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Superficial chemical peeling with salicylic Acid in facial dermatoses

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Objective: To determine the effectiveness of salicylic acid chemical peeling in common dermatological conditions affecting face in people with predominant Fitzpatrick skin type IV and V. Design: An interventional, quasi-experimental study. Place and duration of study: Military Hospital, Rawalpindi and PAF Hospital, Sargodha, from July 2002 to June 2003. Patients and methods: A total of 167 patients of either gender, aged between 13 to 60 years, having some facial dermatoses (melasma, acne vulgaris, postinflammatory hyperpigmentations, freckles, fine lines and wrinkles, post-inflammatory scars, actinic keratoses, and plane facial warts) were included. A series of eight weekly hospital based peeling sessions was conducted in all patients under standardized conditions with 30% salicylic acid. Clinical improvement in different disorders was evaluated by change in MASI score, decrease in the size of affected area and % reduction in lesions count. McNemar test was applied for data analysis. Results: Majority of the patients showed moderate to excellent response. There was 35% to 63% improvement (p<0.05) in all dermatoses. Significant side effects, as feared in Asian skins were not observed. Conclusion: Chemical peeling with salicylic acid is an effective and safe treatment modality in many superficial facial dermatoses.
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JCPSP 2007, Vol. 17 (4): 187-190 187
INTRODUCTION
Chemical peeling is used to improve the appearance of the
skin by chemical application which allows new skin to
regenerate. The new skin is smoother and less wrinkled than
the old skin, and may also be more even in color.
1
Indications
of chemical peeling include actinic keratoses, actinic rhytides,
pigmentary dyschromias, superficial scarring, radiation
dermatitis, and acne vulgaris.
1-4
The depth of penetration of
peeling agent depends upon the depth of epidermal defect.
Deep perioral rhytides may require a deep peel.
5,6
Salicylic acid (Beta hydroxy acid) is one of the newer peeling
agents being used these days for treatment of various facial
disorders and rejuvenation of skin. Unlike fruit acids, it is lipid
soluble and, therefore, is effective in lower concentrations that
are even less irritating than alpha hydroxyl acids (AHAs).
Salicylic acid works like glycolic acid (AHA) in dissolving the
cement between the dead skin cells and this process of
exfoliation is coupled with epidermal cell renewal and new
collagen synthesis.
3,4,7
It can regenerate both epidermis and
papillary dermis by simply injuring cornified layer. It also has a
unique property of penetrating effectively through the sebum,
eliminating acne-causing bacteria and helping to restore the
irritated skin surrounding the pores by exfoliation. At higher
concentration, it has been found very effective in
resurfacing moderately photo-damaged facial skin by
reorganizing the epidermis and rebuilding superficial dermal
connective tissue without producing inflammatory infiltrate.
The use of salicylic acid has been considered safe when
formulated to avoid irritation and to avoid increased sun
sensitivity.
8,9
The long-term affects of salicylic acid are being
evaluated in studies initiated FDA.
10
The use of SA in dermatology is ever increasing these days
and it is being effectively used as rejuvenating agent,
moisturizer, anti-treatment of facial lines and wrinkles, in
moderate to severe acne and other oily skin disorders, in
photo-damaged skin, in melasma and postinflammatory hyper
pigmentations of the face.
1,3,4,9
Previously, it was only used as
a keratolytic agent in psoriasis, warts and various ichthyotic
disorders.
2,3,10
The aim of the present study was to explore this novel
therapeutic option (by using salicylic acid as a peeling agent)
in various common facial disorder like melasma, post-
inflammatory hyper-pigmentation, acne vulgaris, actinic
keratosis etc.
PATIENTS AND METHODS
This quasi-experimental study was conducted on 167 patients
of either gender with predominant Fitzpatrick skin type IV and
V, aged between 15 to 60 years, having some common
dermatological conditions affecting face from July 2002 to
June 2003 were studied. Various facial dermatoses included in
the study were melasma (epidermal and mixed type), acne
vulgaris (mild to moderate inflammatory as well as non-
inflammatory type), post inflammatory hyperpigmentations
(post acne, post chicken pox, post burn, fixed drug eruptions),
freckles, fine lines and wrinkles, postinflammatory scars (mild
ORIGINAL ARTICLE
SUPERFICIAL CHEMICAL PEELING WITH SALICYLIC ACID IN
FACIAL DERMATOSES
Arfan ul Bari, Zafar Iqbal* and Simeen ber Rahman*
ABSTRACT
Objective: To determine the effectiveness of salicylic acid chemical peeling in common dermatological conditions affecting face in
people with predominant Fitzpatrick skin type IV and V.
