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Abstract
Treatment of atrophic acne scars is difficult and generally unsatisfactory. Although many clinical studies have been performed to investigate the efficacy of glycolic acid in the treatment of acne vulgaris, to the best of our knowledge no placebo-controlled study has been carried out to ascertain the effect of glycolic acid on atrophic postacne scars.
A single, blind, placebo-controlled, randomized comparative clinical study was conducted in 58 women with atrophic acne scars. The subjects were randomly divided into three study groups. Glycolic acid peels with 20%, 35%, 50%, and 70% concentrations were applied serially at 2-week intervals to 23 patients in Group A. Twenty patients in Group B used a 15% glycolic acid cream once or twice daily for a period of 24 weeks. The remaining 15 patients in Group C applied a placebo cream twice daily during the same period.
The differences between the results in the different groups were statistically significant at week 24 (P<0.001). Home application of low-strength glycolic acid was better tolerated and had less side-effects than glycolic acid peels; however, repeated short-contact 70% glycolic acid peels provided superior results compared with the maintenance regimen (P<0.05), and apparently good responses were observed only in the peel group (P<0.01).
Glycolic acid peeling is an effective modality for the treatment of atrophic acne scars, but repetitive peels (at least six times) with 70% concentration are necessary to obtain evident improvement. Long-term daily use of low-strength products may also have some useful effects on scars and may be recommended for patients who cannot tolerate the peeling procedure.
... Sulle cicatrici da acne, si ottiene un'efficacia moderata, ma richiede almeno sei peeling ad alte concentrazioni di acido glicolico, per esempio [14] . Il risultato ottenuto con i peeling è maggiore rispetto a quello ottenuto con un uso quotidiano di AHA per sei mesi. ...
... • giorno, l'epidermide e il derma papillare sono ispessiti, la distribuzione dei melanociti è più omogenea [14] e la ripetizione dei peeling porta alla neoformazione del collagene e a una sintesi dei glicosaminoglicani. ...
... Questo trattamento è ben tollerato, dal momento che solo il 5,6% dei pazienti presenta effetti collaterali [25] . L'efficacia di questi peeling è EMC -Cosmetologia medica e medicina degli inestetismi cutanei dimostrata e paragonabile a quella dei beta-HA [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . Picchi infiammatori di acne transitoria possono verificarsi nei giorni successivi all'atto. ...
I peeling superficiali hanno un’azione epidermica regolatrice predominante, principalmente cheratolitica. Tuttavia, la loro ripetizione porta anche a dei miglioramenti dermici, come la neocollagenesi, nonché a un’azione sui melanociti. La loro indicazione si basa sulle iperpigmentazioni tipo melasma, sull’eliodermia, sulla perdita di luminosità, sull’ acne e sulle cicatrici lievi. Il loro utilizzo è possibile indipendentemente dal fototipo. L’acido glicolico, che fa parte degli alfa-idrossiacidi (AHA), è il peeling con il più alto livello di pubblicazione. La sua efficacia è equivalente ad altre molecole (acido tricloroacetico superficiale [TCA], Jessner, pasta di Unna, acido salicilico [AS]), con conseguenze spesso più semplici. Costituisce, dunque, il miglior compromesso per i peeling superficiali. L’uso sporadico dei peeling è raramente soddisfacente, infatti devono far parte di una strategia terapeutica prolungata.
... Incidence in desquamation (green bars) and sensation of pulling (blue bars) in patients of the first sub-sample that is, in the group where GA was applied after adjusted AT (left) and the group where GA was applied without any previously adjusted AT (right). described in the literature for the treatment of acne vulgaris (Lee et al., 2006;Erbagci and Akcali, 2000) which is in accordance with the methodological approach of the current study. The sixteen-week long period of monitoring is in accordance with the research period of some other studies (Lee et al., 2006), as well as an intermittent two-week long treatment (Erbagci and Akcali, 2000). ...
... described in the literature for the treatment of acne vulgaris (Lee et al., 2006;Erbagci and Akcali, 2000) which is in accordance with the methodological approach of the current study. The sixteen-week long period of monitoring is in accordance with the research period of some other studies (Lee et al., 2006), as well as an intermittent two-week long treatment (Erbagci and Akcali, 2000). In a recent study designed by Grover and Reddu (2003), 10 to 30% GA applied at night intervals showed signs of moderate success in acne patients. ...
... The current study aimed to explore the effects of GA in concentrations of 35% in the therapy of acne papulosa, as a monotherapy, as well as combined therapy, that is, after adjusted AT in accordance to the guidence for this stadium of acne. The study used the methodological approach which considered separated symptoms and side effects, and which is in accordance with the contemporary description of other authors (Erbagci and Akcali, 2000). The current study determined the state of objective parameters (comedones, papules, papulopustules and the greasy face look), which is in accordance with the reports of Grimes et al. (2004) and Kim et al. (1999). ...
Chemical peeling of the skin involves the topical application of a chemical agent in order to produce a controlled injury to a desired depth, thus allowing subsequent regeneration of the skin which can result in improved texture, more homogeneous pigmentation and less wrinkling. Acne vulgaris is one of the most common skin diseases. The aim of the actual study was to examine and compare the efficiency, skin tolerance and side effects of a 35% glycolic acid combined with antibiotic therapy in patients with inflammatory aspects of acne. The sample consisted of 120 subjects, divided into two experimental sub-samples of 60 subjects each. The first sub-sample consisted of patients with acne papulosa, while the second sub-sample consisted of patients with acne papulopustulosa. The patients from both sub-samples were additionally divided into two groups of 30 patients each. To the first group of 30 patients (within each sub-sample, respectively), glycolic acid in a concentration of 35% was applied after adjusted antibiotic therapy, while to the second group of 30 patients (within each sub-sample, respectively) glycolic acid in a concentration of 35% was applied without previous adjustment of antibiotic therapy. In each sub-sample, the differences in the manifested symptoms of the ailment and the side effects were analyzed. Glycolic acid had a significant effect in the treatment of acne papulosa and acne papulopustulosa, as a monotherapy, as well as combined therapy, that is, after adjusted antibiotic therapy. Side-effects were experienced by patients treated only by glycolic acid, that is, without previously adjusted antibiotic therapy. Glycolic acid chemical peels in concentration of 35% had overall efficiency and a superior therapeutic effect and are recommended by the authors after adjusted antibiotic therapy. The appearance and intensity of side effects in patients after adjusted monotherapy, adduced us to the choice of combined therapeutic treatment.
... The simplest and most-used has been glycolic acid (GA), derived from sugar cane,
presenting in its structure only two carbon atoms, allowing for better cutaneous
penetration.5,7,8 Its effect
depends on how long it remains on the skin (the longer the period, the stronger the
action) and its concentration. ...
... These were
then removed with water, and volunteers dried their faces with paper towels. Next, they applied the sunscreen.7 The immediate effects were redness and burning (in some
cases), no adverse events were observed. ...
... Study inclusion criteria were: healthy women with fine wrinkles on the external
lateral region of the eyes, aged 35-60, skin phototypes II to IV according to
Fitzpatrick's classification, and signing the informed consent. Exclusion
criteria were recent surgical procedures (2 to 6 months) in area of treatment,
serious inflammatory injuries, herpes on treated region, pregnant and lactating
women due to the risk of appearance of spots; precedents of hipertrofic or
queloidic scars because of their reduced capacity to heal and those who had
taken systemic retinoids for less than four months.7,13,16,17 ...
Peeling is a procedure which aims to accelerate the process of skin exfoliation.
Development of formulations containing lactic acid at 85% or glycolic acid at 70% and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles.
Preliminary stability tests were carried out and an in vivo study was performed with three groups with 9 representatives each. One was the control group, which used only sunscreen; another one used lactic acid+sunscreen, and the last group used acid glycolic+sunscreen. Clinical efficacy was assessed with a CCD color microscope, through the digitization of images before and after treatment. The applications were carried out by a dermatologist, once a mont h every 30 days, during 3 months. The area with wrinkles was calculated by planimetry point counting, in accordance with Mandarin-de-Lacerda.
