Effect of Skin Sebum Levels before and after Chemical Peeling with

30% Salicylic Acid

Ratna Agustina, Martinus Ahmad Raif, Chrismis Novalinda Ginting, Refi Ikhtiari

Department of Biomedical Sciences,Universitas Prima Indonesia,Indonesia

Keywords: Chemical Peeling, Salicylic Acid 30%, Skin Sebum Levels.

Abstract: Salicylic Acid 30% is often considered as gold standard in chemical peels for the treatment of acne vulgaris

and has been proven to be very effective in the treatment of inflamed lesions in acne vulgaris and comedonal

acne. The purpose of this study was to measure sebum levels on facial skin before and after chemical peels

with 30% salicylic acid. The data was collected before and after chemical peeling with 30% salicylic acid. Of

the total 15 samples measured, the average sebum content before chemical peeling was 79.93 ± 23.50%. And

after chemical peeling was 66.20 ± 18.72%. Based on the normality test using the Shapiro-Wilk test, levels

of facial skin sebum before and after chemical peeling with salicylic acid 30% significance value > 0.05, this

implies the data are assumed to be normally distributed. Then the data is analyzed by paired t test. The result

is sig .000. From the results, the average skin sebum level before the procedure was 79.93%, while the average

skin sebum level after the procedure was 66.20%. There is a significant difference between the levels of sebum

in the skin before and after chemical peeling with 30% salicylic acid in patients with skin types Fitzpatrik III,

IV, V aged 17-35 years.

1 INTRODUCTION

Chemoexfoliation, which is often referred to

chemical peeling, is a technique for scrape skin tissue

using certain ingredients that allow rapid erosion to

reach the desired skin depth so that results in

improved appearance is someone skin. The purpose

of chemical peel is to evenly remove damaged skin

tissue, which in turn allows skin regeneration, skin

rejuvenation, and simultaneously minimizing

complications such as scar and unwanted pigment

changes (Soleymani et al., 2018).

Matherial used for chemical peels can control

keratocoagulation and denaturation of protein in the

epidermis and dermis, which causes the release of

inflammatory mediators such as cytokines and

chemokines. The mediator will stimulate the

formation of new collagen and elastin tissue,

rearrange the protein structure of skin connective

tissue, and the formation of new keratinocytes. This

process will cause regeneration and thickening of the

epidermis layer of the skin and increase the thickness

of the dermis layer (Berson et al., 2009).

The mechanism of action of chemical peels is to

stimulate the growth of the epidermis by changing the

stratum corneum layer, destroying the damaged skin

layer and replacing it with normal tissue, causing

deep inflammatory reactions in the tissue and then

causing necrosis caused by chemical peeling

materials. Activation of inflammatory mediators can

produce new collagen in the dermis as well as basic

substances such as glycosaminoglycans (Rendon et

al., 2010).

Although there are some differences between the

chemicals used in peeling, in general, the purpose of

chemical peels is to improve the appearance of the

skin by reducing the amount of wrinkles on the skin

or acne scars, reducing both lesions that are inflamed

or not, increases dispigmentation, and results in a

younger, brighter skin appearance ( Hassan et al.,

2013).

Chemical peeling is a popular, relatively

affordable, and safe procedure in the management of

several types of skin disorders, to brighten and

rejuvenate the skin. Chemical peels are classified

based on their level of penetration as follows

superficial, medium and deep. The depth level of

chemical peels has a significant influence on the

clinical changes in facial skin. The deeper the

penetration is done, the greater the changes obtained.

However, with increasing depth of chemical peels,

there are some disadvantages that can occur, which

248

Effect of Skin Sebum Levels before and after Chemical Peeling with 30 .

DOI: 10.5220/0010296502480253

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 248-253

ISBN: 978-989-758-500-5

can lead to various light spots, a longer healing

period, and the possibility of greater complications

(Arif, 2015; Turnip et al, 2020; Wijaya et al, 2019).

Superficial chemical peels, which are involved in

peeling only the epidermal layer, and may also be

minimal involvement of the dermis, usually this depth

level is used in the management of diseases such as

acne, melasma, actinic keratoses, and increase facial

brightness. After superficial peeling, epidermal

regeneration is expected to occur in 3-5 days.

