How Effective Are Glycolic Peels For Nail Rejuvenation?

Perhaps you or someone you know has had a facial peel for skin rejuvenation. In the last few years, the idea of peels for the feet has had exploration but only a small percentage of podiatrists are doing them.

How about a cosmetic procedure for nails? Well, in a recent article, Banga and Patel completed an open-label, non-randomized study using 70% glycolic acid peels for nails.¹ Glycolic acid is a keratolytic that will aid in the desquamation of the nail corneocytes.

In this study, the authors did not specify if they were treating fingernails or toenails but did permit “rough, dull discolored nails due to chemical abuse, hyperkeratotic nail plates due to onychomycosis or lichen planus, and pitted nails (and) nail ridges due to nutritional deficiencies and aging.”¹ The study excluded those with active infection or inflammation, thin nails or sensitivity to glycolic acid.

There were 31 patients in the study. Group 1 consisted of 22 patients with rough, dry, and discolored nails and group 2 had nine patients with hyperkeratosis (i.e. onychomycosis). After protecting the cuticle and nail folds with a border of petroleum jelly, researchers applied a 70% glycolic acid solution in one or two coats (depending on the nail condition), which patients left on for 45 minutes. After the treatment period, patients washed the nail with plain water. Those in group 1 had a single procedure. Those in group 2 received weekly peels for six to 12 weeks depending on the thickness of the nail plate. Group 2 patients also continued any topical or oral therapy for their underlying nail condition as directed.¹

At their reevaluation two weeks after the last peel, both groups of patients graded their satisfaction as good, average or non-responsive.¹ For group 1, 18 patients had good results while two had no response. For group 2, six patients had a good response while one had no response in the onychomycosis category. The expected complications were dryness, peeling and a burning sensation from the strength of the peel. 

So what does all of this mean? In this study, only nine patients had experiences that are similar to what we see on a daily basis in our practices. That is a pretty small sample size on which to base a judgment so, of course, further studies are needed. Also, this does not address the underlying infection (as in onychomycosis) or skin condition (as in lichen planus). This is solely a cosmetic procedure to aid in improving the appearance of the nail via flattening, smoothing and removal of surface stains. Further studies will show if this can enhance topical antifungal therapies and if there are any beneficial effects from the long-term use of a peel. 

For those who are adventurous and want to initiate peels in their practice, I warn you that one should shroud the surrounding soft tissue with a barrier ointment during the peel in order to avoid post-peel complications. Even post-peel, patients should use a moisturizer liberally daily to protect the integrity of the skin. Grover discusses in the same journal about cautioning the use of a peel in patients with psoriasis as it could incite the Koebner phenomenon but this remains to be proven.²

Overall, a glycolic peel for nail rejuvenation may increase cosmetic satisfaction with patients while they are receiving treatment for the underlying etiology of the nail disease. As with any nail issue, one must educate the patient that it is a long, slow, sometimes frustrating process that may not yield the results desired. Always set realistic expectations. 

References 

1. Banga G, Patel K. Glycolic acid peels for nail rejuvenation. J Cutaneous Aesthet Surg. 2014; 7(4):198-201.
2. Grover C. Role of chemical peeling in nail disorders. J Cutaneous Aesthet Surg. 2014; 7(4):201-2.