title: Combination of glycolic acid peel and topical 20% azelaic acid cream in melasma patients: efficacy and improvement in quality of life.
abstract: BACKGROUND
  Glycolic acid (GA) peel is one of the most versatile agents in the treatment of melasma. GA peeling alone or in combination with topical hypopigmenting agents has shown encouraging results. However, there is paucity of controlled trial demonstrating the efficacy of glycolic peel in conjunction with topical azelaic acid (AA). We therefore sought to highlight the efficacy and safety of this combination in melasma.
  
  
  OBJECTIVE
  To assess the clinical efficacy, safety and reduction in melasma quality of life (MELASQOL) scores on combining serial GA peels with topical 20% AA cream in epidermal melasma.
  
  
  METHODS
  Sixty patients of epidermal melasma were enrolled for 24 weeks. Patients were divided into two groups: (1) Study group received serial GA peel every 3 weeks with twice daily 20% AA cream, and (2) control group received only 20% AA cream. Clinical improvement was assessed objectively using Melasma Area Severity Index (MASI). Melasma-related quality of life was measured by MELASQOL scale in both groups. Side effects were observed at each visit.
  
  
  RESULTS
  The improvement in MASI and percentage decrease in MASI scoring were statistically significant 12 weeks onwards in study group as compared to control group. There was also a significant reduction in MELASQOL scores in study group as compared to control group after treatment. Minor reversible side effects were observed in both groups, which did not require cessation of therapy.
  
  
  CONCLUSIONS
  GA peel enhances therapeutic efficacy of topical AA cream for treatment of melasma, with improvement in quality of life without serious side effects.
authors: Department of Dermatology, Venereology and Leprology, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Surabhi
authors: S
authors: Dayal
authors: Department of Dermatology, Venereology and Leprology, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
authors: Priyadarshini
authors: P
authors: Sahu
authors: Skin clinic, Faridabad, Haryana, India.
authors: Ruchika
authors: R
authors: Dua
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D002615:Chemexfoliation / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003998:Dicarboxylic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006016:Glycolates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007641:Keratolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008548:Melanosis / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D063465:Skin Cream / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D003998:Dicarboxylic Acids; D006016:Glycolates; D007641:Keratolytic Agents; C031149:glycolic acid; C010038:azelaic acid
keywords: azelaic acid cream; glycolic peel; melasma; melasma quality of life