Chemical peeling medium, penetrating to the deeper

layers of the dermis from the superficial, this peeling

is commonly used in the treatment of superficial scar,

and pigmentation disorders. The healing process is

longer peeling, usually complete epithelialization

occurs within 1 week. Chemical peeling deep, peeling

penetration reaches a depth to the dermis,

approximately reaching half its depth. This is

commonly used for the treatment of deep scars and

wrinkles (Ptavitasari and Setyaningrum,2012).

Salicylic acid, also known as orthohydrobenzoic

acid or 2- hydroxy-benzoic acid, has a chemical

structure of C7H6O3. Salicylic acid contains not less

than 99.5% and not more than 101.0% C7H6O3

calculated on the dried substance. Salicylic acid has a

pKa of 2.97 (Bahtiar,2016).

Now, salicylic acid can be synthetically produced.

Macroscopic form of salicylic acid in the form of

white crystalline powder, shaped like a fine needle

with a rather sweet taste, odorless, and stable in free

air. Salicylic acid powder is difficult to dissolve in

water and more easily soluble in fat. The lipophilic

nature of salicylic acid makes its clinical effect

limited to the epidermis layer (Sulistyaningrum et al,

2012).

Sebum is a mixture of triglycerides, cholesterol,

protein and inorganic salt. sebum prevents excessive

evaporation of water, softens the skin and inhibits the

growth of some bacteria. Factors that influence

sebum production such as Androgens, retinoid,

melanocortin, Peroxisome Proliferator Activated and

Acyl-CoA: Diacylglycerol Acyltransferase

(Freedberg et al,2002).

Sebaceous glands require androgenic stimulation

to produce sebum. Although the strongest androgens

are testosterone and DHT, testosterone levels do not

parallel the sebaceous gland activity. Sebum

secretions begin to increase in childhood during

adrenarche or 2 years before puberty. Isotretinoin is

the best pharmacological inhibitor of sebum

production. Sebum reduction can be seen 2 weeks

after retinoid use (Freedberg et al,2002).

Salicylic Acid has been widely used in

dermatology for the past several decades. Salicylates

are soluble in oil but not soluble in water, which

makes it easier, faster to penetrate the protective layer

of fat found in the epidermis. Clinically, this makes

salicylate very effective for the management of skin

disorders associated with an increase in sebum

production, namely acne vulgaris. Salicylic acid 30%

is often considered the gold standard in chemical

peels for the treatment of acne vulgaris and has been

proven to be very effective in the management of

inflamed lesions in acne vulgaris and comedonal acne

(Soleymani et al., 2018).

Indications of salicylic acid such as Acne vulgaris

(whether inflamed or not), Rosacea acne, melasma,

post inflamatory hiperpigmentation, freckles,

lentigines, photodamage (mild to moderate), coarse

textured skin. In other hand, the Contraindications of

salicylic acid is Salicylic acid allergy, Excessive

patient expectations, Active dermatitis /

inflammation, Acute virus infection, Pregnant, The

use of isotretinoin in the last 3-6 months (Soleymani

et al., 2018).

Based on Lee’s research who conducted a study

of 35 patients in Korea with facial acne when treated

with chemical peels of salicylic acid 30% for 12

weeks, inflammatory and non-inflammatory lesions

were found to be reduced. Where one of the cause of

acne is due to increased levels of sebum on the face

(Lee et al., 2003). According to Chen's study, who

claim that salicylic acid seems to be more effective

than jessner solution for the treatment of non-

inflammatory acne lesions. And this was proven in

Chen's study, which compared 30% salicylic acid

with jessner solution. The result is more effective

salicylic acid to reduce the amount of blackheads

(Chen et al., 2018). Chen also compares the

combination of 30% salicylic acid plus 10% mandelic

acid versus 35% glicolic acid. The result is the

combination of salicylic acid and mandelic acid is

better in reducing the amount of blackheads, papules,

and pustules than glycolic acid (Chen et al., 2018).

