Are cold sores a possible side effect of chemical peels?

I haven’t had a cold sore in a while. Prior to that I used to get them a lot but I take vitamins to keep them under control for the most part. I just had my first chem peel (medium TCA) and almost immediately after I developed a big ugly cold sore. Is this common for someone like me who has always been prone to them?


F, 49, Nebraska

Tags:face side effects

Thank you for the question and I generally place patients on Acyclovir to prevent cold sores as in the presence of a peel or resurfacing they can cause scarring 

Dr Corbin

Chemical peels employ acids that kill skin cells to a certain level. This enables patients to grow new skin, resulting in a youthful and healthy complexion.

Chemical peels are classified by how deeply they penetrate the skin. There are three levels :

  • Superficial peels penetrate only the epidermis. They are useful for repairing fine lines and wrinkles caused by sun damage or an uneven skin tone.
  • Medium peels penetrate to the outer layer of the dermis. They work well for treating deeper wrinkles and acne scars.
  • Deep peels penetrate to the lower layers of the dermis. They are most beneficial for treatment of scarring and precancerous lesions such as actinic keratoses. Deep chemical peels may be performed under general anesthesia and require a lengthy recovery time.

Various chemical solutions are used in chemical peels, each with different strengths for the three levels of penetration discussed above. The most common chemicals used include:

  • Trichloroacetic acid (TCA)
  • Alpha Hydroxy acids (lactic acid and glycolic acid)
  • Beta Hydroxy acids (salicylic acid)
  • Retinoids (tretinoin dissolved in propylene glycol)
  • Phenol (carbolic acid)
  • Jessner’s solution (resorcinol and salicylic acid dissolved in ethanol)

Cold sore outbreaks are a very common side effect of all chemical peels, so given your history it’s not surprising you’ve developed one. The reason for this is that the inflammation caused by the peel can activate the herpes virus, which is responsible for cold sores. Antiviral medications such as Acyclovir may help.

Other side effects include:

  • Hyperpigmentation: Skin color becomes darker than normal. Hypopigmentation, where the treated skin becomes lighter than normal, can also occur.
  • Redness: A normal part of the healing process from a chemical peel, this redness can last for a few months following a medium or deep peel. Cold compresses can help to soothe the redness.
  • Scarring: Although rare, scarring can result from a chemical peel. Steroids are used to minimize the appearance of these scars.
  • Organ damage: Some chemicals used for deep peels, such as carbolic acid (phenol), can damage the heart, kidneys, and liver.

Chemical peels are not for everyone. There are some people for whom they would do more harm than good. This includes people with:

  • Darker skin
  • A history of severe cold sore outbreaks
  • Facial warts
  • Red hair and pale skin
  • Keloids