Design: An interventional, quasi-experimental study.
Place and Duration of Study: Military Hospital, Rawalpindi and PAF Hospital, Sargodha, from July 2002 to June 2003.
Patients and Methods: A total of 167 patients of either gender, aged between 13 to 60 years, having some facial dermatoses (melasma,
acne vulgaris, postinflammatory hyperpigmentations, freckles, fine lines and wrinkles, post-inflammatory scars, actinic keratoses, and
plane facial warts) were included. A series of eight weekly hospital based peeling sessions was conducted in all patients under
standardized conditions with 30% salicylic acid. Clinical improvement in different disorders was evaluated by change in MASI score,
decrease in the size of affected area and % reduction in lesions count. McNemar test was applied for data analysis.
Results: Majority of the patients showed moderate to excellent response. There was 35% to 63% improvement (p< 0.05) in all
dermatoses. Significant side effects, as feared in Asian skins were not observed.
Conclusion: Chemical peeling with salicylic acid is an effective and safe treatment modality in many superficial facial dermatoses.
KEY WORDS: Superficial chemical peeling. Salicylic acid. Facial dermatoses.
Department of Dermatology, Combined Military Hospital, Muzaffarabad, Azad
Jammun Kashmir.
*Department of Dermatology, Military Hospital, Rawalpindi.
Correspondence: Maj. Dr. Arfan ul Bari, Consultant Dermatologist, CMH,
Muzaffarabad, Azad Jammu Kashmir.
E-mail: albariul@yahoo.com; albariul@gmail.com
Received June 1, 2004; accepted February 22, 2007.
to moderate pitted and atrophic scars), actinic keratoses,
dermatoheliosis (photo-damaged skin) and plane facial warts.
Pregnant and lactating ladies and patients having known
sensitivity to the salicylic acid were not included. Patient with
known keloidal tendency, active herpes simplex infection, on
oral isotretinoin treatment and those with psychiatric diseases
or conditions, which may lead to non-compliance, were also
excluded. Salicylic acid powder used in the study was of
German origin and packed by a local company at Lahore. A
30% solution was made by dispensing the powder in absolute
ethyl alcohol (30 gms salicylic acid in absolute ethyl alcohol to
make solution to 100 ml). One day prior to actual peeling,
consent was taken from each patient after explanation of the
procedure and a small area in the postauricular region was
subjected to test peel with half the concentration of peeling
agents to detect any adverse reaction and to make the patient
familiar with sequelae.
A series of eight-weekly hospital based peeling sessions was
conducted in all patients under standardized conditions. Face
was washed with soap and water to remove any make up, dust
and debris and was scrubbed with spirit gauze just before
actual peeling. Peeling was done with cotton wool applicator
dipped in required solution with smooth strokes to the affected
areas with patient lying supine at an angle of 45° with closed
eyes and plugged ears. Application was completed within 30
seconds and termination was done by cleaning the face with
cold water but avoiding rubbing. Patients were made to sit in
front of fan if required immediately after peeling. The contact
time of 5 minutes was enhanced sequentially with one minute
increment on each subsequent visit. Avoidance of use of
soaps and sun-exposure at least for one following day was
advised. Patients were prescribed daily use of physical block
sunscreens during day time and 10% salicylic acid lotion at
night time. After eight weekly peeling sessions, patients were
advised to continue with daily use of physical block
sunscreens during day time and 10% salicylic acid lotion at
night for one month and then final assessment was made at
the end of one month follow-up.
Before starting therapy a baseline assessment was done. In
case of melasma, calculation of melasma area severity index
(MASI scoring) and total area of hyperpigmentation were
recorded. In case of other pigmentary disorders, colour
intensity of hyperpigmented areas compared with normal skin
was noted and total area of hyperpigmentation was measured.