The formulations were stable in the visual and Ph evaluation. There was no improvement in the control group; for lactic acid, there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye. For the glycolic acid group, there was significant improvement in the outer lateral area of the left eye after the first application, and of the right eye region, after three applications. The formulations used must be kept under refrigeration and should be manipulated every 30 days.
Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications (p≤0.05%). It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye, relative to the speed of skin improvement.
... 21 In a single-blind, placebo-controlled, and randomized comparative clinical study that evaluated the serial concentration of GA peels (20%, 35%, 50%, and 70%) versus 15% GA cream once or twice daily for 24 weeks, authors concluded that GA peeling is an effective modality for the treatment of atrophic acne scars. 22 The lowest possible strengths at which they start acting as medium-depth peels, that is, GA peel at 70% and TCA at 30% concentration was chosen for this study. In our study, we found that both TCA and GA peels were efficacious in reducing acne scars and there was a significant fall in mean scores on both sides at each of the follow-ups as compared to the baseline score (P = 0.000). ...
Objectives
Medium-depth peels are dynamic tools when used as part of office procedures for the treatment of acne scars. Most of the available literature on chemical peels focuses on their role in skin rejuvenation and hyperpigmentation. There is a paucity of well-conducted studies that have compared peels in the treatment of acne scars in Asian patients.
Material and Methods
The study aimed to compare the efficacy of 70% glycolic acid (GA) and 30% trichloroacetic acid (TCA) chemical peels in the treatment of facial atrophic acne scars. A longitudinal, right-left study was conducted to assess the effectiveness and side effects of 70% GA and 30% TCA in 30 patients with acne scars. A total of four peeling sessions were performed every 4 weeks. Evaluation of the response was done using Goodman and Baron’s quantitative global acne scarring grading system (GBASG), physician visual analog scale (VAS), and patient VAS at baseline and 4, 8, 12, and 16 weeks. Relevant statistical tests were employed to study the effectiveness of both TCA and GA peels.
Results
Significant reduction was noted in mean GBASG scores on both sides at 8, 12, and 16 compared to baseline score ( P = 0.000). Mean GBASG scores decreased from 12.67 ± 3.19 to 8.97 ± 2.73 on the 70% GA side while that on the 30% TCA side reduced from 13.20 ± 3.56 to 6.83 ± 2.60 ( P = 0.003). The results were much better on the TCA peel side as compared to GA peel as per physician VAS ( P = 0.000) and patient VAS ( P = 0.000). Side effects such as post-inflammatory hyperpigmentation and acne were seen on both sides while dryness and crusting were more common on the TCA peel side.
Conclusion
A 30% TCA peel is efficacious and well-tolerated for mild-to-moderate acne scars. About 70% GA peel is an effective alternative to TCA peel, especially for patients not tolerating TCA or requiring lesser downtime.
... Glycolic acid, a member of AHA family is one of the most extensively used and versatile peeling agent, which has been found beneficial in a variety of skin condition including disorders of keratinization (xerosis, ichthyosis) as well as the commonly present skin problems like post inflammatory hyper-pigmentation, melasma, acne, dynamic rhytides, warts, actinic and seborrhoeic keratoses etc. 18 Skin rejuvenation is its most common indication. Burns et al 19 have documented the similar kind of results as obtained in our study in terms of improvement of post inflammatory hyperpigmentation with the use of glycolic acid peels. ...
Hyperpigmentation is a medical term used to describe darker patches of skin from excess melanin production. This can be caused by everything from acne scars and sun damage to hormone fluctuations. The first-line treatment for hyperpigmentation involves topical formulations of conventional agents such as hydroquinone, kojic acid, and glycolic acid followed by oral formulations of therapeutic agents such as transexamic acid, melatonin, and cysteamine hydrochloride. Despite the availability of multiple treatments for the condition, hyperpigmentation continues to present clinical management challenges for dermatologists. The study aims to compare the therapeutic efficacy, to compare the therapeutic efficacy and tolerability of glycolic acid peels and salicylic acid peels for hyperpigmentation treatment.
200 patients were selected and graded on Fitzpatrick scale. A split face peel on right side by Glycolic Acid and left side by Salicylic Acid was done and procedure was repeated after 2 week and then third sitting of PRP was done. Patients were scaled on Fitzpatrick scale at baseline and after 3 sitting (PRP).
Salicylic recorded a mean value of 3.10 at baseline while glycolic acid recorded 2.92 at baseline. After 3 sitting Salicylic Acid recorded a mean reduction value of 0.29 while that of Glycolic Acid mean reduction value was 0.71and this was stastically significant reduction.
Patients with Salicylic Acid peels showed significantly better response than Glycolic Acid peels.
... Daily home-based application of low-strength glycolic acid was better tolerated and had less sideeffects than glycolic acid peels. 4 Long-term daily use of 15% GA is moderately effective in atrophic acne scars and therefore may be advised for persons who cannot tolerate the peeling procedure. ...
Introduction:
Scarring is a common but difficult to manage consequence of acne vulgaris. The intricate balance between the degradation of collagen and its inhibition is disturbed during the formation of acne scars. We mostly rely on invasive, non-topical modalities for the treatment of acne scars which may not be indicated in all patients. There is also a need for maintainence therapies after these procedures.
Review:
The topical agents can be utilized as individual therapy, in combination with other modalities or delivered through assisted technology like iontophoresis. Retinoids have long been tried to prevent and treat acne scars. Tacrolimus and glycolic acid are among the newer sole agents that have been explored. Ablative lasers like Er:YAG, CO2 and Microneedling are being used in combination with topical agents like silicone gel, plasma gel, lyophilized growth factors, platelet rich plasma, insulin, and mesenchymal stem cells. These procedures not only increase the permeability of the topical agents but also concomitantly improve acne scars. Iontophoresis has proven beneficial in increasing the delivery of topical estriol and tretinoin.
Conclusion:
There is lack of evidence to support the widespread use of these topical agents, and therefore, there is need for further well designed studies.
... There are several methods of medical correction of postacne signs (topical treatment, injections and surgery) but none of them satisfy patients or doctors and guarantee good cosmetic effect [2,[5][6][7][8][9][10][11][12]. Development of new methods of postacne treatment is actual. ...
... Light-to-medium depth peels, such as glycolic acid (GA), are more popularized due to their significant benefits for mild-to-moderate acne scars and PIH with rare side effects. [15][16][17] However, the application of CP should be more cautious among Asians because of the natural differences between the skin type of Asians and white people. 14,18 Hence, CPs can only be legally administered in qualified clinics under the supervision of certificated dermatologists in China. ...
Background
There have been few studies on economic evaluation of acne treatments. Chemical peel (CP), a treatment approach primarily aimed at removing acne hyperpigmentation and scarring, is gradually accepted in the Chinese market.
Objectives
This study aimed to detect willingness-to-pay (WTP) and to conduct a benefit–cost analysis for CP treatment among Chinese acne patients.
Materials and methods
The costs were obtained from the patient’s perspective and compared with benefits. The net benefits were approximated by WTP, using the contingent valuation method. A glycolic acid peel served as the demonstrated example. WTP and related information were inquired via an online questionnaire among the Chinese population. Factors for WTP were identified using generalized linear models. The benefit–cost ratio (BCR) was calculated. Discounting was not considered for both WTP and costs.
Results
The response rate of the survey was 95.4% among the 476 anonymous participants. The average cost for three-time CP treatment was USD 383.4. Statistically significant differences in WTP among the cases were identified. The mean WTP for Case 1, Case 2, and Case 3 was USD 234.6, 222.0, and 401.7, respectively. A statistically significant association between WTP and self-reported acne severity was observed for all cases after adjustments for demographic characteristics (P<0.01). The Cardiff Acne Disability Index was positively associated with WTP. The BCRs were 0.61, 0.58, and 1.4 for Case 1, Case 2, and Case 3, respectively.
