|Year : 2012 | Volume
| Issue : 2 | Page : 122-124
Evaluation of efficacy of chemical peeling with glycolic acid in hyperpigmentation disorders of the skin
Supriya P Deshmukh, Nitin C Chaudhari, Kedarnath Dash, Yugal K Sharma, Kirti S Deo
Department of Dermatology, Dr D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||10-Nov-2012|
Supriya P Deshmukh
401 - Gaurangi CHS, Opposite Damani Estate Post Office, L B S Marg, Thane (West) - 400601, Maharashtra
Source of Support: None, Conflict of Interest: None
Background : Chemical peeling entails application of chemical agents to the skin causing a controlled chemical burn, thereby achieving improved texture and quality of skin. Aim: To evaluate the efficacy of glycolic acid in melasma and other causes of hyperpigmentation. Materials and Methods: A total of 20 patients were included in the study. After adequate priming, application of glycolic acid in various concentrations in biweekly interval for a period of 16 weeks was done. Post-treatment photographs were taken and were subjected to analysis. Results: Melasma constituted 11 patients and hyperpigmentation, ie, post acne marks and freckles due to sun exposure accounted nine patients. Complete resolution of melasma was possible only in one (9%) patient and good improvement in four (36.3%), whereas five (45.5%) patients showed fair improvement. In cases of hyperpigmentation, three (33%) patients showed excellent improvement, one (11%) showed good improvement, and five (55.5%) patients showed fair improvement. The patients of melasma took an average of 7.33 number of peels to show improvement and those of hyperpigmentation took 4.2 peels. Conclusions: Melasma shows fair to good improvement and requires more number of peels as compared to other causes of hyperpigmentation in skin. Postinflammatory pigmentation shows excellent improvement in the majority of patients.
Keywords: Chemical peeling, glycolic acid, melasma
|How to cite this article:|
Deshmukh SP, Chaudhari NC, Dash K, Sharma YK, Deo KS. Evaluation of efficacy of chemical peeling with glycolic acid in hyperpigmentation disorders of the skin. Med J DY Patil Univ 2012;5:122-4
|How to cite this URL:|
Deshmukh SP, Chaudhari NC, Dash K, Sharma YK, Deo KS. Evaluation of efficacy of chemical peeling with glycolic acid in hyperpigmentation disorders of the skin. Med J DY Patil Univ [serial online] 2012 [cited 2020 Aug 9];5:122-4. Available from: http://www.mjdrdypu.org/text.asp?2012/5/2/122/103335
| Introduction|| |
Number of patients visiting dermatologists for prevention and treatment of aging of skin is increasing day by day. Many patients also seek advice from non-dermatologists for the same; hence, the idea of our study was to sensitize the physicians from other disciplines about the concept and efficacy of chemical peeling. The most common consequence of photo damage in the Indian skin is hyperpigmentation, with other less common ones being wrinkles, laxity, roughness, and telangiectasia.  The concept of chemical peeling intends to improve the texture of the skin and lighten the complexion. In ancient Egypt, Cleopatra used sour milk, now known to contain lactic acid, which is an alpha hydroxy acid, while French women used old wine containing tartaric acid to enhance the appearance of their skin.  Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part or entire epidermis, with or without the dermis, leading to exfoliation, removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Chemical peeling is a common office procedure that has evolved over the years, using the scientific knowledge of wound healing after controlled chemical skin injury. 
Chemical peeling has been classified depending on the level/depth achieved by the peeling agent. There are two classification systems as shown in [Table 1]. 
| Materials and Methods|| |
A total of 20 patients attending our outpatient department in Dr. D. Y. Patil Hospital and Research Hospital, Pune, with melasma and post-inflammatory hyperpigmentation were included in our study. Patients' clinical details and the nature and severity of lesions were noted. Clinical photographs were taken at week 0 (baseline) and week 16 (completion of study).