The MASI was based on a similar scoring system devised for
psoriasis (maximum score for MASI is 48 and minimum score
is 0). Change in MASI score comparing with baseline score
was noted as percentage improvement. The borders of
individual lesions were outlined and drawn with a permanent
marker over a plastic foil by placing it over the patient’s face
and total area was calculated in sq. cm. At the end of the study
% reduction in lesional area was calculated. Colour intensity of
hyperpigmentation was assessed in comparison with colour of
patient’s normal unaffected skin of the face according to the
following rating: (i) minimal difference, (ii) slightly darker, (iii)
moderately darker (iv) markedly darker and (v) very dark. The
baseline and end of the study colour intensity was compared
and level change was recorded, as the improvement in colour
intensity, for example, level 5 to 2 was a three level change
(50-75% improvement). Two level change was considered to
be 25-50% and one level change as < 25% improvement
Efficacy in other dermatoses (acne vulgaris, acne scars,
freckles, fine lines and wrinkles, actinic keratosis and photo-
damaged skin) was assessed according to % reduction in
number of lesions and area of involvement. 0 to 10% reduction
was graded as no improvement (grade 0), 10% to 25%
reduction was graded as mild (grade 1), 25% to 50% as
moderate (grade 2), 50-75% as marked (grade 3) and more
than 75% as excellent response (grade 4) to treatment.
For data analysis and statistical results, McNemar test was
applied and (p< 0.05) was considered clinically significant.
RESULTS
A total of 167 patients having skin phototype IV and V were
included in the trial. There were 104 females (62.3%) and 63
males (37.7%). Age group ranged from 13 to 60 years with
mean age 24.70 years. Most of the patients were in third or
fourth decade (80%). Sixty-eight patients (40.7%) were having
melasma, 32(19.2%) had postinflammatory hyperpigmen-
tation, 30 (17.9%) had acne vulgaris, 15 (9.0%) had freckles,
10 (6.0%) had fine lines and wrinkles, 7(4.2%) had photo-
damaged skin and 5 (3.0%) had plane warts over their faces.
Duration of facial pathology was from 3 months to 11 years
with average duration of 2.6 years. Forty patients (24%) had
skin phototype IV and rest 127 (76%) had phototype V. Three
patients of melasma, 2 of postinflammatory hyperpig-
mentation and one each having fine lines and freckles on the
face were dropped out during the study. Two acne patients and
one having fine wrinkles did not show any appreciable
improvement. Rest of all the patients showed variable degree
of improvement at the end of 8 weekly sessions of chemical
peeling.
The frequency of individual disorder is shown in (Figure 1). In
melasma the mean score before starting the treatment was
(MASI-1) =12.57 (3.60 to 28.20), which was reduced at the
end of 8 weeks to (MASI-2) = 6.29 (1.80 to 13.80) and after
one month follow-up (MASI-3) = 5.16 (1.64 to 12.10). The
response to salicylic acid peeling was significant (p<0.001)
after 8 peeling sessions and the improvement continued
slowly during one month follow-up period. The mean lesion
area in melasma patients was 89.47 cm
2
, which was reduced
to 47.52 cm
2
(p<0.05) at the end of treatment and 42.73 cm
2
at the end of follow-up. Out of 30 cases of other pigmentary
disorders the improvement in colour intensity was mild in 5,
moderate in 24 and excellent in 2 patients. Reduction in total
area of hyperpigmentation was significant (p<0.05), the
respective area readings were 53.62 cm
2
, 28.45 cm
2
and
26.50 cm
2
. Patients with acne vulgaris showed no response in
2 cases, mild in 7, moderate in 19 and excellent in 2 patients.
Clinical responses seen in other disorders (freckles, fine lines
and wrinkles, photo-damaged skin and planewarts) are shown
in (Figure 2). Almost all of the patients experienced mild
burning, irritation and occasional stinging just after application
which was efficiently controlled with twice application with
beta-methasone valerate (0.1%) cream for a day or two and
dryness was managed with local application of emulsifying
ointment. During the peeling sessions, 3 patients developed
herpes labialis that responded adequately to the topical
application of acyclovir cream and avoidance of acyclovir
cream and avoidance of peeling during activity of the herpetic
disease.
