title: The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark-skinned patients: a comparative study.
abstract: BACKGROUND
  Melasma continues to be a difficult condition to treat, especially in dark-skinned patients, although various topical modalities including hydroquinone, tretinoin, and/or topical steroids have been used singly or in combination with variable results.
  
  
  OBJECTIVE
  To determine if serial glycolic acid peels provide additional improvement when combined with a time-tested topical regimen, a modification of Kligman's formula (hydroquinone 5%, tretinoin 0.05%, hydrocortisone acetate 1% in a cream base). All cases had epidermal melasma as detected by Wood's light examination.
  
  
  METHODS
  Forty Indian melasma patients were divided into two groups of 20 each. One group received serial glycolic acid peel combined with a topical regimen, modified Kligman's formula. The other, a control group, received only modified Kligman's formula. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 (before the fourth peel), and 21 (3 weeks after the sixth peel) weeks. For clinical evaluation, the Melasma Area and Severity Index (MASI) was used.
  
  
  RESULTS
  A significant decrease in the MASI score from baseline to 21 weeks was observed in both groups (P <.001). The group receiving the glycolic acid peels showed a trend toward more rapid and greater improvement, with statistically significant results (P <.001). Only a few side effects were observed in the peel group.
  
  
  CONCLUSIONS
  This study demonstrates that serial glycolic acid peels provide an additional effect to a topical regimen which is a modification of the time-tested Kligman's regimen for treating melasma in dark-complexioned individuals if used judiciously and under supervision. It demonstrates that superficial chemical peels are beneficial in the treatment of melasma.
authors.affiliation: Department of Dermatology and Venereology, Government Medical College and Hospital, Chandigarh, India. rashmisarkar@yahoo.com
authors.forename: Rashmi
authors.initials: R
authors.lastname: Sarkar
authors.forename: Charandeep
authors.initials: C
authors.lastname: Kaur
authors.forename: Mala
authors.initials: M
authors.lastname: Bhalla
authors.forename: Amrinder J
authors.initials: AJ
authors.lastname: Kanwar
mesh_terms: D000287:Administration, Topical; D000328:Adult; D002615:Chemexfoliation / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D006016:Glycolates / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006873:Hydroquinones / Q000008:administration & dosage / Q000627:therapeutic use*; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008548:Melanosis / Q000628:therapy*; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D004338:Drug Combinations; D006016:Glycolates; D006873:Hydroquinones; D007641:Keratolytic Agents; C031149:glycolic acid; D014212:Tretinoin; C031927:hydroquinone