Following an informed consent for the procedure and clinical photographs, a test peel was done and all patients were primed with tretinoin cream (0.025%) and a broad-spectrum sunscreen for a total of two weeks. Serial glycolic acid (GA) peels were then undertaken at fortnightly intervals. Superficial chemical peels (up to the level of stratum granulosum) were attempted according to Brody's and Mark Rubin's classification. We started with 35% GA for a period of 1-2 minutes, serially increasing the duration and concentration of 50% GA for five minutes was used. All patients were advised total sun protection with a broad-spectrum sunscreen. Side effects, if any, were also recorded. At 16 weeks, the patients were evaluated and the response to therapy was graded on a five-point scale as excellent (>80% improvement), good (50-80%), fair (<50%), and no change or worse. The final assessment was recorded on the basis of the opinion of the clinician, perception of the patient, and photographic analysis.
| Results|| |
Among 20 patients included in the study, 16 were female and 4 male. The patients were in the age group of 16-56 years. Melasma constituted 11 patients and hyperpigmentation, ie, post acne marks and freckles due to sun exposure, accounted nine patients. Complete resolution of melasma was possible only in one patient (9%) [Figure 1]a and b and good improvement in four (36.3%), while five (45.5%) patients showed fair improvement. In cases of hyperpigmentation, three (33%) patients [Figure 2]a and b showed excellent improvement, one (11%) showed good improvement, and five (55.5%) patients showed fair improvement [Table 2]. The patients with melasma took an average of 7.33 number of peels to show improvement and those with hyperpigmentation took 4.2 number of peels [Table 3]. No side effects were encountered. Better skin texture and smoothness was found in all patients who underwent peeling.
|Figure 2: (a) Patient showing hyperpigmentation over bilateral nasolabial folds and forehead; (b) Excellent improvement in the pigmentation with overall lightening of complexion|
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|Table 2: Number of patients with the skin condition and the percentage improvement obtained at the end of 16 weeks|
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|Table 3: Range of number of peels required for patients of melasma and hyperpigmentation and the average amount of peels required to improve the same|
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| Discussion|| |
Glycolic acid is an alpha hydroxy acid derived from sugarcane. Glycolic acid is one of the most commonly used and versatile peeling agents. It has been used in various skin disorders, including disorders of keratinisation apart from common skin problems such as pigmentary changes (post-inflammatory hyperpigmentation, melasma), acne, wrinkles, warts, actinic and seborrheic keratoses, etc, with the most common indication being skin rejuvenation. 
Melasma is a common disorder characterised by symmetric, hyperpigmented patches with an irregular outline that occur most commonly on the face.  Exacerbating factors include pregnancy, oral contraceptives, and sun exposure.  Freckles are hyperpigmented macules occurring on face mainly due to sun exposure in fair-skinned individuals.  Acne vulgaris on resolution can leave hyperpigmented spots, especially in dark-skinned individuals, they may be aggravated due to sun exposure.  Pigmentation on face is of great concern cosmetically; hence, large numbers of affected individuals seek treatment for it.
In our study on patients of melasma, a majority of patients (81.82%) had good to fair improvement, which is in agreement with the finding by Lim et al. and Grover et al. in their study of melasma. , Burns et al.  and Grover et al.  reported a more rapid and better improvement in postinflammatory hyperpigmentation with the use of GA peels. This was reflected in our study as well, as melasma improved with an average 7.33 number of peels as compared to an average of 4.2 peels in cases of other hyperpigmentation disorders.
| Conclusions|| |
In our small, non-blinded study, we conclude that chemical peeling with GA gives better and faster results with post-acne hyperpigmentation and freckles as compared to melasma. Moreover, we report this study to create awareness among physicians of all disciplines that chemical peeling is a simple, office-based procedure for effectively addressing common hyperpigmentation disorders of skin.
| References|| |
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|3.||Khunger N. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol 2008;74:5-12. |
|4.||Grover C, Reddu BS. The therapeutic value of glycolic acid peels in dermatology. Indian J Dermatol Venereol Leprol 2003;69:148- 50. |
|5.||Chang MW. Disorders of hyperpigmentation. In: Bolognia JL, Rapini RP, editors. Dermatology, 2 nd ed. Spain: Mosby Elsevier Publishers; 2008. p. 939-64. |
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|7.||Burns RL, Prevost- Blank PL, Lawry MA, Lawry TB, Faria DT, Fivenson DP. Glycolic acid for postinflammatory hyperpigmentation in black patients. Dermotol Surg 1997;23:171- 5. |
|8.||Lim JT, Tham SN. Glycolic acid peels in the treatment of melasma among Asian women. Dermatol Surg 1997;23:177-9. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]