Comparative efficacy of 20% trichloroacetic acid and 50% glycolic acid peels in treatment of recalcitrant melasma

Abstract

Background Melasma, one of the common aesthetically displeasing entities, continues to be a difficult problem to treat. Chemical peeling is one new weapon in the therapeutic armamentarium of melasma. Glycolic acid and trichloroacetic acid chemical peels have been used alone and also in combination to treat melasma. Objective To compare the efficacy of 50% glycolic acid and 20% trichloroacetic acid in the treatment of recalcitrant melasma. Patients and methods 50 patients of recalcitrant epidermal melasma were recruited in the study.  Recalcitrant melasma included the patients who failed to respond to 3 months or more of medical treatment.  Patients were randomly allocated into two groups: group A (glycolic acid 50%) and group B (TCA 20%) with 25 patients in each group. Patients carried out a pre-peel programme of daily application of sunscreens (day time) and 5% hydroquinone and 0.025% retinoic acid at bed time for two weeks. 3 peels were carried out at 3 weekly intervals.  MASI scoring and coloured photographs of each patient were taken before each peel and at end of the follow-up period i.e. 30 days after the last peel. Side effects if any were also recorded. Results In both the groups there was constant decrease in MASI scores after each peel as compared to pre-peel scores.  However, the comparison of mean MASI scores i.e. both pre-peel and after each peel, between the two groups showed no statistically significant difference (p>0.05). The mean score of response calculated for both the groups revealed better overall clinical response in TCA group (2.00+0.50) than in GA group (1.76+0.66). But the difference was statistically insignificant (p>0.05). Whereas the local reactions, such as burning sensation and erythema during the peel were significantly more with TCA as compared to GA. Conclusions Both 50% glycolic acid and 20% trichloroacetic acid were found to be equally effective agents in the treatment of melasma. But as regards the local irritant effects, tolerability to glycolic acid peels was better than trichloroacetic acid. Follow-up period in the study was short to make conclusions regarding relapse rates in both the groups.