Comparative Efficacy and Safety of Laser Versus Chemical Skin Peeling in Skin Rejuvenation: A Systematic Review and Meta-Analysis.

Abstract

Laser resurfacing and chemical peeling represent two widely practiced skin rejuvenation techniques, each with distinct mechanisms and risk profiles. Despite their widespread use, comparative efficacy and safety across various dermatologic conditions remains incompletely synthesized. This systematic review and meta-analysis compared these modalities to guide evidence-based decision-making. Following PRISMA guidelines, we searched major databases through October 2024 for studies directly comparing laser treatments and chemical peels. Data on clinical improvement, adverse effects, and treatment sessions were pooled using random-effects models. Thirty-eight studies involving 1,695 patients were included. Both modalities achieved significant improvement over baseline. Overall efficacy was comparable between lasers and peels SMD: 1.53, 95% CI: 0.57 to 2.50). Laser treatment was more effective for melasma (SMD 1.53 [95% CI: 0.57, 2.50]), while chemical peeling was superior in psoriasis SMD -4.30 [95% CI: -6.84, -1.76]). No significant efficacy difference was observed in acne/acne scarring or overall photoaging. Lasers required fewer treatment sessions on average (mean difference: 2.00 sessions, p < 0.001). Transient erythema and procedure pain were more common with lasers (RR: 6.63, 95% CI: 0.39 to 113.14; RR 4.42; 95% CI: 1.72, 11.37, respectively), whereas rates of post-inflammatory hyperpigmentation were similar. Both modalities are effective for skin rejuvenation. Lasers may offer advantages in melasma and require fewer sessions, but with more short-term redness and discomfort. Chemical peels remain valuable, especially for certain conditions (e.g., psoriasis) and in patients prioritizing minimal downtime. Treatment choice should be individualized to patient skin type, condition, and tolerance for side effects.