Conclusion
Patients with acne in China are willing to pay for acne treatment. Although the benefits of CP treatment have not generally outweighed their aggregated costs, WTP for CP treatment was positively associated with self-reported acne severity and desirable efficacy of treatment. Individualized acne treatments are recommended to target a specific population in the Chinese market.
... A study by Erbağci and Akçali, [29] was conducted on 23 patients in the first group and 20 patients in the second group. Their study concluded that a 70% GA peel performed every 2 weeks resulted in significant improvement in atrophic acne scarring, as compared to 15% GA cream used daily. ...
... Thirty-five percent glycolic acid (GA) peels were as efficacious as 20% salicylic-10% Dermabrasion (14) TCA CROSS [26][27][28][29] Microneedling [31][32][33][34][35] Laser resurfacing: CO 2 [41,42]; Er:YAG [44,47,49] Subcision [52,53] Filler (poly-L-lactic acid) [ Used as adjunct to other procedures mandelic acid peel for icepick scars, but less efficacious for boxcar scars [19]. Biweekly GA peels have shown superior results compared with daily low-strength GA cream over a period of 24 weeks [20]. Medium-depth peeling with 35% trichloroacetic acid (TCA) can improve acne scarring with a short downtime in patients with skin types V-VI [21]. ...
Background:
Modalities for atrophic acne scarring can be classified depending upon the needs they satisfy; that is, resurfacing, lifting/volumization, tightening, or surgical removal/movement of tissue that is required for correction. A plethora of treatment options have resulted from the need to treat various acne scar types, variability of responses noted in various skin types, and increasing popularity of minimally invasive modalities. Still, there is a lack of consensus guidelines on treatment or combination therapies for various clinical scenarios.
Objective:
This systematic review includes a critical evaluation of the evidence relevant to these modalities and various multimodality therapies.
Methods:
We performed a systematic literature search in Medline and EMBASE databases for studies on acne scar management. Also, we checked the reference lists of included studies and review articles for further studies. A total of 89 studies were included in our quality of evidence evaluation.
Results:
The efficacy of lasers and radiofrequency in atrophic acne scarring is confirmed by many comparative and observational studies. Other modalities can be used as an adjunct, the choice of which depends on the type, severity, and number of atrophic scars. Minimally invasive procedures, such as fractional radiofrequency and needling, provide good outcomes with negligible risks in patients with dark or sensitive skin types.
Conclusions:
There is a lack of high-quality data. Fractional lasers and radiofrequency offer significant improvement in most types of atrophic acne scars with minimal risks and can be combined with all other treatment options. Combination therapies typically provide superior outcomes than solo treatments.
... There are many different treatments for the reduction of the acne scars. The abrasion and peeling were one of the first treatments [1]. Ablative lasers such as CO 2 and erbium were also used with great results but with significant downtime [2]. ...
... 17 When used in higher concentrations, superficial AHA AQ : 2 peels (e.g., glycolic acid [70%]) have also been shown to be effective in treating atrophic acne scars. 18 Pioneered by Lee and colleagues, the chemical reconstruction of skin scars (CROSS) method uses a sharpened wooden applicator to focally apply TCA at high concentration (100%) to the depressed area of atrophic acne scars. 19 In a cohort of 20 patients (14 men), 2 sessions of the CROSS method 3 months apart demonstrated similar effects on acne scars compared with 3 sessions of 1,550-nm erbium:glass fractional laser at 1.5 months intervals. ...
Background:
Chemical peels are a mainstay of aesthetic medicine and an increasingly popular cosmetic procedure performed in men.
Objective:
To review the indications for chemical peels with an emphasis on performing this procedure in male patients.
Materials and methods:
Review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men.
Results:
Conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Male patients may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density.
Conclusion:
Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should have an understanding of chemical peel applications and techniques to address the concerns of male patients.
... Glycolic acid GA (10%) oil-in-water emulsion; mild acne (n=120) [127] 90 days; double-blind, placebo-controlled, randomized, monocenter trial Improvement in mild acne and well tolerated GA (35% and 50%) peels and GA (15%) home care products; moderate to moderately severe acne (n=40) [128] 12 weeks GA has considerable therapeutic value GA (70%) chemical peels; all types of acne (n=80) [129] 1 year 11 months Effective treatment for all types of acne GA peels versus GA cream; atrophic acne scars (n=58) [130] 24 weeks; single, blind, placebo-controlled, randomized comparative clinical study GA peels effective for acne treatment; GA cream beneficial for patients nontolerable to peels GA (12%) versus AzA (10%); acne vulgaris -type not specified (n=30) [131] 12 weeks; prospective study Comparable efficacy; constant decline in PIH with GA GA (6%) + retinaldehyde (0.1%) cream; Moderate acne (n=145) [132] 3 months; double-blind vehicle-controlled study Efficient therapy for acne prevention as well as treatment Salicylic acid SA (30%) peels; acne vulgaris -type not specified (n=35) [133] 12 weeks Effective and safe therapy Contd... ...
Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications.
... Participants were asked to use broad-spectrum (UVA and UVB) sunscreen of SPF 50+ for 2 weeks prior to the initiation of the study [11]. ...
Background . Tretinoin has been shown to improve photoaged skin. This study was designed to evaluate the efficacy and tolerability of a 5% retinoic acid peel combined with microdermabrasion for facial photoaging. Materials and Methods . Forty-five patients, aged 35–70, affected by moderate-to-severe photodamage were enrolled in this trial. All patients received 3 sessions of full facial microdermabrasion and 3 sessions of either 5% retinoic acid peel or placebo after the microdermabrasion. Efficacy was measured using the Glogau scale. Patients were assessed at 2 weeks and 1, 2, and 6 months after treatment initiation. Results . The mean ± SD age of participants was 49.55±11.61 years, and the majorities (73.3%) were female. Between 1 month and 2 months, participants reported slight but statistically significant improvements for all parameters ( P<0.001 ). In terms of adverse effects, there were statistically significant differences reported between the 5% retinoic acid peel groups and the control group ( P<0.001 ). The majority of adverse effects reported in the study were described as mild and transient. Conclusion . This study demonstrated that 5% retinoic acid peel cream combined with microdermabrasion was safe and effective in the treatment of photoaging in the Iranian population. This trial is registered with IRCT2015121112782N8 .
... On the other hand, such findings have never occurred in SA in PEG. With respect to acne scars, the evidence on the usefulness and safety of high concentrations of GA 17 and TCA 18 peeling were insufficient, because studies on the design of these treatments by the types of scars were absent. ...
Chemical peeling may be defined as the therapies, procedures and techniques used for the treatment of certain cutaneous diseases or conditions, and for aesthetic improvement. The procedures include the application of one or more chemical agents to the skin. Chemical peeling has been very popular in both medical and aesthetic fields. Because neither its scientific background is well understood nor a systematic approach established, medical and social problems have taken place. This prompted us to establish and distribute a standard guideline of care for chemical peeling. Previous guidelines such as the 2001 and 2004 versions included minimum standards of care such as indications, chemicals, applications, and any associated precautions, including post-peeling care. The principles in this updated version of chemical peeling are as follows: (i) chemical peeling should be performed under the strict technical control and responsibility of a physician; (ii) the physician should have sufficient knowledge of the structure and physiology of the skin and subcutaneous tissues, and understand the mechanisms of wound-healing induced by chemical peeling; (iii) the physician should be board-certified in an appropriate specialty such as dermatology; and (iv) the ultimate judgment regarding the appropriateness of any specific chemical peeling procedure must be made by the physician while considering all standard therapeutic protocols, which should be presented to each individual patient. Keeping these concepts in mind, this new version of the guidelines includes a more scientific and detailed approach from the viewpoint of evidence-based medicine.
... [12,13] Erbağci and Akçali in their study titled "biweekly serial GA peels versus long term daily use of topical low-strength GA in the treatment of atrophic acne scars" showed that long term daily use of GA is effective on scars and may be recommended for patients who cannot tolerate the peeling procedure. [14] Studies conducted by Dreno et al. showed that RALGA combination can efficiently treat acne scars and PIH. [8] However, the combination of RAGA had not yet been studied. ...
Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA) is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA) is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA) combination remains unexplored.
The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne.
A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron's global scarring grading system (GSGS), before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement.
At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients.
The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.
... Furthermore, apparently good responses were observed in the peel group only (P , 0.01). 26 In the author's experience, GA peels are excellent for use on Indian skin. Patients with Fitzpatrick's skin types III-IV with post acne pigmentation are treated with 20% GA peel for the first three sessions. ...
Chemical peels have been time-tested and are here to stay. Alpha-hydroxy peels are highly popular in the dermatologist's arsenal of procedures. Glycolic acid peel is the most common alpha-hydroxy acid peel, also known as fruit peel. It is simple, inexpensive, and has no downtime. This review talks about various studies of glycolic acid peels for various indications, such as acne, acne scars, melasma, postinflammatory hyperpigmentation, photoaging, and seborrhea. Combination therapies and treatment procedure are also discussed. Careful review of medical history, examination of the skin, and pre-peel priming of skin are important before every peel. Proper patient selection, peel timing, and neutralization on-time will ensure good results, with no side effects. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the time for which it is applied. Hence, it can be used as a very superficial peel, or even a medium depth peel. It has been found to be very safe with Fitzpatrick skin types I-IV. All in all, it is a peel that is here to stay.
Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well‐being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.
Atrophic acne scars are the most common type of acne scars and are classified into three main types: icepick, boxcar, and rolling scars. Various procedures and techniques for atrophic acne scarring are discussed in detail, with stronger evidence-based support for lasers (non-fractional, fractional, ablative, and non-ablative), platelet-rich plasma as adjunctive treatment, chemical peels (glycolic acid, trichloroacetic acid, and Jessner’s solution), dermal fillers such as hyaluronic acid, and microneedling, and lesser quality evidence for microdermabrasion, subcision, and lipoaspirate grafting. Further research is needed to optimize treatment protocols, assess the efficacy of monotherapies, and establish standardized guidelines for clinicians. This paper will provide a comprehensive review of the evidence-based management of atrophic acne scars, including currently commonly utilized therapies as well as more innovative treatment options.
Molluscum contagiosum (MC) is a benign papular skin infection caused by Molluscum contagiosum virus (MCV). Over the past 30 years, the incidence of MK has continued to increased association with sexually transmitted infections and human immunodeficiency virus (HIV) infection. The incidence of MC in HIV patients is quite high at 5–8%. Until now there is no standard therapy used for the treatment of MC in patients with HIV. In HIV patients, anti retro viral therapy (ARV) is the main therapy with several other additional therapies such as cantaridin, chemical peeling agents such as glycolic acid (20–70%) and trichloroacetic acid (20–100%), cryosurgery, electrosurgery, incision, lactic acid, laser surgery, podophyllin, retinoic acid, and urea. There have been no studies regarding the administration of topical 20% glycolic acid in MC patients. We report a case of MC in an HIV patient who was treated with 20% topical glycolic acid after failing treatment with topical tretinoin. The diagnosis was made clinically, cytologically, and histopathologically, a white mass was found on compression of the lesion and Henderson-Paterson bodies. The lesions on the face, arms, and legs were given glycolic acid lotion 20% which was applied once a day at night. The lesions started to show responses to the treatment at week 6th as some of the MC papules became hyperpigmented macules. The side effects of therapy that appeared were itching and hyperpigmentation. Topical 20% glycolic acid can be used for MC therapy with minimal side effects, easy to apply and safe.
Acne is a very common inflammatory disease with superimposed opportunistic infection, which, if left untreated, will often lead to lifelong scarring. The resultant scarring is graded for the purposes of classification and communication, but the scarring is a very individual issue with even minor scarring a great issue for patients.
Melasma is a common acquired disorder of hyperpigmentation characterized by symmetric brown macules and patches on sun-exposed skin. The treatment of melasma often necessitates a multifaceted approach combining broad-spectrum photoprotection, topical agents, and, in refractory cases, chemical peels and laser/light therapy. Superficial chemical peels, including glycolic, salicylic, and trichloroacetic acid, are safe and cost-effective procedures that remove excess cutaneous pigment through controlled chemical injury followed by skin regeneration. Lasers and light-based devices, including fractional resurfacing and Q-switched lasers, are also effective in the treatment of refractory melasma, particularly when used in combination with topical depigmenting agents. Microneedling and picosecond lasers have more recently been added to the treatment armamentarium. This chapter provides an evidence-based approach to the treatment of melasma with laser and light-based devices, chemical peeling agents, and other dermatologic procedures. Herein, the authors review the safety and efficacy of dermatologic procedures and provide evidence-based recommendations for procedural selection and peri-procedural care in melasma.
The Guidelines for the Treatment of Acne Vulgaris of the Japanese Dermatological Association was first published in Japanese in 2008 and revised in 2016 and 2017. These guidelines (GL) indicate the standard acne treatments in Japan and address pharmaceutical drugs and treatments applicable or in use in Japan. In these GL, the strength of the recommendation is based on clinical evidences as well as availability in Japanese medical institutions. In the 2016 and 2017 GL, some of the clinical questions were revised, and other questions were added in accordance with approval of topical medicines containing benzoyl peroxide (BPO). Rather than monotherapies of antibiotics, the 2017 GL more strongly recommend combination therapies, especially fixed‐dose combination gels including BPO in the aspects of pharmacological actions and compliance in the acute inflammatory phase to achieve earlier and better improvements. The 2017 GL also indicate to limit the antimicrobial treatments for the acute inflammatory phase up to approximately 3 months and recommend BPO, adapalene, and a fixed‐dose combination gel of 0.1% adapalene and 2.5% BPO for the maintenance phase to avoid the emergence of antimicrobial‐resistant Propionibacterium acnes. The 2017 GL also discuss rosacea, which requires discrimination from acne and a different treatment plan.
Background:
Microneedling with dermaroller and glycolic acid peels is commonly used for treatment of acne scars.
Objective:
To compare efficacy of microneedling alone versus combination of microneedling with serial 70% glycolic acid peel in management of atrophic acne scars.
Methods & materials:
Sixty patients with atrophic acne scars were randomized into group 1 receiving microneedling at 0, 6, and 12 weeks and group 2 receiving microneedling at 0, 6, and 12 weeks along with 70% glycolic acid peel at 3, 9, and 15 weeks. Acne scar scoring was performed by a blinded observer using ECCA (Echelle d'evaluation clinique des cicatrices d'acne) scoring at baseline and after 22 weeks. Additionally, patients were asked to grade the improvement in acne scars and skin texture on visual analogue scale (VAS).
Results:
Of 60 patients, 52 completed the 22-week study period. The decrement from baseline in mean ECCA score was more in group 2 as compared to group 1 (39.65±2.50 vs 29.58±0.18; P<.001). Group 2 also showed more improvement in skin texture as compared to group 1 on VAS.
Conclusion:
Addition of sequential 70% glycolic acid peel to microneedling gives better scar improvement as compared to microneedling alone. In addition to this, it also improves skin texture.
Background:
Acne scarring is a frequent complication of acne and resulting scars may negatively impact on an affected person's psychosocial and physical well-being. Although a wide range of interventions have been proposed, there is a lack of high-quality evidence on treatments for acne scars to better inform patients and their healthcare providers about the most effective and safe methods of managing this condition. This review aimed to examine treatments for atrophic and hypertrophic acne scars, but we have concentrated on facial atrophic scarring.
Objectives:
To assess the effects of interventions for treating acne scars.
Search methods:
We searched the following databases up to November 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2015, Issue 10), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included studies and relevant reviews for further references to randomised controlled trials.
Selection criteria:
We include randomised controlled trials (RCTs) which allocated participants (whether split-face or parallel arms) to any active intervention (or a combination) for treating acne scars. We excluded studies dealing only or mostly with keloid scars.
