Review on Chemical Peels for Nail Surface Rejuvenation (2025)

Abstract

Introduction

Chemical peels are well known as a facial resurfacing technique often aimed at targeting aging, hyperpigmentation, and smoothing skin texture. They are among a number of techniques used to resurface the skin alongside microdermabrasion and ablative lasers. Historically, the use of chemicals for skin rejuvenation has been practiced since ancient times [1]. Alongside a booming skin care industry, nails also have long played a significant role in aesthetics. Nail cosmetics are universally used to beautify the nail, and new techniques and ingredients are continuously developed. Although nail cosmetics are useful to improve nail appearance by covering and masking abnormalities in the nail surface, they often contribute in making the nail plate more fragile and irregular. This is particularly common with gel or acrylic manicure that requires filing of the superficial nail plate for better nail adhesion [2]. Chemical peels have recently been proposed to smooth the nail plate surface and produce fast improvement of superficial scaling, discoloration, roughness, and pitting. In the skin, chemical peels destroy the outer layers of the skin, promoting exfoliation; the type of agent influences the depth of penetration [1]. The mechanism of chemical peels on the nail plate is possibly similar to the peeling agent inducing the desquamation of corneocytes, thus leading to cosmetic improvement of the nail surface. Different peeling agents have been utilized for this purpose including glycolic acid, salicylic acid, trichloroacetic acid (TCA), and phenol. This review aimed to highlight studies that have investigated the use of chemical peels on nails for cosmetic benefit.

Methods

Literature searches on PubMed/MEDLINE and Embase were performed to identify studies that assessed the efficacy of chemical peels on the nail published up to July 2022. The search terms used included “chemical peels,” “nails,” “phenol,” “salicylic acid,” “trichloroacetic acid,” and “glycolic acid,” yielding a total of 21 articles from PubMed/MEDLINE and 19 articles from Embase. The articles were screened for duplicates, abstract-only, and for the specific use of chemical peels on the nail, yielding 4 articles all of which were prospective open-label uncontrolled studies.

Results

From the 4 studies included in this review, we identified a total of 96 patients who underwent a chemical peel treatment for the nails. Table 1 provides identifying information regarding each study, treatment protocol, and patient information. Figure 1 provides an example of the use of TCA peel on rough-textured nails.

In a prospective open-label uncontrolled study conducted by Banga and Patel, 70% glycolic acid was applied for 45 min to the nail plate of 31 patients, 22 of which had dry, rough-textured, and discolored nails and 9 with hyperkeratotic nails [3]. A single treatment was performed for those with dry-rough nails and multiple treatments depending on nail thickness were applied for patients with hyperkeratotic nails. Results were based on the level of patient satisfaction where 80% of the patients with rough nails and 60% of the patients with hyperkeratotic nails expressed that there was good improvement.

A right-left comparative study of 15 patients with superficial nail abnormalities performed by Daulatabad, Nanda, and Grover compared 70% glycolic acid versus 8% phenol combined with 15% TCA peel with nail plate surface abnormalities due to different diseases [4]. Patients’ subjective opinion and physician assessment via self-designed objective scoring systems found that both peel types were equally effective. However, results specific to each nail condition in the study were not described.

Mukhija et al. [5] performed a similar prospective open-label uncontrolled study. In this study, multiple treatments (3–6) in 15-day intervals of 70% glycolic acid were performed on 33 patients with superficial nail changes. The authors described a good to moderate treatment response in the majority of the patients.

In a prospective single open-label uncontrolled study of 20 patients by Chiheb, Kamal, Elfiboumi, and Hali, nail peeling with 50% glycolic acid was assessed [6]. The number of coats of glycolic acid and the number of treatment sessions differed between two groups. In the first group, patients with superficial nail abnormalities due to cosmetics received 1–2 coats every week for 1–2 sessions. The second group consisted of patients with superficial nail abnormalities due to pathologic conditions. These patients received 2–4 coats of 50% glycolic acid weekly for 6–8 sessions. Overall, good treatment response was reported for the majority of patients with cosmetic-induced superficial nail abnormalities and patients with onychomycosis.

Discussion

Nail cosmetics are frequently used by dermatologists as a supportive treatment when bridging the gap between patient presentation of a nail condition and the 3- to 6-month lag to achieving treatment efficacy [2]. Chemical peels for the nails may provide a fast improvement of the appearance of the nail. This treatment may be used as an adjunct treatment in certain nail pathologies such as fungal infections, thick dystrophic nails, nail psoriasis, ingrown nails, and nail discoloration. The concentration and duration of the chemical peel treatment should be tailored to the individual patient and their specific nail conditions. Chemical peels can be associated with potential side effects such as pain, irritation, and nail damage and should only be performed under the supervision of a trained healthcare professional. During the chemical peel, it is important to take precautions in protecting the periungual soft tissue via occluding the cuticle margins. Post-treatment, it is of benefit to inform patients to maintain good hydration of the nails as well as in between treatment sessions. Chemical peels are not a substitute for proper medical treatment of underlying nail conditions, and patients should consult with a healthcare professional before initiating any cosmetic treatment.

Currently, evidence on chemical peels for nails best demonstrates marked improvement in aesthetic appearance for nail surface abnormalities induced by cosmetics compared to abnormalities secondary to nail pathologies. However, many factors still need to be clarified including which peels are more effective, the number of sessions needed and which patients can really benefit from this treatment as well as when this treatment can even be contraindicated. We would like to suggest some proposed measures for future investigators to use in order to assess the outcome of the effect of chemical peels on the nails. Nail thickness can be measured using a micrometer before and after the chemical peel treatment. This can help determine if the treatment resulted in a reduction in nail thickness. Quantifying the amount of ridging before and after the peel can also be another outcome measure. Nail smoothness and luster can be assessed using a grading system, where a score is given based on the degree of roughness or unevenness and sheen/color of the nail surface. This can be done by a trained evaluator who is blind to the treatment received by the patient. Lastly, patients can be asked to complete a survey after the treatment to assess their level of satisfaction with the results. This survey can include questions about nail appearance, pain, and any adverse effects experienced after the treatment. While future studies to evaluate nail pathology after using chemical peels on the nails can mainly be done via visual inspection, these studies may also benefit from the use of techniques such as histopathology and scanning electron microscopy. A biopsy of the nail plate can be taken before and after the chemical peel treatment to evaluate any structural changes in the nail. The biopsy can be stained and examined under a microscope to assess changes in the nail matrix, nail bed, and nail plate. Scanning electron microscopy can be used to examine the surface of the nail plate and underlying structures at high magnification to identify any surface changes that have occurred as a result of the chemical peel treatment.

Statement of Ethics

An ethics statement is not applicable because this study is based exclusively on published literature

Conflict of Interest Statement

Wilhelmina Lam has nothing to disclose.

Dr. Antonella Tosti’s disclosures: consultant – DS Laboratories, MONAT Global, Almirall, Thirty Madison, Eli Lilly, P&G, Pfizer, Myovant, Bristol Myers Squibb, Ortho Dermatologics, and Curallux, LLC; PI – Eli Lilly, Concert, and Erchonia.

Funding Sources

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Contributions

The authors confirm contribution to the paper as follows: study conception – Antonella Tosti; data collection, analysis, and interpretation of results – Wilhelmina Lam; and draft manuscript preparation – Wilhelmina Lam and Antonella Tosti. All authors reviewed the results and approved the final version of the manuscript.

Funding Statement

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Data Availability Statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

References

Associated Data

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