Comparative Efficacy of a 35% Glycolic Acid Peel Alone or in Combination With a 10% and 20% Trichloroacetic Acid Spot Peel for Melasma: A Randomized Control Trial

Abstract

BACKGROUND To study and compare the therapeutic efficacy and side effects of a 35% glycolic acid (GA) full face peel alone or in combination with a 10% or 20% trichloroacetic acid (TCA) spot peel for facial melasma. METHODS Thirty patients with facial melasma were randomly divided into 3 equal Groups A, B, and C. Group A was treated with a 35% GA full-face peel, Group B and C with 35% GA full-face peel followed by a 10% and 20% TCA spot peel respectively once every 15 days. Four peels were performed once every 15 days. The response to the treatment was evaluated by the percentage reduction in melasma area severity index (MASI) scoring. RESULTS All 3 groups had significant reduction of MASI, but there was no significant difference between the groups. Group A had minimum side effects. CONCLUSION Chemical peels with GA alone or in combination with TCA do result in a significant improvement in melasma, but the combination of the peels in the same sitting does not seem to have any additive or synergistic effect while they may increase the side effects.

Modified Jessner's Solution Combined With Trichloroacetic Acid 20% Versus Glycolic Acid 70% Combined With Trichloroacetic Acid 20% in the Treatment of Melasma

“…They reasoned that because of some inherent factors in this group (combined GA & TCA), for example the use of oral contraceptives. 11…”

Actualización en el tratamiento del melasma. Revisión sistemática

“…Incluyó Los peelings superficiales con AG, AS y TCA deberían considerarse tratamientos de segunda línea. Los peelings con AG al 35% pueden ser útiles en el tratamiento del melasma [28]; Sarkar et al [29] mostraron que los peelings de AG 35% y salicílico-mandélico 20% pueden mejorar el melasma en pieles oscuras, y Dayal et al [30] alcanzaron resultados prometedores combinando AG (30-50%) y AA. Las exfoliaciones con TCA combinadas con solución de Jessner podrían ser una alternativa prometedora en el tratamiento del melasma recalcitrante, pero se necesitan estudios de mayor tamaño muestral [31].…”

<p>A Treatment Combination of Peels, Oral Antioxidants, and Topical Therapy for Refractory Melasma: A Report of 4 Cases</p>

“…16 Another more recent study using chemical peels with TCA alone or combined with glycolic acid showed a significant improvement in melasma in both. 17 Daily treatment with mild depigmenting agents has been shown to help maintain the treatment effects of peeling. 18 It is important in this population to use a broadspectrum sunscreen with high SPF and good protection against UVA and visible light, which are known aggravating factors of pigmented lesions and melasma.…”