188 JCPSP 2007, Vol. 17 (4): 187-190
Arfan ul Bari, Zafar Iqbal and Simeen ber Rahman
DISCUSSION
Facial chemical peeling is being increasingly employed as a
therapeutic modality in a wide variety of facial dermatoses but
there is a dearth of published data regarding efficacy of the
procedure in Pakistani population, which is provided by this
study.
Chemical peel produces a controlled partial thickness injury to
the skin. Following this insult, a wound healing process ensues
that can regenerate epidermis from surrounding epithelium
and adnexal structures, decreased solar elastosis, and replace
and reorient the new dermal connective tissue. The result is an
improved clinical appearance of the skin, with fewer rhytides,
acne lesions and decreased pigmentary dyschromias.
1,2,11
Salicylic acid has been used for several decades and is found
in various tropical medications. Being lipid soluble, it is a good
peeling agent for comedonal acne and it has the ability to
penetrate the comedones better than other acids. The anti-
inflammatory and anesthetic effects of the salicylate result in a
decrease in the amount of erythema and discomfort that is
generally associated with chemical peels.
3,4,7
Facial
dermatoses, including melasma, acne, freckles and
postinflammatory pigmentation or scarring are of great
psychosocial concern for the patients. These are commonly
encountered dermatological problems in Pakistan.
A number of studies have shown efficacy of various chemical
peeling agents including salicylic acids in the treatment of
different facial dermatoses worldwide
11-16
, but there has been
very few published studies with salicylic acid in this part of the
world.
In this study, increased female preponderance was in
consonance with earlier studies stating that the facial disorders
were commoner in females. More frequent disorders were
pigmentary in nature, followed by acne, wrinkles, actinic and
viral infection (warts). The mean age (24.70 years) was lower
than the mean age quoted in other studies.
2,17
This implies that
dermatoses may affect relatively younger age group in this
population.
Response to chemical peeling was found to be highly
satisfactory, showing 35% to 63% improvement in different
dermatoses. It was most rewarding in case of acne and
pigmentary dermatoses and was comparatively less effective
in improving fine lines, wrinkles and postinflammatory scarring
(being a superficial procedure, this was expected of such
treatment). This clinical response to chemical peeling with
salicylic acid correlates well with the responses seen in other
international studies as well as a couple of local
studies.
4,8,9,18,19
Since the regular use of sunscreen
(micronized zinc oxide formulation) was an essential
component of the treatment protocol in all the patients,
therefore, the results may be partially attributed to sunscreen
also. Almost all of the patients tolerated the procedure of
salicylic acid peeling well. Most of the adverse reactions that
occurred were already expected of such treatment and these
did not affect compliance of the patients.
Skin wounding during chemical peeling could possibly be the
cause of reactivation with herpes viruses in 3 patients, but
these could also be chance occurrences. None of the patients
developed postinflammatory hyper or hypopigmentation of the
affected or surrounding unaffected skin. This was quite
encouraging because postinflammatory dyspigmentation
(hyper or hypopigmentation) was initially considered as a risk
factor in dark skinned population.
17,20
CONCLUSION
Under the conditions of this study, chemical peeling with
salicylic acid is an effective, safe and easy to carry out
treatment modality in patients having various superficial
(epidermal) dermatoses. Being cost-effective, this may be
considered as first choice peeling agent (in appropriate
concentration) in treating different facial dermatoses.
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JCPSP 2007, Vol. 17 (4): 187-190 189
Salicylic acid peeling for facial dermatosis
Figure 1: Frequency of individual facial dermatoses subjected to chemical peeling.
Figure 2: Response to treatment in other facial dermatoses (% improvement).
