Patient glycolic acid

Glycolic acid peels are contraindicated in contact dermatitis, pregnancy and in patients with glycolate hypersensitivity. Moreover, they can increase skin sensitivity to ultraviolet light. 

Patients with photodamage can apply a lotion containing 25% glycolic acid for 6 months. In such cases an increase in total skin thickness of approximately 25% was reported, accompanied by an increased thickness of viable epidermis and dermis, an increased content of acid mucopolysaccharides, a greater collagen density and an improved quality of the elastic fibers. This could be defined as self-treatment. 

Since TCA in higher concentrations tends to produce increased scarring and hypopigmenta-tion, 70% glycolic acid solution was applied to the entire face of patients and diluted with water after 2 min. This was followed by the sequential application of EMLA cream (lidocaine 2.5% and prilocaine 2.5%) or ELA-Max cream (lidocaine 4%) to selected areas on the face for 30 min without occlusion. These agents were then removed and 35% TCA was applied to the entire face [10]. 

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]. 

In patients with acne (Fig. 2.4), the chemical peels were performed with a 70% glycolic acid solution, for 2 to8 min. The number and frequency of the applications depended on the intensity of the clinical response. The most rapid improvement was observed in comedonic acne, in the papulo-pustular forms. An average of six applications were necessary (Fig. 2.5a, b). 

Patients of varying skin types (1-V) having striae distensae alba on the abdomen or thighs can apply topical 20% glycolic acid daily to the entire treatment area. In addition, these patients apply 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine to half of the treatment area and 0.05% tretinoin emollient cream to the other half of the treatment area. The creams are applied on a daily basis for 12 weeks. Improvement is evaluated at 4 and 12 weeks with increased elastin content within the reticular and papillary dermis [14]. 

PseudofoUiculitis barbae is a foreign-body inflammatory reaction surrounding ingrown facial hair, which results from shaving. Topical application of glycolic acid lotion is an effective therapy and allows the patient to resume a daily shaving regimen [15]. 

In patients with scalp psoriasis a combination of a 10% glycolic acid scalp lotion is used as well as a 0.1% betamethasone scalp application, applied twice daily without any bandage for a period of 8 weeks [16]. 

Glycolic acid peeling is a medical procedure that requires the informed consent of the patient. The medical doctor must obtain from the patient a well-standardized formal consent that shows that all information about the medical procedure performed was explained to the patient. We include below the formal consent form submitted to the patient before the glycolic acid peeling procedure. 

Kim SW, Moon SE, Kim JA, Eun HC (1999) Glycolic acid versus Jessner s solution which is better for facial acne patients A randomised prospective clinical trial of split-face model therapy. Dermatol Surg 25(4) 270-273... 

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. 

Lawrence et al. [21] compared the efficacy of Jessner s solution and 70% glycolic acid in a split-face study of 16 patients. Of the total group, five were skin type IV, three were skin type V, and one was skin type VI. There was no statistically significant difference in improvement between the two groups. The investigator did not report an increased frequency of side effects in patients of skin types IV-VI. 

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-... 

Burns RI, Provost-Blank PC, Lawry MA, et al (1997) Glycolic acid peels for post inflammatory hyperpigmentation in black patients a comparative study. Dermatol Surg 23 171-174... 

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... 

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. 

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 cosme-ceutical products such as glycolic acid. Compared with hydroquinone, these kojic acid formulations usually show less efficacy. However, they may be effective in patients who do not... 

The concomitant use of various bleaching agents has also been shown to improve PIH. In 1975, tretinoin in combination with hydroqui-none and dexamethasone was reported as an effective treatment for PIH [14]. In a small study, the application of 2% hydroquinone and 10% glycolic acid gel twice daily and 0.05% tretinoin cream at night has been shown to provide benefit for darker-skinned patients with PIH [15]. Similarly, Yoshimura et al. [16] suggested efficacy of tretinoin combined with hydroquinone and lactic acid in reducing PIH. More re-... 

Burns R, Prevost-Blank PL, Lawry MA, Lawry TB, Faria DT, Fivenson DP (1999) Glycolic acid peels for postinflammatory hyperpigmentation in black patients. Dermatol Surg 25 18-22... 

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