Glycolic acid hyperpigmentation treatment

Glycolic acid can be applied simultaneously with TCA, which represents another technique for a medium-depth peel. Glycolic acid is also used in creams for self-treatment. Since complications such as hyperpigmentation, infection, irritation, and photosensitivity are very rare, it is well tolerated. 

PIH after a peel with 70% unbuffered glycolic acid neutralization with a sodium bicarbonate solution as soon as erythema appeared. There is no visible frosting. Postoperative developments were normal. On the 8th day, the patient consulted the doctor about the appearance of PIH 3 days before (a). Treatment consisted of tyrosinase inhibitors, topical antioxidants, sun avoidance and protection, (b) The patient after 5 weeks, (c) After 8 weeks. The hyperpigmentation has improved significantly. A telephone call revealed that the problem has cleared up completely after 3 months. 

Kojic acid (5-hydroxy-4 pyran 4-1-2 methyl) is a fungal derivative which inactivates tyrosinase via chelation of copper. Concentrations range from 2% to 4%. It can be used for monotherapy or in combination with retinoids or other cosmeceutical products such as glycolic acid. Compared to hydroquinone, these kojic acid formulations usually show less efficacy however, they may be effective in patients who do not tolerate hydroquinone. In addition, they can be used as maintenance therapies for treatment of hyperpigmentation following 4-6 months of hydroquinone treatment. Use of kojic acid has been associated with contact dermatitis in sensitized individuals, however [41 3]. 

Glycolic acid peels are used as adjunctive treatments in conditions such as acne, postinflammatory hyperpigmentation usually resulting from acne, shallow acne scars, papulopustular rosacea, melasma, seborrheic and actinic keratoses, keratosis pilaris, and some warts resistant to conventional treatments. 

The most common indications we use TCA peels to treat are solar lentigos and severe acne scars [Figure 13.3). TCA can also be combined with salicylic acid for treatment of solar lentigos. For the treatment of recalcitrant hyperpigmentation and melasma, TCA can be combined with salicylic acid or glycolic acid. 

We also utilize TCA in the treatment of xanthelasma. In mild to moderate photoaging, when 50-70% glycolic acid is ineffective, TCA 50% is the best choice for an all-over medium-depth peel. We tend to avoid the use of higher concentration TCA in darker skintypes. It is important to stress sun protection in all patients after treatment to avoid postpeel hyperpigmentation. 

---