Melasma glycolic acid

Patients with melasma (Eig. 2.3) applied topical sunscreens (sun protection factor 15) and 10% glycolic acid lotion at night for 2 weeks. They were then treated with 50% glycolic acid facial peels once a month for 3 consecutive months. At regular intervals and at the end of the follow-up period (3 months) after the last peel, the degree of improvement in pigmentation was assessed by measuring MASl (Melasma Area and Severity Index) [11]. 

Javaheri SM, Handa S, Kaur I, Kumar B (2001) Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol 40(5) 354-357... 

In 2002, Grimes reported the efficacy of combination salicylic acid/TCA 10% peeling [1]. She treated patients with moderate to severe melasma with this combination regimen. In the series, nine patients were classified as Fitzpatrick skin type IV, eleven were skin type V, and seven were skin type VI. Many of the subjects included in the study had not responded to salicylic acid or glycolic acid peels. The concentration of salicylic acid was 20 and 30%, and the TCA concentration was 10%. A series of four peels was performed at 2-week intervals. Thirty percent of the patients experienced moderate improve-... 

Fig. 10.2. a Patient with recalcitrant melasma unresponsive to glycolic acid or salicylic acid peels, b Responded to combination salicylic acid/TCA peeling... 

The safety and efficacy of a series of glycolic acid facial peels were investigated in 25 Indian women with melasma [16]. Patients were treated with 50% glycolic acid peels monthly for 3 months. Improvement was noted in 91% of patients with maximal clearing occurring in patients classified with epidermal melasma. Side effects were observed in one patient who developed brow hyperpigmentation. 

Tretinoin 1% has also been used as a chemical peeling agent [22,23]. The efficacy of tretinoin peels was compared with glycolic acid peels in the treatment of melasma in dark skinned patients [23]. In a split face study of ten Indian women, 1% tretinoin was applied to one half of the face, while 70% glycolic acid was applied to the opposite side. Peels were performed weekly. Significant improvement occurred on both sides as assessed by photographs and a Modi-... 

Lim JT, Tham SN (1997) Glycolic acid peels in the treatment of melasma in Asian women. Dermatol Surg 20 27-34... 

Wang CM, Huang CL, Hu CT, Chan HL (1997) The effects of glycolic acid on the treatment of melasma among Asian skin. Dermatol Surg 23 23-29... 

Sarkar R, Kaur C, Bhalla M, et al (2002) The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark-skinned patients a comparative study. Dermatol Surg 28 828-832... 

Lawrence NL, Cox SE, Brady HJ (1977) Treatment of melasma with Jessner s solution versus glycolic acid a comparison of clinical efficacy and evaluation of the predictive ability of Wood s light examination. J Am Acad Dermatol 36 589-593... 

Khunger N, Sarkar R, Jain RK (2004) Tretinoin peels versus glycolic acid peels in the treatment of melasma in dark-skinned patients. Dermatol Surg 25 270-273... 

Azelaic acid is a non-phenolic derivative (1,7-hep tanedicarboxylic acid) used at concentration of 10-20% twice a day to treat melasma with minimal side effects (allergic reactions). It acts to disturb the tyrosinase synthesis and can be used as a bleaching agent in patients sensitive to hydroquinone. Better results are obtained if a glycolic acid cream is applied sequentially to azelaic acid treatment. 

Garcia A, Fulton JE Jr (1996) The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg 22 443-447... 

Erbil, H., Sezer, E., Tastan, B. et al. (2007) Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma. The Journal of Dermatology, 34, 25-30. 

As a general rule, it is worthwhile preparing the skin carefully with tyrosinase inhibitors if there is any risk of post-peel pigmentary changes or to optimize results when treating melasma. Retinoic acid and sometimes glycolic acid are used to make transepidermal penetration more even or to deepen the action of the acid solution. 

On the other hand, it is worthwhile combining the two in the daily treatment of melasma between or after peels. The pharmacist should be asked to add 3-8% hydroquinone to a water-in-oil cream with an 8-10% glycolic acid concentration. 

Resorcinol solutions have been used in combination with glycolic acid, trichloroacetic acid (TCA) and 5-fluorouracil (5-FU). Many modified versions of Jessner s solution have been presented, containing kojic acid, hydroquinone, etc. The effectiveness of these resorcinol solutions depends on skin preparation, skin sensitivity and thickness, the type of applicator and the force of application, the number of coats applied, the type of solution used, the quality of the solution s preparation, etc. Moreover, products with a tyrosinase-inhibiting action (kojic acid, hydroquinone, etc.) only produce their effect in the long term. Single application of these products cannot treat melasma in any way. Only repeated applications, allowing the gradual absorption of products that inhibit melanocyte metabolism, can be considered as an effective treatment. 

The melanogenesis-inhibiting properties of lactic acid and glycolic acid have been shown in the treatment of melasma as well as solar lentigines and PIH. The mechanism of action not only lies in the faster dispersion of pigments in a more rapidly renewed epidermis, but also in the inhibition of tyrosinase activity. This inhibition has no relation to the acidity of these products, as studies show that tyrosinase-inhibiting activity is constant, even below pH 5.6. 

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