PIH = Post inflammatory hyperpigmentation, Ls & Ws = Fine lines and
wrinkles,Photo skin= Photodamaged skin, P-Warts = Plane warts
[Ls/Ws = (Fine lines & wrinkles), Actinic skin = Photodemaged skin]
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Hypomelanoses and hypermelanoses: in: Freedberg IM, Eisen AZ, Wolff
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19. Arfan ul Bari. Efficacy of facial chemical peeling with salicylic acid and
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190 JCPSP 2007, Vol. 17 (4): 187-190
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Arfan ul Bari, Zafar Iqbal and Simeen ber Rahman
... SA peels in combination with 4% hydroquinone or alone have shown to be safe and effective in reducing PIH in darker skin patients (especially SPT IV and V). [11,12] Although SA peel is often combined with hydroquinone, there is paucity of literature investigating its inclusion in routine patient regimens. Additionally, there are concerns about the safety and adverse effect profile of hydroquinone. ...
... The authors concluded that there was nominal clinical improvement in PIH on the treated side as compared to the control side, but this clinical study did not demonstrate statistical significant improvement. [13] Similar studies were conducted by Grimes [11] and Bari et al. [12] to treat various facial dermatosis including PIH. Grimes [11] used serial SA peel with hydroquinone and later used 30% SA peel alone. ...
... Both the studies had shown encouraging results. [11,12] Ahn and Kim [14] also reported a whitening effect in patients of acne-induced PIH with 30% SA peel, with a significant decrease in erythema and improvement in greasiness, dryness, and scaliness. This whitening effect can be very fascinating, while selecting a chemical peel for dark complexioned races. ...
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Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis arising after inflammation or injury to the skin and can develop in all skin types especially in Fitzpatrick skin phototypes III to VI. In higher skin phototypes, chances of PIH following procedures using laser and other light sources are high. Therefore, it is becoming increasingly important to manage this unforeseen condition. Wide variety of treatment options are available for PIH, but there is limited literature regarding efficacy and safety of chemical peels in PIH. Hence, a thorough systematic review was performed by searching Pubmed, Scopus, Medline, and Cochrane databases in English language involving studies on PIH. Thus, this article is an attempt to bring together all the possible ways of using chemical peels (alone, in combination with other peels or topical agents) for the management of PIH.
... In the present study, most of the patients under GA group complained of burning sensation and redness (erythema) whereas cuneiform eruptions were observed in patients of GA group. This observation is in concordance with other studies done by Bari AU et al. [22] and Gupta RR et al. [23] . Hypertrichosis was observed in both the sides. ...
... None of the side effects interfered with the peeling process in any patient. This finding is in concordance with the study done by Bari AU et al. [22] . Follow up in this study was done for 2 months. ...
... In one study by Saoji, et al. [8], in spite of burning sensation in all patients, effectiveness was seen in 88% of the patients. There are many reports regarding safety of topical salicylic acid [13,14] but most of the applications were in other formulation and for short contact. As per one review [15] on toxicity from topical salicylic acid, it was concluded that in last 50 years, there were total 25 cases of toxicity with topical use of 6% salicylic acid and over with as little as 40% body surface area. ...
... 10 Repeated salicylic acid 30% peeling on the face has also not resulted in any major side effects. 11 In this analysis also, 48.16% of the patients reported AE of which 2 patients discontinued the treatment due to severe irritation and burning. ...
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p class="abstract"> Background: In recent times, there is increase in prevalence of hyperkeratotic dermatophytosis in India. These hyperkeratotic lesions usually impede the absorption of topical anti-mycotic agent making infection recalcitrant to topical anti-fungal therapy alone. Hence, many times topical keratolytic are used in combination with topical anti-fungal agents which augment the shedding of scales. Methods: To seek for short period therapy in hyperkeratotic dermatophytosis, we conducted multicentre, retrospective data analysis at 61 dermatology clinics to study effectiveness and safety of Luliconazole 1% and Salicylic acid 3% fixed dose combination (FDC) cream for 2 weeks. Results: A data of 191 patients’ were included in this analysis. All patients have received some of the topicals and switched to FDC. Total symptom score of 7.19±1.91 improved to 3.15±1.12 in just 2 weeks (p<0.05). The clinical improvement rate (percentage of ‘marked improvement’ plus ‘moderate improvement’) was 78% after 2 weeks of treatment. Moreover, 5 patients (2.61%) achieved complete clearance. This FDC was found to be safe in 51.83% (n=99) of the patients whereas 37.7% of the patients (n=72) reported it as almost safe. Minor problems with the safety was found in 9.42% of the patients (n=18). Two patients (1.04%) reported it as not safe and thus shifted to another drug. Irritation and burning were reported as most common adverse events (AE). Conclusions: The short combination therapy with luliconazole and salicylic acid as FDC has been found to be effective and safe. It should be a valuable option for hyperkeratotic dermatophytosis for early achievement of clinical cure and better patient compliance.</p
... 30% salicylic acid was used in that experiment. The study shows that almost all the patients tolerated the procedure well, although mild discomfort, burning, irritation, erythema, and excessive dryness were quite common [13]. ...
