Comparison of the Outcome of Treatment of 15% Trichloroacetic Acid versus Topical 0.05% Tretinoin in the Treatment of Acanthosis Nigricans at Tertiary Care Hospital, Karachi

Abstract

Background: Acanthosis Nigricans (AN) is a dermatological condition characterized by hyperpigmented, velvety plaques, commonly linked with insulin resistance, obesity, and hormonal disorders. The treatment of AN primarily focuses on managing skin changes, with topical agents like trichloroacetic acid (TCA) and tretinoin being explored for their efficacy. Objective: The study aimed to compare the effectiveness of 15% trichloroacetic acid and topical 0.05% tretinoin in the treatment of Acanthosis Nigricans, focusing on improvements in hyperpigmentation and patient satisfaction. Methods: This randomized control trial was conducted at Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to June 2023. A total of 90 participants with diagnosed AN were recruited and randomly assigned into two groups: Group A (n=45) received 15% TCA peels every two weeks, and Group B (n=45) applied topical 0.05% tretinoin daily, both for a duration of 8 weeks. The efficacy was assessed using serial photographs and a grading system for improvement. Data analysis was performed using SPSS Version 25.0, with the Chi-square test employed for comparing efficacy. Results: The mean age in Group A was 35.11 ± 7.05 years and in Group B was 37.20 ± 6.37 years. Group A showed a higher success rate with 42 participants (93.3%) demonstrating improvement, compared to 35 participants (77.8%) in Group B (P-value: 0.034, Odds Ratio: 4.000). Grades of improvement indicated that 26 participants (57.8%) in Group A and 14 (31.1%) in Group B experienced good improvement (51%-75%). Adverse effects such as erythema and post-inflammatory hyperpigmentation were more common in Group A. Conclusion: The study suggests that 15% trichloroacetic acid may offer greater improvement in hyperpigmentation in Acanthosis Nigricans compared to topical 0.05% tretinoin. However, the treatment choice should consider individual patient factors, and further research is needed to confirm these findings.