Comparison Between 1% Tretinoin Peeling Versus 70% Glycolic Acid Peeling in the Treatment of Female Patients With Melasma
December 2011 | Volume 10 | Issue 12 | Original Article | 1439 | Copyright © 2011
Gita Faghihi MD,a,b Anahita Shahingohar MD,a Amir Hossein Siadat MDa,b
aSkin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran bSkin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
Melasma is an irregular brownish pigmentation observed on the faces of young to middle-aged women, especially of Asian races, which may contribute to various emotional disturbances. Although not any favorable treatment being approved yet, one appropriate approach is peeling by glycolic acid 70% (GA 70%). Considering the efficiency of Tretinoin in lower concentrations as over-the-counter lightening agents, peelings with higher strength Tretinoin may effectively relieve the pigmentation (melasma) sooner than other topical therapies.
Objective: The main purpose was to compare the efficiency and complications of GA 70% with Tretinoin 1% peeling.
Methods: A randomized, double-blinded clinical trial performed on 63 female patients with bilateral melasma. One facial side was treated by drug A (GA 70%) and the opposite side by agent B (Tretinoin 1%) peeling for four sessions with 2-week intervals. Descending changes in Melasma Area and Severity Index (MASI) scores, patients' discomfort and untoward complications following peeling all were evaluated and compared during the research period.
Results: The efficiency of Tretinoin 1% peelings in declining the MASI score (treatment of melasma) was similar to GA 70%, as well as the rare unwanted complications of them. However, the patients' discomfort following procedures as expressed by their own, was significantly lower with Tretinoin 1% compared to GA 70% peeling. The cases' satisfaction with the intervention was statistically similar to each other. Furthermore, we experienced almost the equal times of beginning the therapeutic responses in both groups.
J Drugs Dermatol. 2011;10(12):1439-1442.
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Melasma is one of the most common hyperpigmen- tary disorders; it is a frequently acquired disturbance characterized by symmetric, hyperpigmented patch- es with an irregular outline that occurs most commonly on the face. It is most prevalent among young to middle-aged women who are Hispanic, Asian, or of African or Middle Eastern descent.
The hypermelanosis affects the upper lip, cheeks, forehead, and chin and becomes more apparent following sun exposure.1,2 Le- sions fade during winter months, and they frequently first appear or are accentuated following exposure to UV irradiation during pregnancy. In light pigmented individuals, “the mask of preg- nancy” often diminishes or disappears after parturition, whereas it may persist in women with more darkly pigmented skin.
Although the exact pathogenesis of melasma is unknown, it is hypothesized that following exposure to UV irradiation, hyper- functional melanocytes within involved skin produce increased amounts of melanin as compared to uninvolved skin.3,4
Melasma is an important cosmetic problem that can cause serious emotional and psychological problems especially in Asian females.5
A lot of topical medications have been used for treatment of melas- ma. They are divided into two major groups: 1) Phenol derivatives: hydroquinone, which may be used as a monotherapy or in combi- nation with Tretinoin (0.05–0.1%) and a corticosteroid (class V–VII).
2) Nonphenolic lightening agents: glycolic acid, kojic acid (a thy- rosinase inhibitor), and azelaic acid (15–20%), also an inhibitor of thyrosinase.
Nowadays chemical peelings are generally used in treatment of melasma, and the standard one is glycolic acid 70% (GA 70%), a superficial chemical peel and one of the alpha-hydroxy acids (AHAs) frequently used in low concentrations as an over-the- counter preparation for daily use. Weekly or biweekly application of GA 40–70% have been used most often for acne, mild photo- aging, and melasma.6-10
Tretinoin in low concentrations (up to 0.1%) is also used as a topical lightening agent for melasma. Recently, Tretinoin in higher concentrations (1%) has been used as a peeling agent for treatment of melasma and seems to be very effective ac- cording to some users.11,12