Efficacy of Combination of Glycolic Acid Peeling With Topical Regimen in Treatment of Melasma

October 2013 | Volume 12 | Issue 10 | Original Article | 1149 | Copyright © October 2013

Savita Chaudhary MD Fellow ISDa and Surabhi Dayal MDb

aDepartment of Dermatology, Era’s Lucknow Medical College and Hospital, Lucknow, India
bDepartment of Dermatology, Pt. BD Sharma, PGIMS, Rohtak, India

table 2
patients had burning and stinging sensation for which ice cooling was done and calamine lotion was applied (Table 3). None of the patients in either of the groups experienced any severe and persistent side effects.


This study demonstrated that combining topical regimen of hydroquinone plus tretinoin plus hydrocortisone acetate to serial glycolic acid peeling is better than topical regimen alone for treatment of melasma in dark complexioned individuals. Very few side effects were encountered and none was severe and persistent. This might be because all the three components of the topical regimen have unique importance when used with glycolic acid peeling. Hydroquinone acts as a priming agent and also decreases the post inflammatory hyperpigmentation especially in Indian skin ie, Fitzpatricks type III –V which has more tendency towards post inflammatory hyperpigmentation.31 Tretinoin also acts as a priming agent which increases the penetration of hydroquinone and glycolic acid,35 thereby making peel more effective and protects from the side effects of topical steroids like atrophy. The third component ie, hydrocortisone decreases the chance of post peel hyperpigmentation due to its anti inflammatory action.
This study demonstrated that the combination of serial glycolic acid peeling with topical regimen of 2% hydroquinone plus 0.05% tretinoin plus 1% hydrocortisone is a well-tolerated and highly effective treatment stratergy for melasma.


None of the authors have disclosed any relevant conflicts of interest.


  1. Grimes PE. Melasma: etiologic and therapeutic considerations. Arch Dermatol Res1995;131:1453-7.
  2. Sanchez NP, Pathak MZ, Fitzpatrick TB. Melasma. J Am Acad Dermatol 1981;4:698-710.
  3. Pandya AG, Guevara IL. Disorders of hyperpigmentation. Dermatol Clin 2000;18:91-8.
  4. Tse Y. Choosing the correct peel for the appropriate patient. In : Rubin MG, Dover JS, Alam M, editors. Procedure in cosmetic dermatology. Ist ed. New Delhi: Elseiver 2006. p. 14.
  5. Pigmentary disorders. In: Wolff K, Johnson RA, Surrmod D, editors. Fitzpatricks color atlas and synopsis of clinical dermatology 5th ed.United States of America: Mc Graw-Hill Medical publishing division 2005. p .348
  6. Thappa DM. Melasma (Chloasma): A review with current treatment options.Ind J Dermatol 2004;49 (4): 165-76.
  7. Pathak MA, Fitzpatrick TB, Kraus EW. Usefulness of retinoic acid in the treatment of melasma. J Am Acad Dermatol 1986;15:894-9.
  8. Resnick S. Melasma induced by oral contraceptive drugs.JAMA 1967; 199:95-9.
  9. Johnston GA, Sviland L, McLelland J. Melasma of arms associated with hormonal replacement therapy. Br J Dermatol 1998;139:932.
  10. Lufti RJ, Fridmanis M, Misrunas AL. Association of melasma with thyroid autoimmunity and other thyroid abnormalities and their relationship to the origin of melasma. J Clin Endocrinol Metab 1985; 61:28-31.
  11. Stewart MI, Bernhard J, Cropley TG, Fitzpatrick TB. The structure of skin lesions and fundamentals of diagnosis. In : Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI ,editors. Fitzpatrick’s dermatology in general medicine. 6th ed. New York: McGraw-Hill Medical Publishing Division 2003. p . 27.
  12. Sanchez NP, Pathak MA. Sceto Set at melasma: a clinical light microscopic, ultrastructural and immunoflourescence study. J Am Acad Dermatol 1981;4: 698-710.
  13. Rendon M, Berneburg M, Arellano et al. Treatment of melasma. J Am Acad Dermatol 2006;54:S2272-81.
  14. Griffiths CEM, Finkel LJ, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ. Topical tretinoin (retinoic acid) improves melasma: a vehicle controlled clinical trial. Br J Dermatol 1993;129:415-21.
  15. LeenutaphongV, Nettakul A, Rattanasuwon P. Topical isotretinoin for melasma in Thai patients: a vehicle-controlled clinical trial. J Med Assoc Thai 1999;82:868-75.
  16. Dogra S, Kanwar AJ, Prasad D. Adapalene in treatment of melasma: a preliminary report. J Dermtol 2002;29:539-40.
  17. Neering H. Treatment of melasma (cholasma) by local application of a steroid cream. Dermatologica 1975;151:349-53.
  18. Lowe NJ, Rijk D, Grimes P, Billips M, Pincus S. Azelaic acid 20% cream in treatment of facial hyperpigmentation in darker skinned patients. Clin Ther 1998;20:945-59.
  19. Garcia A, Fulton JE Jr. The combination of glycolic acid and hydroquinone or kojic acid for treatment of melasma and related conditions. Dermatol Surg 1996;22(5):443-7.
  20. Usuki A, Ohashi A, Sato H, et al. The inhibitory effect of glycolic acid and lactic acid on melanin synthesis in melanoma cells. Exp Dermatol 2003;2(Suppl 12):43-50.
  21. Espinal-perez LE. Moncada B, Castanedo-Cazares JP. A double–blind randomized trial of 5% ascorbic acid vs hydroquinone in melasma. Int J Dermatol 2004;43(8):604-7.
  22. Sugimoto K, Nomura K, Nishimura T et al. Synthesis of alpha-arbutin-alpha-glycosides and their inhibitory effects on human tyrosinase. J Biosci Bioeng 2005;99(3);272-6.
  23. Amer M, Metwalli M. Topical liquiritin improves melasma. Int J Dermatol 2003;39(4):299-301.
  24. Kauch YC, Zachian TF. Melasma. Adv Exp Med Biol 1999;455:491-9.
  25. Guervara IL, Pandya AG. Safety and efficacy of 4% hydroquinone combined 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma. Int J Dermatol 2003;42;966-72.