The results of this study are also supported by the

statement of Soleymani that Salicylic Acid is very

effective in the management of diseases associated

with increased sebum production, such as acne

vulgaris. In fact, 30% salicylic acid is often regarded

as the gold standard superficial peeling for the

treatment of acne vulgaris (Soleymani et al., 2018).

So, in this study, skin sebum levels will be

measured to see how much different levels of sebum

in the skin before and after chemical peels with

salicylic acid.

Effect of Skin Sebum Levels before and after Chemical Peeling with 30

249

2 MATERIALS AND METHODS

This type of research is comparative research. The

application of comparative research in this study was

used to determine the comparison between sebum

levels before chemical peels with 30% salicylic acid

and after chemical peels with 30% salicylic acid.

Fifteen subjects were recruited by nonprobability

purposive sampling technique; anyone who meets the

criteria will be included in the study. The inclusion

criteria are: women aged 17-35 years old; belongs to

Fitzpatrick skin type III, IV, or V; agreed to be

involved throughout the experiment. On the other

hand, anyone with hypersensitive to salicylic acid.

The research located in Miracle Aesthetics Clinic

Medan. The research material consisted of a 30%

salicylic acid and instrument used to measure skin

hydration was Janus Facial Skin Analysis System.

The stages of the research procedure are

Gathering the subject , Fill in informed consent, the

status of the research such as subject identity, subject

history, taking photo documentation before chemical

peeling and measurement of skin sebum levels before

treatment with Jannus Facial Skin Analysis System.

After that, Apply 30% salicylic acid as much as 2.5

ml using brush. Wait a while until it reaches frosting

(reddish colored covered like white powder). Then

neutralize the post peel neutralizer containing sodium

bicarbonate. After that, rinse your face with running

water. Measure the skin sebum levels after treatment.

Figure 1: apply 30% salicylic acid as much as 2.5 ml using

brush. Wait a while until it reaches frosting (reddish colored

covered like white powder).

Figure 2: measure the skin sebum levels after treatment

using Jannus Facial Skin Analysis System.

Fig 3. Showed the result of the skin sebum levels after

peeling.

The results of skin sebum measurements were

processed using the SPSS 13.0 for Windows Statistics

Base Program. Furthermore, in this study, a normality

test will be conducted from the data obtained. If the

normality test results show that the numerical data is

normally distributed, then it will be statistically tested

by paired t-test.

3 RESULTS AND DISCUSSION

Table 1 shown the result of the 15 subjects assessed

by age, gender, skin type and sebum levels before and

after chemical peeling.

250

Table 1: Data of 15 Subjects

No Age Gender

Fitzpatrick

skin type

Sebum

levels

before

Sebum

levels

after

1 30 FM V 48% 32%

2 20 M V 128% 92%

3 32 FM IV 100% 78%

4 18 FM III 72% 68%

5 23 M III 108% 90%

6 33 FM IV 55% 50%

7 28 FM IV 45% 43%

8 25 M III 60% 45%

9 24 M IV 86% 75%

10 27 FM III 76% 65%

11 31 FM III 105% 90%

12 35 FM III 89% 80%

13 22 M III 68% 50%

14 26 M IV 79% 70%

15 29 FM IV 80% 65%

Based on Table 1, according to the age, the

majority are aged <30 years old 66.7%, the rest are

aged ≥ 30 years 33.3%.

According to gender the majority are women

60.0%, the rest are men 40.0%. because women are

more concerned with facial appearance and the

average sample was found to be <30 years old, where

at that age the sebum gland was still actively working

so that sebum production was higher. Sebaceous

glands in humans show age-related differences as

determined by quantitative and qualitative

examinations. Sebaceous secretions are low in

children and begin to increase in the mid to late

childhood under the influence of androgen hormones.

This increase continues until the end of adolescence,

after which there is no further significant effect until

the end of life (Pochi et al., 1979).

According to Fitzpatrick's skin type, the majority

are type III (46.7%) , Fitzpatrick type IV (40.0%)

and the rest are Fitzpatrick type V (13.3%). This is

quite reasonable considering that Indonesia only has

2 seasons and located on the equator, while

Fitzpatrick I and II mostly found in Caucasians.