Data collection and analysis:
Three review authors independently extracted data from each of the studies included in this review and evaluated the risks of bias. We resolved disagreements by discussion and arbitration supported by a method expert as required. Our primary outcomes were participant-reported scar improvement and any adverse effects serious enough to cause participants to withdraw from the study.
Main results:
We included 24 trials with 789 adult participants aged 18 years or older. Twenty trials enrolled men and women, three trials enrolled only women and one trial enrolled only men. We judged eight studies to be at low risk of bias for both sequence generation and allocation concealment. With regard to blinding we judged 17 studies to be at high risk of performance bias, because the participants and dermatologists were not blinded to the treatments administered or received; however, we judged all 24 trials to be at a low risk of detection bias for outcome assessment. We evaluated 14 comparisons of seven interventions and four combinations of interventions. Nine studies provided no usable data on our outcomes and did not contribute further to this review's results.For our outcome 'Participant-reported scar improvement' in one study fractional laser was more effective in producing scar improvement than non-fractional non-ablative laser at week 24 (risk ratio (RR) 4.00, 95% confidence interval (CI) 1.25 to 12.84; n = 64; very low-quality evidence); fractional laser showed comparable scar improvement to fractional radiofrequency in one study at week eight (RR 0.78, 95% CI 0.36 to 1.68; n = 40; very low-quality evidence) and was comparable to combined chemical peeling with skin needling in a different study at week 48 (RR 1.00, 95% CI 0.60 to 1.67; n = 26; very low-quality evidence). In a further study chemical peeling showed comparable scar improvement to combined chemical peeling with skin needling at week 32 (RR 1.24, 95% CI 0.87 to 1.75; n = 20; very low-quality evidence). Chemical peeling in one study showed comparable scar improvement to skin needling at week four (RR 1.13, 95% CI 0.69 to 1.83; n = 27; very low-quality evidence). In another study, injectable fillers provided better scar improvement compared to placebo at week 24 (RR 1.84, 95% CI 1.31 to 2.59; n = 147 moderate-quality evidence).For our outcome 'Serious adverse effects' in one study chemical peeling was not tolerable in 7/43 (16%) participants (RR 5.45, 95% CI 0.33 to 90.14; n = 58; very low-quality evidence).For our secondary outcome 'Participant-reported short-term adverse events', all participants reported pain in the following studies: in one study comparing fractional laser to non-fractional non-ablative laser (RR 1.00, 95% CI 0.94 to 1.06; n = 64; very low-quality evidence); in another study comparing fractional laser to combined peeling plus needling (RR 1.00, 95% CI 0.86 to 1.16; n = 25; very low-quality evidence); in a study comparing chemical peeling plus needling to chemical peeling (RR 1.00, 95% CI 0.83 to 1.20; n = 20; very low-quality evidence); in a study comparing chemical peeling to skin needling (RR 1.00, 95% CI 0.87 to 1.15; n = 27; very low-quality evidence); and also in a study comparing injectable filler and placebo (RR 1.03, 95% CI 0.10 to 11.10; n = 147; low-quality evidence).For our outcome 'Investigator-assessed short-term adverse events', fractional laser (6/32) was associated with a reduced risk of hyperpigmentation than non-fractional non-ablative laser (10/32) in one study (RR 0.60, 95% CI 0.25 to 1.45; n = 64; very low-quality evidence); chemical peeling was associated with increased risk of hyperpigmentation (6/12) compared to skin needling (0/15) in one study (RR 16.00, 95% CI 0.99 to 258.36; n = 27; low-quality evidence). There was no difference in the reported adverse events with injectable filler (17/97) compared to placebo (13/50) (RR 0.67, 95% CI 0.36 to 1.27; n = 147; low-quality evidence).
Authors' conclusions:
There is a lack of high-quality evidence about the effects of different interventions for treating acne scars because of poor methodology, underpowered studies, lack of standardised improvement assessments, and different baseline variables.There is moderate-quality evidence that injectable filler might be effective for treating atrophic acne scars; however, no studies have assessed long-term effects, the longest follow-up being 48 weeks in one study only. Other studies included active comparators, but in the absence of studies that establish efficacy compared to placebo or sham interventions, it is possible that finding no evidence of difference between two active treatments could mean that neither approach works. The results of this review do not provide support for the first-line use of any intervention in the treatment of acne scars.Although our aim was to identify important gaps for further primary research, it might be that placebo and or sham trials are needed to establish whether any of the active treatments produce meaningful patient benefits over the long term.
Introduction
Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options.
Objectives
To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices.
Method
Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality.
Results
A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy.
Conclusion
There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.
Die moderne Aknetherapie beruht auf der Anwendung von antikomedogenen, antimikrobiellen und entzündungshemmenden Substanzen sowie Antiandrogenen. Ergänzend stehen traditionelle oder neu entwickelte Verfahren zur Verfügung. Hierzu zählen pharmakologische (Dapson, Zink) und physikalische (Phototherapie, photodynamische Therapie, Aknetoilette, Abrasiva) Prinzipien. Diese ergänzenden Verfahren werden hinsichtlich ihrer Wirksamkeit und ihres Stellenwertes innerhalb der Aknetherapie beurteilt.
The mainstays of modern acne therapy include comedolytic, antimicrobial, and anti-inflammatory substances, as well as antiandrogens. Additionally, traditional or newly developed therapeutic approaches may be considered, including pharmacologic (dapsone, zinc) and physical measures (phototherapy, photodynamic therapy, comedone extraction, abrasives). This article reviews such adjunctive therapies with regard to efficacy and their roles in acne therapy.
I peeling superficiali hanno un’azione epidermica regolatrice predominante principalmente cheratolitica. Tuttavia, la loro ripetizione determina anche dei miglioramenti dermici, tipo neocollagenesi, così come un’azione sui melanociti. Le loro indicazioni si basano sulle iperpigmentazioni tipo melasma, sull’eliodermia, sulla perdita di vivacità della carnagione, sull’acne e sulle cicatrici leggere. Il loro impiego è possibile qualunque sia il fototipo. L’acido glicolico, che fa parte degli alfa-idrossi-acidi, è il peeling che è stato oggetto del maggior numero di pubblicazioni. La sua efficacia è equivalente alle altre molecole (acido tricloroacetico [TCA] superficiale, Jessner, pasta di Unna, acido salicilico), con esiti spesso più semplici. Costituisce, quindi, il miglior compromesso per i peeling superficiali. Il loro uso sporadico è raramente soddisfacente, poiché essi devono integrarsi in una strategia terapeutica prolungata.
Glycolic acid peels and microdermabrasion are widely recommended by dermatologists and others for facial skin rejuvenation, but few studies have assessed their clinical efficacy.
To compare the relative efficacy of glycolic acid peels and microdermabrasion for facial skin rejuvenation.
An unblinded, randomized controlled trial was used. Each of 10 patients received paired treatments with glycolic acid peels (20%) and microdermabrasion (mild setting) for 6 consecutive weeks. The right and left sides of the face were treated with different modalities. Once a patient was assigned to receive a particular modality to a particular side of the face, all subsequent treatments were delivered in the same manner. Patient ratings, investigator ratings, and photographs were obtained before the first treatment and 1 week after the last treatment.
In terms of overall preference for a given type of treatment, seven patients chose glycolic acid peels, one selected microdermabrasion, and two had no favorite treatment. The relative preference for glycolic acid peels approached significance (P =.0578). Investigator ratings and photographic comparisons did not reveal treatment-specific differences or significant improvement from baseline. No serious side effects were seen with either treatment, and even mild effects were seldom reported.
In this study, patients appeared to prefer low-strength glycolic acid peels to low-intensity microdermabrasion for facial rejuvenation. Differences in patient satisfaction were subtle and may be technique dependent.
