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

in 7th session 50% glycolic acid was used for 1-2 minutes and in 8th session 50% glycolic acid was used for 3 minutes. Before performing the peeling procedure patients were advised to stop topical regimen 2 days prior to the session, avoid extensive sun exposure, stop any cosmetic procedures like waxing, depilators, electrolysis, masks, loofahs, other sponges, hair dying, permanent wavening, straightening treatment and other resurfacing and exfoliating treatments one week prior to the treatment. Patients were asked to come with a fully cleansed face, with no makeup or aftershave. Male patients were advised to avoid shaving on the day of peel. Peeling was done and after the procedure patients were instructed to take strict photoprotective measures and apply sunscreen , not to use abrasives or exfoliating sponges on the treated areas. Patients were strictly advised not to peel, scratch, pick or scrape the skin and not to use masks on the skin and start the topical regimen after 3 days of session.

In Group 2 (Control Group) the triple combination of topical regimens ie, 2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin cream was used at night time for total 24 weeks duration and broad spectrum sunscreen of SPF 15 or more regularly in day time. Follow up was done at 3 weekly interval. The results were evaluated by comparing the changes in the MASI scoring of the patients in the two groups by the following formula

MASI score was calculated before treatment as baseline and after every two successive sessions for 24 weeks. Clinical photographs were taken at baseline and after two sessions at 6 weekly intervals. Front, right and left view of each patient was photographed. All photographs were taken using a Sony digital still camera of model DSCW70. A high MASI score correlates well with severe hyperpigmentation.The results were tabulated and evaluated using statistical analysis using student’s t –test and paired t – test.

Forty Indian patients of melasma were included in the study. Majority of patients were in age range of 21 – 40 years and the mean age of patients was 34 years. There were 38 females and 2 males (male: female 1:19), indicating female preponderance. The duration of disease varied from 6 months to 5-6 years. The mean duration of disease was 3.12 ± 1.57 years.

Mean MASI scoring of the group 1 (peel group) and group 2 (control group) patients at various intervals are compared in Table 1 and Figure 1.

Mean percentage decrease in MASI scoring of the group 1 patients (peel group) group 2 patients at various intervals are compared in Table 2 and Figure 2. The percentage decrease in MASI scoring in group 1 (peel group) was significantly higher than group 2 (control group).

Erythema, three had post inflammatory hyperpigmentation which resolved after appplication of 1% hydrocortisone cream, one had hypertrichosis at the end of 24 weeks of therapy, which resolved after stopping the topical regimen and four had burning and stinging sensation for which ice cooling was done and calamine lotion was applied. In group 2 (control group) three