Comparative efficacy of 10-20% trichloroacetic acid and 35-70% glycolic acid peel in 60 cases of melasma, freckles, lentigines and postinflammatory hyperpigmentation

Abstract

Background Melasma, freckles, lentigines and post-inflammatory hyperpigmentation are common disorders of cutaneous hyperpigmentation, which present in Dermatology clinics. Despite the availability of a large number of skin lightening treatments, hyperpigmentation of skin remains a therapeutic challenge. Chemical peeling has been widely used for the treatment of cutaneous hyperpigmentation. The present study compares the effects of 10-20% trichloroacetic acid and 35-70% glycolic acid peel in these common disorders of skin hyperpigmention.Patients and methods The study included 60 patients of melasma, freckles, lentigines and post-inflammatory hyperpigmentation of both sexes, in 15-45 year age group. Patients were randomly divided into two equal groups A and B. Pre-peel priming was carried out with 3% hydroquinone for two weeks. Group A was treated with trichloroacetic acid (TCA, 10-20%) peel and group B with glycolic acid (GA, 35-70%) peel. Four peels were done at serial intervals of 15 days. Full-face peel was done for melasma and regional or spot peeling forfreckles, lentigines and post inflammatory hyperpigmentation. Patients were followed every month for three months after the last peel. Clinical photographs were taken at the beginning of the therapy and then serially to assess the response. Results Glycolic acid showed better response compared to trichloroacetic acid at end of four peels, but this difference was not statistically significant (p>0.05). Chemical peeling with trichloroacetic acid produced significantly more erythema (p<0.05) and burning sensation (p<0.01) compared to glycolic acid. Also, tricholoroacetic acid peel was associated with higher incidence of post peel hyperpigmention (p< 0.05).Conclusion Chemical peeling with both tricholoroacetic acid (10-20%) and glycolic acid (35-70%) is safe and effective for the treatment of the skin pigmentary disorders. Glycolic acid is a superior peeling agent with better patient tolerance and lesser side effects.