Chemical peeling for skin of color arose in ancient Egypt, Mesopotamia, and other ancient cultures in and around Africa. Our current fund of medical knowledge regarding chemical peeling is a result of centuries of experience and research. The list of agents for chemical peeling is extensive. In ethnic skin, our efforts are focused on superficial and medium-depth peeling agents and techniques. Indications for chemical peeling in darker skin include acne vulgaris, postinflammatory hyperpigmentation, melasma, scarring, photodamage, and pseudofolliculitis barbae. Careful selection of patients for chemical peeling should involve not only identification of Fitzpatrick skin type, but also determining ethnicity. Different ethnicities may respond unpredictably to chemical peeling regardless of skin phenotype. Familiarity with the properties each peeling agent used is critical. New techniques discussed for chemical peeling include spot peeling for postinflammatory hyperpigmentation and combination peels for acne and photodamage. Single- or combination-agent chemical peels are shown to be efficacious and safe. In conclusion, chemical peeling is a treatment of choice for numerous pigmentary and scarring disorders arising in dark skin tones. Familiarity with new peeling agents and techniques will lead to successful outcomes.
Acne vulgaris is a common inflammatory skin condition that presents management difficulties to cosmetic surgeons. Acute management and treatment focuses on early diagnosis as well as treatment with topical agents, oral antibiotics, hormonal therapy,and nonablative chemical peel and laser applications. The treatment of postinflammatory scarring must be individualized to address potential macular dyschromia, cystic lesions,epithelial bridges, or deep pitted scars. A review of interventional options is presented to apply to the spectrum of acne scarring as well as a review of the literature to address objectively published reports on efficacy.
Facial acne scarring has been treated with multiple methods with varying degrees of improvement. Although the 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been widely used to improve photoaging, studies analyzing its effects on atrophic acne scarring are limited.
To evaluate the efficacy of a dynamic cryogen-cooled 1,320 nm Nd:YAG laser for the treatment of atrophic facial acne scars in a larger cohort of patients with long-term follow-up.
Twenty-nine patients (skin phototypes I-IV) with facial acne scarring received a mean of 5.5 (range 2-17) treatments with a 1,320 nm Nd:YAG laser. Objective physician assessment scores of improvement were determined by side-by-side comparison of preoperative and postoperative photographs at a range of 1 to 27 months (mean 10.4 months) postoperatively. Subjective patient self-assessment scores of improvement were also obtained.
Acne scarring was significantly improved by both physician and patient assessment scores. Mean improvement was 2.8 (p < .05) on a 0- to 4-point scale by physician assessment and 5.4 (p < .05) on a 0- to 10-point scale by patient assessment. No significant complications were observed.
Nonablative laser skin resurfacing with a 1,320 nm Nd:YAG laser can effectively improve the appearance of facial acne scars with minimal adverse sequelae.
The mainstays of modern acne therapy include comedolytic, antimicrobial, and anti-inflammatory substances, as well as antiandrogens. Additionally, traditional or newly developed therapeutic approaches may be considered, including pharmacologic (dapsone, zinc) and physical measures (phototherapy, photodynamic therapy, comedone extraction, abrasives). This article reviews such adjunctive therapies with regard to efficacy and their roles in acne therapy.
Acne scars may negatively impact quality of life. The purpose of this study was to collect preliminary data on the efficacy and safety of injectable poly-L-lactic acid (PLLA, Sculptra, Dermik Laboratories) for the treatment of acne scars.
Twenty subjects aged 42.4+/-10.7 years (10 men, 10 women) with facial scars resulting from moderate to severe acne or varicella participated in this single-center, open-label prospective study. The primary end point was the resolution of the acne or varicella scars. Secondary end points were the physician and subject assessments of scar improvement. PLLA reconstituted with 5 mL of sterile water was injected serially at or near the sites of the acne scars without topical anesthesia.
Investigator-assessed reductions in acne scar size and severity were significant (p<.0001) during the course of seven treatments. Subject-rated reduction in scar severity was also significant (p=.0078). Subject satisfaction with treatment trended toward an increase with each treatment session and approached significance (p=.0899). Adverse events were limited to depression (n=1) not related to the treatment.
Injectable PLLA as used in this investigation appears to correct the types of acne scars treated in this study without serious adverse effects.
To evaluate the efficacy and tolerability of 2 widely used topical alpha-hydroxy acids at low concentrations, 8% glycolic acid and 8% lactic (L-isoform) acid creams, in the treatment of photodamaged skin.
A single-center, 22-week, double-blind, vehicle-controlled, randomized clinical trial assessed the overall severity of photodamage on the faces and forearms of volunteers, based on 7 individual clinical components of cutaneous photodamage.
The study was performed in an outpatient clinical research unit at the Massachusetts General Hospital, Boston.
Seventy-four women, aged 40 to 70 years, with moderately severe photodamaged facial skin were enrolled in the study. One subject withdrew from the study early because of skin irritation, and 6 subjects withdrew from the study for personal reasons.
Glycolic acid, L-lactic acid, or vehicle creams were applied twice daily to the face and outer aspect of the forearms.
Improvement in alpha-hydroxy acid-treated photodamaged skin as determined by patient self-assessments and physician evaluations of efficacy and irritancy.
The percentage of patients using either 8% glycolic acid or 8% L-lactic acid creams on the face achieving at least 1 grade of improvement (using a scale from 0 through 9) in overall severity of photodamage was significantly greater than with the vehicle cream (76% glycolic acid, 71% lactic acid, and 40% vehicle; P < .05). On the forearms, after 22 weeks, treatment with glycolic acid cream was superior to the vehicle in improving the overall severity of photodamage and sallowness (P < .05). L-Lactic acid cream was significantly superior to the vehicle in reducing the overall severity of photodamage (P < .05), mottled hyperpigmentation (P < .05), sallowness (P < .05), and roughness on the forearms (P < .05) at week 22.
Topical 8% glycolic acid and 8% L-lactic acid creams are modestly useful in ameliorating some of the signs of chronic cutaneous photodamage. These agents are well tolerated and available without prescription.
Low-strength daily formulations of glycolic acid are widely promoted for the treatment of photoaging. However, there are few clinical studies that objectively confirm the benefits of such formulations.
The purpose of this study was to determine the effectiveness of a 5% unneutralized formulation of glycolic acid in the treatment of facial and neck photoaging.
Seventy-five volunteers were recruited to take part in this double-blind randomized placebo-controlled clinical study. Participants applied either the 5% glycolic acid cream or the placebo cream to the face and neck for a period of 3 months. Pre- and posttreatment clinical assessments of photoaging effects were made by the same physician and were analyzed for statistical significance.
Overall there were trends towards greater improvement or less worsening in the glycolic acid group for all clinical assessments for photoaging. There was statistically significant improvement favoring the active-cream in general skin texture and discoloration. There was a trend favoring glycolic acid in reduction of wrinkles, but this did not achieve statistical significance.
Unneutralized 5% glycolic acid topical cream when used on a regular daily basis can improve some photoaging effects.
Alpha hydroxy acids (AHAs) have been used as cosmetic agents since ancient times. In low concentrations AHAs cause a decrease in corngocyte cohesion. In higher concentrations they result in epidermolysis and upper dermal changes, producing a vibrant, less wrinkled, and more uniformly colored skin. The method of application is important as is decreasing pH to increase the AHA bioavailability.
Topical corticosteroids produce atrophic changes in skin, including thinning of the epidermis and decrease in dermal ground substance. We observed that 12% ammonium lactate produced an increase in the thickness of epidermis and increased amounts of dermal glycosaminoglycans.
Our purpose was to determine whether 12% ammonium lactate could minimize cutaneous atrophy produced by a potent topical corticosteroid.
Clobetasol propionate, 12% ammonium lactate, and both agents were repetitively applied under occlusive patches as well as in open patches on the forearms of human volunteers for 3 to 4 weeks. Biopsy specimens were analyzed for thickness of the epidermis and dermal glycosaminoglycans by image analysis.
Twelve percent ammonium lactate produced a significant sparing of atrophy in both the epidermis and dermis without any influence on the bioavailability or antiinflammatory properties of the corticosteroid.
Twelve percent ammonium lactate may be useful in mitigating the adverse effects of corticosteroid on skin.
