Background: Chemical peeling is increasingly used in dermatology nowadays. Salicylic acid peels have been widely used in Asian patients since long ago, but very few published literature is there focusing on the efficacy and safety of it in Asian population. This study was planned to compare the efficacy of salicylic acid (SA) peel either commercially available or freshly prepared in treatment of acne. Methods: A prospective, randomized, open-label, parallel-group study was carried out in patients with acne. A total of 126 patients were randomized to receive 30% salicylic acid peel either commercially available (group A, n = 60) or freshly prepared (group B, n = 63). Assessment of acne lesions was done at baseline and at 2, 4, 6, 8, 10, and 12 weeks. Objective assessment was carried out using total acne score and subjective assessment using visual analog scale and were compared. Results: Mean age of patients was 22.4 ± 3.1 years with female predominance. After six sessions with commercially available SA peel, reduction in average number of comedones was 88.45% (P = 0.002), in inflammatory papules 89.16% (P = 0.01), in pustules 31.47% (P = 0.06), and in nodules/cyst 50% (P = 0.5). After six sessions with freshly prepared SA peel, reduction in average number of comedones was 89% (P = 0.0001), in inflammatory papules 90.36% (P = 0.0001), in pustules 28.3% % (P = 0.05), and in nodules 96% (P = 0.05). Significant reduction of both non-inflammatory and inflammatory acne was seen in both groups (P < 0.05). Both of the agents led to a highly significant (P < 0.001) improvement in the total acne score; freshly prepared SA peel showed improvement significantly earlier at 6 weeks onwards. VAS score was significantly high for the freshly prepared SA group (P = 0.05). Conclusion: This study has shown equivalence in therapeutic efficacy of both commercially available and freshly prepared SA peels both in terms of objective and subjective assessments in acne treatment with more patient satisfaction with freshly prepared peel.
Introduction: Salicylic acid is increasingly used as a superficial peeling agent for acne. Widespread use has caused increasing awareness about the adverse events associated with SA like erythema, exfoliation, itching, redness etc. Appropriate use of priming agents like retinoids, hydroquinone etc., can help in reduction of ADRs and can affect final treatment result. Aim: Evaluation of efficacy and safety of salicylic acid (SA) peel with or without priming agents in patients of acne. Methodology: A prospective, randomized, open-label, parallel-group study was carried out in patients with acne. Total 72 patients were randomized in to three groups A, B and C to receive 30% salicylic acid (SA) peel with either 0.05% tretinoin or 4% hydroquinone or without any priming agent. Objective and subjective assessment in improvement in acne was compared. For safety analysis, all reported adverse drug events were compared. Results: Mean age of patients was 22.46±5.32 years. Both non-inflammatory and inflammatory acne lesions reduced with SA peel in all three groups. Improvement in total acne score is significantly higher in SA peel with priming agents (p<0.05). The change in total acne score (Week 0-12) was 81.45% with SA alone, 94.3% with isotetinoin and 90.2% with hydroquinone priming (p<0.05). Total adverse event reported were 10(58.82%), 4 (23.53%) and 3(17.65%) in SA peel without priming agent, with isotetinoin and with hydroquinone respectively. Rate of occurrence of adverse events was significantly high in SA without priming agent (p<0.05). Mean visual analogue score was 91.47, 94.31 and 83.46 in group A, B and C respectively. SA peel with priming agent was rated as significantly more effective by patients rather than SA without priming agent (p<0.05). Conclusion:Appropriate priming agents should always be used with superficial peeling agents like SA in management of acne which enhances the effectiveness and reduces the adverse effects of therapy.
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