... Superficial peels include 15-20% trichloroacetic acid (TCA), 50-70% glycolic acid (GA), four to ten coats of Jessner's solution, 20-30% salicylic acid (SA) etc. SA peels (with or without 4% hydroquinone) have shown good results in the treatment of PIH in darker skin patients. [3,4] In total, 20-30% SA peel may also be combined with 0.1% topical tretinoin solution, for better results. [5] GA peels give excellent results in post-acne pigmentation. ...
... Ref: Fung et al (2008) According to the Applicant, the plasma concentrations in the Fung et al. study (30%; 5 min) were similar to that of a low concentration (2%) applied in a leave-on product to the same body surface area. Reviews of the safety of skin peeling agents have been performed by Bari et al., (2005) and Arif et al., (2015). ...
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"Opinion on salicylic acid (CAS 69-72-7) - Submission I" SCCS/1601/18 - Final Opinion – Corrigendum of 20 & 21 June 2019 U. Bernauer, L. Bodin, Q. Chaudhry, P.J. Coenraads, M. Dusinska, J. Ezendam, E. Gaffet, C. L. Galli, B. Granum, E. Panteri, V. Rogiers, Ch. Rousselle, M. Stepnik, T. Vanhaecke, S. Wijnhoven, A. Koutsodimou, A. Simonnard, W. Uter The SCCS adopted the final Opinion by written procedure on 21 December 2018 (70 pages) Corrigendum published on 25 June 2019 https://ec.europa.eu/health/sites/health/files/scientific_committees/consumer_safety/docs/sccs_o_223.pdf
... Ref: Fung et al (2008) According to the Applicant, the plasma concentrations in the Fung et al. study (30%; 5 min) were similar to that of a low concentration (2%) applied in a leave-on product to the same body surface area. Reviews of the safety of skin peeling agents have been performed by Bari et al., (2005) and Arif et al., (2015). ...
... Ref: Fung et al (2008) According to the Applicant, the plasma concentrations in the Fung et al. study (30%; 5 min) were similar to that of a low concentration (2%) applied in a leave-on product to the same body surface area. Reviews of the safety of skin peeling agents have been performed by Bari et al., (2005) and Arif et al., (2015). ...
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... Ref: Fung et al (2008) According to the Applicant, the plasma concentrations in the Fung et al. study (30%; 5 min) were similar to that of a low concentration (2%) applied in a leave-on product to the same body surface area. Reviews of the safety of skin peeling agents have been performed by Bari et al., (2005) and Arif et al., (2015). ...
