title: Comparative Evaluation of Efficacy and Tolerability of Glycolic Acid, Salicylic Mandelic Acid, and Phytic Acid Combination Peels in Melasma.
abstract: BACKGROUND
  Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. Chemical peels have become a popular modality in the treatment of melasma.
  
  
  OBJECTIVE
  To compare the therapeutic efficacy and tolerability of glycolic acid (35%) versus salicylic-mandelic (SM) acid (20% salicylic/10% mandelic acid) versus phytic combination peels in Indian patients with melasma.
  
  
  METHODS
  Ninety patients diagnosed with melasma were randomly assigned into 3 groups of 30 patients each. Group A received glycolic acid (GA-35%) peel, Group B received SM acid, and Group C received phytic combination peels. Each group was primed with 4% hydroquinone and 0.05% tretinoin cream for 4 weeks before treatment. Chemical peeling was done after every 14 days in all groups until 12 weeks. Clinical evaluation using melasma area and severity index (MASI) score and photography was recorded at every visit and follow-up was done until 20 weeks.
  
  
  RESULTS
  There was a decrease in MASI score in all 3 groups but it was statistically significantly lower in Group A than Group C (p = .00), and it was also statistically significantly lower in Group B than Group C (p = .00) but there was no statistically significant difference between Groups A and B (p = .876). Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was 62.36% reduction in GA group, 60.98% reduction in SM group, and 44.71% in phytic acid group.
  
  
  CONCLUSIONS
  It is concluded that GA (35%) and SM acid peels are both equally efficacious and a safe treatment modality for melasma in Indian skin, and are more effective than phytic acid peels. Salicylic-mandelic peels are better tolerated and more suitable for Indian skin.
authors: Department of Dermatology and Venereology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
authors: Rashmi
authors: R
authors: Sarkar
authors: Vijay
authors: V
authors: Garg
authors: Shivani
authors: S
authors: Bansal
authors: Sumit
authors: S
authors: Sethi
authors: Chitra
authors: C
authors: Gupta
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000627:therapeutic use; D002615:Chemexfoliation / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006016:Glycolates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006873:Hydroquinones / Q000627:therapeutic use; D007194:India; D007641:Keratolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008333:Mandelic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D008548:Melanosis / Q000628:therapy*; D008875:Middle Aged; D010833:Phytic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D020156:Salicylic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000975:Antioxidants; D004338:Drug Combinations; D006016:Glycolates; D006873:Hydroquinones; D007641:Keratolytic Agents; D008333:Mandelic Acids; C031149:glycolic acid; D014212:Tretinoin; D010833:Phytic Acid; C037938:mandelic acid; D020156:Salicylic Acid; C031927:hydroquinone