Based on Table 2, The average levels of facial

skin sebum before chemical peeling with salicylic

acid 30% is 79.93% with a standard deviation of

23.50. The average sebum after chemical peeling with

salicylic acid 30% is 66.20% with a standard

deviation of 18.72.

Normality test using the Shapiro-Wilk test, levels

of skin sebum level before chemical peeling with

30% salicylic acid significance value > 0.05, this

implies the data are assumed to be normally

distributed, then the data is then analyzed by paired

T-test.

Correlation test was conducted in this study. The

first test was carried out between skin sebum levels

before and skin sebum levels after chemical peels. In

Table 2, the value of sig. shows the number .000.

Because this value <0.05, it can be concluded that

there is a correlation between the two variables tested;

in this case the skin sebum levels before and after the

chemical peeling procedure with 30% salicylic acid.

The average skin sebum level before the procedure

was 79.93%, while the average skin sebum level after

the procedure was 66.20%. Decrease in skin sebum

levels is said to be significant because the sig value

<0.05.

Table 2 correlation analysis of data before and after

chemical peeling.

P0 (Skin sebum levels before peeling)

P1 (Skin sebum levels after peeling)

P2 (Skin sebum level before and after peeling)

Mean N Std.

Deviation

Std.

Error

Mean

P0 79,93 15 23,496 6,067

P1 66,20 15 18,724 4,835

N Correlation Sig.

P2 15 .946 .000 P2

Chemical peeling is the use of ingredients for skin

exfoliation, with the purpose to exfoliate the existing

epidermis and / or dermis to regenerate new

epidermis and dermis tissue (Rendon et al., 2010).

In this study, chemical peels using 30% salicylic

acid. The results showed sebum levels of skin after

chemical peels with 30% salicylic acid tended to

decrease. The results of this study are consistent with

the results of previous studies that equally examined

the effect of chemical peels with 30% salicylic acid

by (Lee et al., 2003) who conducted a study of 35

patients in Korea with facial acne when treated with

chemical peels of salicylic acid 30% for 12 weeks,

inflammatory and non-inflammatory lesions were

found to be reduced (Lee et al., 2003).

The results of this study are also supported by the

statement of Soleymani that Salicylic Acid is difficult

Effect of Skin Sebum Levels before and after Chemical Peeling with 30

251

to dissolve in water, but is very soluble in fat, coupled

with its small molecular size, salicylic acid can easily,

quickly and can penetrate the protective layer of fat

from the epidermis (Soleymani et al., 2018).

Clinically,it is very effective in the management of

diseases associated with increased sebum production,

such as acne vulgaris. In fact, 30% salicylic acid is

often regarded as the gold standard superficial peeling

for the treatment of acne vulgaris (Soleymani et al.,

2018). According to Abdel-Motaleb, the histological

image after chemical peeling with salicylic acid also

shows the appearance of sebaceous glands

surrounded by many inflammatory cells. This might

cause a decrease in skin sebum levels (Abdel, 2017).

The number of sebaceous glands remains

approximately the same throughout life, while their

size tends to decrease with age. The function of the

sebaceous glands is to secrete sebum. Androgens are

famous for their effects on sebum excretion

(Zouboulis, 2005). Based on Sugawara's research,

which examined the relationship of age to sebaceous

glands, it was found that, the area of sebaceous units

was reduced and the depth of the maximum area was

shallower in elderly female subjects compared with

young female subjects. Therefore, the sebaceous

glands are thought to shrink with age (Sugawara et

al., 2019). According to Abdallah, which examines

the comparison of sebum levels in men and women,

the result is that sebum levels in men tend to be higher

than women, this can be explained by the fact that

skin sebum is mainly influenced by androgen

hormones such as testosterone and

dehydroepiandrosterone, whereas estrogen has the

opposite effect in the function of the sebaceous

glands. Androgens are also known to have an

important role in the physiology of the sebaceous

glands through modulation of sebum production

(Abdallah et al., 2017).