Glycolic acid is a member of the AHA family, which occurs naturally in foods and has been used for centuries as a cutaneous rejuvenation treatment. Recently it has proved to be a versatile peeling agent and it is now widely used to treat many defects of the epidermis and papillary dermis in a variety of strengths, ranging from 20% to 70%, depending on the condition being treated. People of almost any skin type and color are candidates, and almost any area of the body can be peeled. Several weeks prior to a peel the skin may be prepared with topical tretinoin or glycolic acid, and immediately prior to the peel the skin may be degreased with a variety of agents. Following the peel the skin is carefully observed for any complications such as hyperpigmentation and infection. Results are maintained with serial peels and at-home use of tretinoin or glycolic acid, as well as sun avoidance. The glycolic acid can be applied simultaneously with TCA and is another technique for a medium-depth peel. Comparison of 35% TCA-treated skin with 70% glycolic acid-treated skin examined histologically at different times reveals similar changes in papillary dermis connective tissue proteins, epidermal necrosis seen only with TCA, and reversion at 2 years postpeel to pretreatment appearance.
Glycolic acid is an alpha hydroxyacid that is useful as a chemical peeling agent.
To discuss the techniques using glycolic acid to remove actinic keratoses, fine wrinkles, lentigines, melasma, and seborrheic keratoses.
Applied in a carefully timed manner, the depth of penetration can be titrated by the timed duration of application of acid on the skin. Chemical peels are left on the skin for 3 to 7 minutes for most patients. For ideal results, the chemical peel can be repeated 3 to 4 times.
Glycolic acid can easily be used to peel skin of all skin types with minimal risk.
We have found glycolic acid can be an ideal adjunct to other cosmetic modalities such as soft tissue augmentation.
Although there is increasing interest in the use of glycolic acid in the treatment of photoaged skin, to our knowledge, no controlled study has been done to assess the efficacy or the mode of this agent.
The purpose of this study was to determine whether 50% glycolic acid can improve photoaged skin and to study the histological basis for this improvement.
Forty-one volunteers were recruited into this double-blind vehicle-controlled study. Glycolic acid (50%) or vehicle was applied topically for 5 minutes to one side of the face, forearms, and hands, once weekly for 4 weeks. Punch biopsies were taken at pretherapy and at 5 weeks for histologic study.
Significant improvement noted included decrease in rough texture and fine wrinkling, fewer solar keratoses, and a slight lightening of solar lentigines. Histology showed thinning of the stratum corneum, granular layer enhancement, and epidermal thickening. Some specimens showed an increase in collagen thickness in the dermis.
The results of this study demonstrate that the application of 50% glycolic acid peels improves mild photoaging of the skin.
Glycolic acid has been one of the more commonly used alpha hydroxy acids for the treatment of photodamaged skin. Its value as a quick "skin refreshing" peeling agent has been widely touted. This type of peel differs from a conventional therapeutic peel (eg, phenol, trichloroacetic acid, or a longer time exposure alpha hydroxy acid peel) in that there is little skin reaction and patients can go about their daily routine without concern.
To assess the potential value of glycolic acid-based refresher peels as a cosmetic procedure.
Twelve healthy subjects with at least a moderate degree of photodamage were treated with monthly serial 70% glycolic acid peels over a period of 4 months. In addition to the "peels," six subjects were randomized to a 10% glycolic acid-based moisturizer twice daily. Patients were evaluated monthly and graded on a clinical scale using objective measures.
No conclusive differences were noted on histologic evaluation. Ninety percent (9/10) of patients felt that overall they noticed significant improvement, however, there was no distinction between the two treatment options. The improvement in fine wrinkling and pigmentation was primarily seen in the patients who additionally received 10% glycolic emollient twice daily.
In this limited pilot study, no specific benefit could be assigned to the concomitant use of monthly glycolic acid refresher "peels" in the treatment of photodamaged skin.
Glycolic acid has been used extensively for the treatment of photoaging and wrinkles. Suggestions have been made that glycolic acid may have specific dermal effects, although biochemical studies are limited.
This study's purpose was to examine the effect of glycolic acid on the radioactively labeled collagen production in human skin fibroblasts in culture.
Normal dermal fibroblasts were grown to semi-confluence and incubated in the presence of glycolic acid for 24 hours. Radioactive proline was added to the cultures. Using a specific amino acid assay, the amount of radioactive hydroxyproline was measured and was used as an accurate index of collagen production.
Results show that glycolic acid caused an elevated collage production in the fibroblasts.
These results demonstrate a specific stimulatory effect by the glycolic acid and could explain some of the positive benefits from the clinical use of glycolic acid.
Concerns about photosensitizing potential of alpha hydroxy acids have been expressed. A previous study, however, reported topical glycolic acid showing the opposite potential, that is, photoprotective. This study was designed to test the antiinflammatory and photoprotective capabilities of glycolic acid.
The effects of short-wave ultraviolet light (UVB) on skin treated with glycolic acid were evaluated in two different studies at two different locations.
In the first study the antiinflammatory potential of topical glycolic acid was tested on erythematous templates on the backs of human volunteers. Erythema was induced by exposure to three times the minimum erythema dose (MED) of UVB. Glycolic acid cream in an oil-in-water vehicle at 12% partially neutralized with ammonium hydroxide to a pH of 4.2 was applied to the template beginning 4 hours postirradiation four times a day. A second template on the same subject was used as a vehicle control. After 48 hours a marked reduction of erythema was noted when compared with the vehicle control site. In the second study, four test sites were exposed to UVB light in the following manner. Site 1 was a nontreated control site and was used to establish the MED for the subjects being tested; site 2 was also exposed to a MED series but was treated 24 hours postirradiation for 7 days with two glycolic acid-based products (cleanser and oil-free moisture lotion, both containing 8.0% glycolic acid at a pH of 3.25); site 3 was treated first with the two glycolic acid-based formulas for 3 weeks prior to being exposed to UVB light; and site 4 was treated as outlined in site 3, with the inclusion that the site was chemically peeled for 6 minutes (with a 50% glycolic solution at a pH of 2.75) 15 minutes prior to UVB exposure.
When UVB-burned skin was treated with glycolic acid daily for 7 days (site 2), a 16% reduction in irritation was observed compared to nontreated skin (site 1), implying that skin healed sooner when treated with glycolic acid. When a comparison of nontreated skin was made to skin treated with glycolic acid for 3 weeks prior to UVB exposure (site 1 vs site 3), a sun protection factor (SPF) of 2.4 was achieved. When a comparison of skin treated for 3 weeks was made to skin treated for 3 weeks and chemically peeled (site 3 vs site 4) the data implied that the chemical peel reduced the SPF value of skin treated with glycolic by approximately 50%, however, an SPF trend of 1.7 was still obtained when compared with untreated skin. CONCLUSIONS. The studies demonstrated that topical glycolic acid provides a photoprotective effect to pretreated skin yielding an SPF of approximately 2.4. In addition, when glycolic acid is applied to irradiated skin, it accelerates resolution of erythema. The data obtained from both studies support the hypothesis that glycolic acids acts as an antioxidant.
Much has been said about the effects of glycolic acid with little scientific evidence to substantiate the findings. OBJECTIVE. This study reports on the clinical and histological effects of glycolic acid at pH levels 3.25, 3.80, and 4.40, and at 3.25%, 6.50%, 9.75%, and 13.00% on ichthyotic/xerotic skin.
Product treatment consisted of a 2-week washout period followed by 3 weeks of product application (BID) with A 1-week regression period. Shave biopsies and clinical evaluations for dryness, moisturization, and transepidermal water loss were made at baseline, 1, 2, and 3 weeks of use, and at the regression period.
Clinically, ichthyotic/xerotic skin was normalized with histologic evidence of stratum corneum thinning, viable epidermal thickening, and marked increases in glycosaminoglycan and collagen content.
All pH levels and concentrations demonstrated significant improvement in the condition of the skin with trends implying that increasing the pH increases efficacy.
alpha-Hydroxy acids (AHAs) have been reported to improve aging skin. The mechanisms of action of AHAs on epidermal and dermal compartments need clarification.
