Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner's solution chemical peels.
BACKGROUND
Many chemicals have been used in the skin peeling for melasma such as Jessner's solution and glycolic acid. Lactic acid is an alpha-hydroxy acid that has not been used before in chemical peeling of melasma.


OBJECTIVE
The purpose of the present work was to evaluate the efficacy and safety of lactic acid in chemical peeling of melasma in comparison to Jessner's solution chemical peels.


METHODS
This study was conducted at the Department of Dermatology and Venereology, Baghdad Hospital, in the period between April 2001 and August 2002. Thirty patients with melasma were included in this study. They were mostly of skin type IV according to Fitzpatrick's classification, 26 (86.67%) were women, and 4 (13.33%) were men, with an age range from 18 and 50 years (mean+/-SD, 33.53+/-6.96 years). Full clinical examination was done to all patients including Wood's light. The severity of melasma was assessed by MASI (Melasma Area Severity Index). Pure lactic acid full strength (92%, pH 3.5) was used as a new peeling agent on the left side of the face while Jessner's solution was applied to the right side of the face. The chemical peeling sessions were done every 3 weeks until the desired response was achieved. Follow-up was carried out for 6 months after the last session.


RESULTS
Six patients were defaulted from the study after the first session for unknown reasons. Twenty-four patients completed the study. Twenty (83.33%) were women and four were men (16.67%). Wood's light examination showed increased contrast in all patients of mostly epidermal melasma. The number of sessions ranged from 2 to 5. All patients showed marked improvement as calculated by MASI score before and after treatment, and the response was highly statistically significant. No side effect was recorded in all treated patients.


CONCLUSIONS
Lactic acid was found to be an effective and safe peeling agent in the treatment of melasma, and it was as effective as Jessner's solution.
Sharquie
Khalifa E
KE
Department of Dermatology, College of Medicine, University of Baghdad, Baghdad, Iraq. Ksharquie@yahoo.co.uk
Al-Tikreety
Mohammad M
MM
Al-Mashhadani
Sabeeh A
SA
D000328:Adult; D002615:Chemexfoliation / Q000379:methods*; D004338:Drug Combinations; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000627:therapeutic use*; D008297:Male; D008548:Melanosis / Q000628:therapy*; D012118:Resorcinols / Q000627:therapeutic use*; D012459:Salicylates / Q000627:therapeutic use*; D012880:Skin Pigmentation; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D004338:Drug Combinations; C061170:Jessner's solution; D012118:Resorcinols; D012459:Salicylates; D019344:Lactic Acid; D000431:Ethanol