A prospective observational study on efficacy of black acetic acid combination peel in patients of facial nodulocystic acne

Raj Kumar, Prasoon Sachan, Santosh Kumar Singh, Anil Kumar Gupta, Lalit Mohan


Background: Nodulocystic acne is a severe form of acne which can result in significant damage to the skin with great impact on quality of life. Oral isotretinoin is considered to be the best treatment for such cases. Although it has a high rate of success and its efficacy is well established in the treatment of nodulocystic acne, it may occasionally fail to meet expected degree of disease control. Known side-effects and long duration to achieve cumulative dose might lead to poor compliance and known contraindications sometimes as well limit its usage.

Methods: A prospective observational studies on 20 patients who presented themselves with facial nodulocystic acne on regular OPD basis and were poorly compliant to treatment with isotretinoin owing to its side-effects, the drug failed to meet patients’ expectations or due to any contraindication to isotretenoin usage were included. A peel containing black acetic acid, jasmonic acid, salicylic acid, potassium iodide (“black peel”, Theraderm) was used topically as an alternative treatment, for a course of 3 treatment sittings 2 weeks apart.

Results: Significant reduction of nodulocystic lesions was noted after 3 sittings of “black peel” 2 weeks apart. Among 20 patients 55% showed excellent response; 45% showed good response while none of the patients were non responsive. Post treatment ISGA score of 0.45 as opposed to pre-treatment score of 3.70 (p<0.0001) was observed.

Conclusions: Black peel can be used as promising and hopeful alternative treatment for difficult to treat nodulocystic acne.


Acne vulgaris, Acne conglobata, Isotretinoin, Black peel

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