Tretinoin peels versus glycolic acid peels in the treatment of Melasma in dark-skinned patients.
BACKGROUND
Chemical peels have become a popular method for treating melasma. Although daily topical 0.05 and 0.1% tretinoin have been used for melasma, the therapy takes at least 4 to 6 months to produce clinically significant lightening. In a recent trial, 1% tretinoin peel has shown good clinical and histologic results after biweekly applications in 2.5 weeks only in the treatment of melasma.


OBJECTIVE
Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent versus a standard peeling agent, 70% glycolic acid, in the treatment of melasma in Indian women.


METHODS
Ten female patients of melasma, after written consent, were taken up for an open left-right comparison pilot study of 12 weeks. One percent tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other at weekly intervals. The results were evaluated by a clinical investigator by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks.


RESULTS
A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed on both facial sides (p<0.001). Nevertheless, there was no statistically significant difference between the right and the left sides. Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients.


CONCLUSIONS
It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel, 70% glycolic acid, although larger trials over longer periods may be necessary to substantiate such findings.
Khunger
Niti
N
Department of Dermatology and Venereology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Sarkar
Rashmi
R
Jain
R K
RK
D000287:Administration, Topical; D000328:Adult; D044466:Asian People; D002615:Chemexfoliation / Q000379:methods*; D005145:Face; D005260:Female; D006016:Glycolates / Q000008:administration & dosage*; D006801:Humans; D007194:India; D007641:Keratolytic Agents / Q000008:administration & dosage*; D008548:Melanosis / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage*
D006016:Glycolates; D007641:Keratolytic Agents; C031149:glycolic acid; D014212:Tretinoin