4 CONCLUSIONS

Based on the results of research and discussion it was

concluded that there was significant difference in skin

sebum levels before and after chemical peeling

salicylic acid 30%. The effect of reducing skin sebum

levels may be caused by salicylic acid which

penetrates the fat layer very well so that activity of the

sebaceous glands can decrease. Clinically, this makes

salicylate very effective for the management of skin

disorders associated with an increase in sebum

production, such as acne vulgaris.

REFERENCES

Abdallah M, et al. Comparative Study of Male and Female

Sebum Production. The Egyptian Journal of Hospital

Medicine, 2017; Vol 69 (2), Page 1874-18

Abdel – Motaleb AA., “Dermal morphological changes

following salicylic acid peeling and

microdermabrasion,” J Cosmet Dermatol 2017; 1-6

Arif Tasleem. “Salicylic Acid as a Peeling Agent : a

Comparative Review,” 2015; 455- 461. Available at :

https:// www.ncbi.nlm.nih.gov

Bahtiar R. 2016. “Optimasi Formula Gel Asam Salisilat

dengan Kombinasi Basis Karbomer dan HPMC

menggunakan metode SLD,” 2016. Universitas Gadjah

Mada.

Berson DS, Cohen JL, Rendom MI, et al. “Clinical Role and

Application of Supperficial Chemical Peels in Today’s

Practice,” J Drugs Dermato. 2009; (9) : 803-811.

Chen X, Wang S, Yang M, et al. “Chemical Peels for Acne

Vulgaris : A Systematic Review of Randomised

Controlled Trials,” BMJ Open

2018;8:e019607.doi:10.1136/bmjopen-2017-019607.

Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith

LA, Katz SI. 2002. “Fitzpatrick’s Dermatology in

General Medicine,” 2002. Edisi ke-6. Newyork:

McGraw-Hill; Hlm. 109-675.

Hassan KM, Benedetto AV. “Facial Skin Rejuvenation:

Ablative Laser Resurfacing, Chemical Peels, or

Photodynamic Therapy Facts and Controversies,” Clin

Dermatol. 2013; 31(6):737–740.

Lee HS, et al. “Salicylic Acid Peels For The Treatment of

Acne Vulgaris in Asian Patients,” Dermatol surg.

2003;14725662.

Pochi PE, et al. 1979. “Age Related Changes in Sebaceous

Gland Activity,” J Invest Dermatol.

Ptavitasari DN, Setyaningrum T.“Chemical Peeling pada

Melasma. Staf Medik Fungsional Ilmu Kesehatan Kulit

dan Kelamin Fakultas Kedokteran Universitas

Airlangga Surabaya,”.2012. Berkala Ilmu Kesehatan

Kulit & Kelamin Vol 24 No. 1 pp 55-57.

Rendon ML, Berson DS, Cohen JL, et al. “Evidence and

Considerations in the Application of Chemical Peels in

Skin Disorders and Aesthetic Resurfacing,” J Clin

Aesthet Dermato.2010; 3 (7) : 32 – 43.

Soleymani T., Lanoue J., Rahman Z., “A practical approach

to chemical peels: A review of fundamentals and step-

by-step algorithmic protocol for treatment,” J Clin

Aesthet Dermatol 2018;11(8):21-28.

Sugawara T, et al. 2019. Gender and Age Related

Differences in Facial Sebaceous Glands in Asian Skin,

as Observed by Non-Invasive Analysis Using Three

Dimensional Ultrasound Microscopy. Skin Res

Technol.

Turnip, A., Andrian, Turnip, M., Dharma, A., Paninsari, D.,

Nababan, T., Ginting, C.N., 2020. An application of

modified filter algorithm fetal electrocardiogram

signals with various subjects, International Journal of

Artificial Intelligence, vol. 18, no., 2020.

Wijaya, C., Andrian, M., Harahap, M., Turnip, A., 2019.

Abnormalities State Detection from P-Wave, QRS

252

Complex, and T-Wave in Noisy ECG, Journal of

Physics: Conference Series, Volume 1230, (2019)

012015. doi:10.1088/1742-6596/1230/1/012015.

Zouboulis CC. 2004. Acne and Sebaceous Gland Function.

Clin Dermatol.

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