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Salicylic acid (CAS 69-72-7) - Submission I Link to opinion : https://ec.europa.eu/health/sites/health/files/scientific_committees/consumer_safety/docs/sccs_o_223.pdf WG on Cosmetic Ingredients SCCS members: U. Bernauer, L. Bodin, Q. Chaudhry, P.J. Coenraads (Chairperson), M. Dusinska, J. Ezendam, E. Gaffet, C. L. Galli, B. Granum, E. Panteri (Rapporteur), V. Rogiers, Ch. Rousselle, M. Stepnik, T. Vanhaecke, S. Wijnhoven SCCS external experts: A. Simonnard, A. Koutsodimou, W. Uter Acknowledgements: N. von Goetz Contact: SANTE-C2-SCCS@ec.europa.eu On request from: European Commission SCCS Number: SCCS/1601/18 Adopted on: 21 December 2018 Conclusion of the opinion: 1. In light of the new data provided, does the SCCS still consider Salicylic acid (CAS 69-72-7) safe when used as a preservative in all cosmetic products up to a maximum concentration of 0.5% (acid) considering its current restriction as reported above? The SCCS considers salicylic acid (CAS 69-72-7) safe when used as preservative at a concentration of 0.5 % in cosmetic products considering its current restrictions in place. This Opinion is not applicable to any oral product (such as toothpaste and mouthwash) with the exception of lipsticks. Sprayable products that could lead to exposure of the consumer’s lung by inhalation are also excluded. The provided information shows that salicylic acid is an eye irritant with the potential to cause serious damage to the eye. 2. In addition, does the SCCS still consider Salicylic acid (CAS 69-72-7) safe when used for purposes other than inhibiting the development of micro-organisms at a concentration up to 3.0 % for the cosmetic rinse-off hair products and up to 2.0 % for other products considering its current restrictions as reported above? Based on the data provided and available literature, the SCCS considers salicylic acid (CAS 69-72-7) safe when used for purposes other than preservative at a concentration up to 3.0 % for the cosmetic rinse-off hair products and up to 2.0 % for other products, considering its current restrictions in place. However, in body lotion, eye shadow, mascara, eyeliner, lipstick and roll on deodorant applications, salicylic acid is considered safe up to 0.5% only as preservative. This Opinion is not applicable to any oral product (such as toothpaste and mouthwash). Sprayable products that could lead to exposure of the consumer’s lung by inhalation are also excluded. 3. Does the SCCS have any further scientific concerns with regard to the use of Salicylic acid (CAS 69-72-7) in cosmetic products? Salicylic acid is also used as a preservative in food and as a biocide in some consumer products (see section 3.2.3) or in various pharmaceutical formulations such as anti-acne products. As no specific exposure data were made available to SCCS to assess exposure following these non-cosmetic uses, it was not possible to include them in the aggregated exposure scenarios. Therefore, the actual total exposure of the consumer may be higher than exposure from cosmetic products alone. The conclusions of this Opinion refer only to Salicylic Acid and should not be applied to other salicylates or salicylic acid salts. Keywords: SCCS, scientific opinion, salicylic acid, Regulation 1223/2009, CAS 69-72-7, EC 200-712-3, SCCS/1601/18 Opinion to be cited as: SCCS (Scientific Committee on Consumer Safety), Opinion on salicylic acid (CAS 69-72-7) - Submission I, preliminary version of 10 September 2018, final version of 21 December 2018, SCCS/1601/18.
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Objective: To assess the effects of priming of facial skin with topical tretinoin prior to peeling and to see the comparative efficacy of two different peeling agents for the treatment of melasma. Design: A prospective and experimental study. Place and Duration of Study: Military Hospital, Rawalpindi, Pakistan between November, 2000 and May 2001. Patients and Methods: Forty patients of either sex and in the age group between 18-48 years, having melasma of all types and of variable duration, were included in the study. Group-I (n=20) patients were pre-treated with tretinoin cream for two weeks while no such treatment was offered to group-II (n=20) patients. Six fortnightly peeling sessions with glycolic acid(40%-60%) on right side and salicylic acid (20%-30%) on left side of the face were performed. Avoidance of sun exposure and regular use of sunscreen was emphasized. Evaluation was done before and after treatment based on MASI scoring, measurement of lesional area and photographs. Results: Moderate to excellent response was observed in all patients regarding reduction in melasma (p < 0.05). But the results were not statistically better in patients of group-I when compared with group:II (p > 0.05). Mild and transient adverse reactions like burning, stinging and erythema were seen in most of the patients. Conclusion: Salicylic acid and glycolic acid have almost equal efficacy and pre-peel priming of skin with topical tretinoin may not be an essential component of chemical peeling.
