Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma

Abstract

Melasma is a common acquired disorder of facial hyperpigmentation. In this study we investigated the efficacy and safety of a combined treatment regimen including serial glycolic acid peels, topical azelaic acid cream and adapalene gel in the treatment of recalcitrant melasma. Twenty-eight patients with recalcitrant melasma were enrolled in a prospective, randomized, controlled trial lasting 20 weeks. The patients of the group receiving chemical peels underwent serial glycolic acid peels in combination with topical azelaic acid 20% cream (b.i.d.) and adapalene 0.1% gel (q.i.d., applied at night). The control group received only topical treatment including topical azelaic acid and adapalene. The clinical improvement was assessed with the Melasma Area Severity Index (MASI) at baseline and monthly during the 20-week treatment period. The results showed a prominent decrease in MASI scores at the end of the treatment in both groups, although the results were better in the group receiving chemical peels (P=0.048). All patients tolerated the topical agents well with minimal irritation observed in the first few weeks of the therapy. Three patients in the glycolic acid peel group developed a mild-degree postinflammatory hyperpigmentation with total clearance at the end of the treatment period. Therefore, the present study suggests that combined treatment with serial glycolic acid peels, azelaic acid cream and adapalene gel should be considered as an effective and safe therapy in recalcitrant melasma.

A Comparative Study of Glycolic Acid Versus Mixture of Trichloroacetic Acid and Glycolic Acid Peeling for Treatment of Three Benign Epidermal Lesions

“…Erbil et al [22] reported that glycolic acid concentrations of 50-70% decrease melanin deposits in the epidermis as well as acceleration of desquamation.…”

Melasma: A comprehensive update

“…A similar trial evaluated patients with epidermal melasma treated with azelaic acid plus adapalene with half of the group additionally treated with glycolic acid peels of increasing concentrations every 2 weeks. 63 The investigators found that the group treated with peels in addition to topicals had an 83% decrease in MASI scores as compared to a 69% decrease in the group using topicals alone. Glycolic acid has also been studied as an adjunct to hydroquinone in a split-face trial where the authors found no additional benefit to chemical peeling in terms of Mexameter readings, reduction in MASI scores, or blinded physician global assessments.…”

Melasma in Latin America: options for therapy and treatment algorithm

“…Results have been variable: some studies show no additional benefit over hydroquinone alone, while in one report, there was a significant improvement in patients with recalcitrant melasma receiving glycolic acid or focal trichloroacetic acid peels and a topical regimen. 45,56,59,60 Darker-skinned patients of Hispanic, Asian or African origin frequently experience hyperpigmentation as a result of peeling treatments and so require lower concentrations of peeling agents. 40,44,71 Glycolic acid peels (20-70%) subjectively improved melasma in combination with 2% hydroquinone and 10% glycolic acid in 10 Asian women.…”