, Miller-Monthrope Y. Dermatology: how to manage facial hyperpigmentation in skin of colour. Drugs in context. 2022; 11.