Our purpose was to determine the effects of AHAs on photoaged human skin by clinical and microanalytic means.
Patients applied a lotion containing 25% glycolic, lactic, or citric acid to one forearm and a placebo lotion to the opposite forearm for an average of 6 months. Thickness of forearm skin was measured throughout the study. Biopsy specimens from both forearms were processed for analysis at the end of the study.
Treatment with AHAs caused an approximate 25% increase in skin thickness. The epidermis was thicker and papillary dermal changes included increased thickness, increased acid mucopolysaccharides, improved quality of elastic fibers, and increased density of collagen. No inflammation was evident.
Treatment with AHAs produced significant reversal of epidermal and dermal markers of photoaging.
Glycolic acid has become important and popular for treating acne.
To evaluate the efficacy and safety of serial glycolic acid peels with glycolic acid home care products on facial acne lesions and other associated skin problems.
We collected 40 Asian candidates with moderate to moderately severe acne. They were divided into two groups according to the degree of greasiness of their facial skin. The two groups' members were treated with four series of 35% and 50% glycolic acid peels, respectively. They also used 15% glycolic acid home care products during this study period. The improvement of acne as well as other associated problems were assessed by both the physicians and the patient themselves.
Significant resolution of comedones, papules, and pustules was found. The skin texture of each candidate was dramatically rejuvenated. Consistent and repetitive treatment with glycolic acid was needed for the apparent improvement of acne scars and cystic lesions. The follicular pores also became comparatively smaller. Furthermore, most of the candidates had much brighter and lighter looking skin. Only small percentage of patients (5.6%) developed side effects.
Glycolic acid has considerable therapeutic value for acne with minimal side effects even in Asian skin. It may be an ideal adjunctive treatment of acne.
Treatment of postinflammatory hyperpigmentation in patients of Fitzpatrick skin types IV, V, and VI is difficult. Glycolic acid peels are useful for pigment dyschromias in caucasians; however, there are no controlled studies examining their safety and efficacy in dark-complexioned individuals.
To determine if serial glycolic acid peels provide additional improvement when compared with a topical regimen of hydroquinone and tretinoin.
Nineteen patients with Fitzpatrick skin type IV, V, or VI were randomized to a control or peel group. The control group applied 2% hydroquinone/10% glycolic acid gel twice daily and 0.05% tretinoin cream at night. The peel patients used the same topical regimen and, in addition, received six serial glycolic acid peels (68% maximum concentration). Patients were evaluated with photography, colorimetry, and subjectively.
Sixteen patients completed the study. Both treatment groups demonstrated improvement, but the patients receiving the glycolic acid peels showed a trend toward more rapid and greater improvement. The peel group also experienced increased lightening of the normal skin.
This pilot study demonstrates that serial glycolic acid peels provide an additional benefit, with minimal adverse effects, for the treatment of postinflammatory hyperpigmentation in dark-complexioned individuals.
Alpha hydroxyacids (AHAs) are used to enhance stratum corneum desquamation and improve skin appearance. The purpose of this study was to evaluate whether some AHAs improve skin barrier function and prevent skin irritation. Eleven healthy subjects (aged 28 +/- 6 years, mean +/- SD) entered the study. Six test sites of 8 x 5 cm (four different AHAs, vehicle only (VE) and untreated control (UNT) were selected and randomly rotated on the volar arm and forearm. The four different AHAs at 8% concentration in base cream were glycolic acid (GA), lactic acid, tartaric acid (TA) and gluconolactone (GLU). The products were applied twice a day for 4 weeks (2 mg/cm2). At week 4, a 5% sodium lauryl sulphate (SLS) challenge patch test was performed under occlusion for 6 h (HillTop chamber, 18 mm wide) on each site. Barrier function and skin irritation were evaluated by means of evaporimetry (Servomed EP-1) and chromametry (a* value, Minolta CR200) weekly, and at 0, 24 and 48 h after SLS patch removal. No significant differences in transepidermal water loss (TEWL) and erythema were observed between the four AHAs at week 4. After SLS challenge, GLU- and TA-treated sites resulted in significantly lower TEWL compared with VE, UNT (P < 0.01) and GA (P < 0.05) both at 24 and 48 h. Similarly, a* values were significantly reduced after irritation in GLU- and TA-treated sites. This study shows that AHAs can modulate stratum corneum barrier function and prevent skin irritation; the effect is not equal for all AHAs, being more marked for the molecules characterized by antioxidant properties.
Glycolic acid treatment is believed to reverse the photoaging process by increasing collagen synthesis in the skin. However, this effect has not been clearly defined even though alpha hydroxy acid products are used extensively.
This study aimed to define the primary effect of glycolic acid on collagen synthesis that may be achieved by functional activation or proliferation of fibroblasts.
Glycolic acid treatment was compared in vivo with lactic acid (hairless mice) and in vitro to malic acid (normal human skin fibroblast culture) with controls. To find the functional activation of fibroblasts, Northern blot assay for type I collagen synthesis with histometric analysis (in vivo) was performed. Cell proliferation assay (MTT) with procollagen type I C-peptide (PICP) enzyme immunoassay and radioisotope ([3H]proline) incorporated collagen production from cultured fibroblasts were determined.
The in vivo collagen mRNA expression with histometric analysis revealed greater collagen synthesis by glycolic acid compared with lactic acid and control. In vitro cell proliferative effect of glycolic and greater amount of collagen production showed a steady increase in a dose-dependent manner.
Both in vivo and in vitro, glycolic acid treatment increased the production of collagen and fibroblast proliferation. These effects may be the mechanism by which glycolic acid reverses the process of photoaging.
Atrophic acne scars are a frequent problem after acne. Hitherto, mainly invasive treatment measures were possible. In a recent paper, we demonstrated the positive effects of iontophoresis with 0.025% tretinoin gel vs. estriol 0.03%.
In this further study, the recording of the clinical effects of iontophoresis with 0.025% tretinoin gel in atrophic acne scars was supplemented by immunohistochemistry investigations of collagen I and III, proliferation markers, and the estimation of epidermal thickness.
The treatment was performed twice weekly in 32 volunteer patients for a period of 3 months by application of the substance under a constant direct current of 3 mA for 20 min. Skin biopsies prior to and at the end of treatment were performed in 32 voluntary patients in order to investigate collagen I/III and proliferation markers by immunohistochemistry methods.
Clinically, at the end of treatment, in 94% of patients a significant decrease in the scar depth was observed. Neither epidermal thickness nor proliferation markers revealed a significant increase at the end of treatment. Furthermore, collagen I and collagen III showed no common trend, as expressed statistically by a lack of significance. In some cases, increases in collagen III became evident at the end of treatment.
Tretinoin-iontophoresis is an effective, noninvasive treatment of atrophic acne scars without causing disturbing side-effects.
Glycolic acid chemical peels have been widely accepted as a useful modality in many cutaneous conditions characterized by abnormalities of keratinization.
The aim of this study is to evaluate the use of glycolic peels in the main clinical forms of acne.
Between January 1995 and December 1996, 80 women, aged 13-40 years, were visited for acne and selected for the study at the Cagliari University Dermatology Department (Italy). The type and severity of acne in each patient was assessed following the Leeds technique. The chemical peels were performed with a 70% glycolic acid solution, for times that varied in a range between 2 and 8 minutes. The number and frequency of the applications depended on the intensity of the clinical response.
The main clinical forms were comedonic acne in 32 cases, papulo-pustular acne in 40 cases and nodule-cystic acne in the remaining eight cases. The most rapid improvement was observed in comedonic acne. In the papulo-pustular forms an average of six applications was necessary. Although nodular-cystic forms required eight to ten applications, a significant improvement of the coexisting post-acne superficial scarring was noted. The procedure was well tolerated and patient compliance was excellent.
Glycolic acid chemical peels are an effective treatment for all types of acne, inducing rapid improvement and restoration to normal looking skin.