Article
Background: Salicylic acid peeling has recently been rediscovered as an effective treatment modality in various pigmentary disorders including melasma. Objective: The study aimed to assess the efficacy of superficial chemical peeling with salicylic acid in patients of melasma having predominant Fitzpatrik skin type IV and V and to see the effects of 4% hydroquinone as an adjuvant treatment modality. Methods: Forty patients of either sex and in the age group between 21-45 years, having melasma of all types and of variable duration, were included in the study. These were divided randomly into two groups of twenty each. Six fortnightly facial peeling sessions with salicylic acid (20%-30%) were performed in all patients. Group I patients were treated with 4% hydroquinone cream for subsequent three months while no such treatment was offered to group II patients. Avoidance of sun exposure and regular use of broad spectrum sunscreen was emphasized throughout in all patients. Evaluation was done before and after treatment. Results. Moderate to excellent response to chemical peeling was observed in all patients (p<0.05). The results were significantly better in patients who were given 4% hydroquinone subsequently (p<0.05). Mild and transient adverse reactions like burning, stinging, irritation, erythema and dryness were seen in most of the patients. No serious side effect was noted. Conclusion. Use of hydroquinone in post peeling phase can significantly enhance the efficacy of chemical peeling with salicylic acid in melasma.
Article
Several chemical agents are currently used to perform superficial chemical peels of the face. These include trichloracetic acid (15-30%), alpha-hydroxy acids (e.g., glycolic acid, 40-70%), and Jessner's solution (14% lactic acid, 14% resorcinol, and 14% salicylic acid). We have developed salicylic acid, a beta-hydroxy acid, at a higher strength (30% in a hydro-ethanolic vehicle) as an alternative peel. This peel has distinct advantages for resurfacing moderately photodamaged facial skin. We have peeled patients singly and multiply at 4-week intervals. The benefits are fading of pigment spots, decreased surface roughness, and reduction of fine lines.
Article
Melasma is a common disorder of facial hyperpigmentation among Asian women. Many modalities of treatment are available but none is satisfactory. This study was undertaken to see if glycolic acid peels are effective and safe in the treatment of melasma and fine facial wrinkling. Ten Asian women with moderate to severe melasma were recruited into the study. The women had twice daily applications of a cream containing 10% glycolic acid and 2% hydroquinone (Neostrata AHA Age Spot and Skin Lightening Gel) to both sides of the face, and glycolic acid peels every 3 weeks (20-70%) to one-half of the face using Neostrata Skin Rejuvenation System. All patients had to use a sunblock (SPF 15%). At regular intervals and at the end of 26 weeks (or after eight peels) the degree of improvement of pigmentation and fine facial wrinkling on each side of the face were assessed. Any skin irritation or side effects were also noted. Assessment was by an independent dermatologist, the patients themselves, and the use of the Munsell color chart and photographs. The nonparametric Wilcoxon Rank-Sum test was used for statistical analysis. The melasma and fine facial wrinkling improved on both sides of the face. The side that received glycolic acid peels did better but the results were not statistically significant (P > 0.059). A cream containing 10% glycolic acid and 2% hydroquinone (Neostrata AHA Age Spot and Skin Lightening Gel) improved melasma and fine facial wrinkling in Asian women. In combination with glycolic acid peels at 3-week intervals the lightening of melasma is subjectively much better. This improvement does not reach statistical significance and the sample size is small (n = 10).
Article
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.
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There is a dearth of published data regarding chemical peels in darker racial-ethnic groups. The purpose of the present investigation was to assess the clinical efficacy and safety of a new superficial salicylic acid peel in individuals of skin types V and VI. Twenty-five patients were included in this pilot investigation. Nine had acne vulgaris, 5 had post-inflammatory hyperpigmentation, 6 had melasma, and 5 had rough, oily skin with enlarged pores. The patients were pre-treated for 2 weeks with hydroquinone 4% prior to undergoing a series of five salicylic acid chemical peels. The concentrations of salicylic acid were 20% and 30%. The peels were performed at 2 week intervals. RESULTS. Moderate to significant improvement was observed in 88% of the patients. Minimal to mild side effects occurred in 16%. The results of this study suggest that superficial salicylic acid peels are both safe and efficacious for treatment of acne vulgaris, oily skin, textural changes, melasma, and post-inflammatory hyperpigmentation in patients with skin types V and VI.
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Studies comparing purported antiaging compounds are rare. To compare in a randomized, placebo-controlled double-blind study 10% glycolic acid (GA), 2% 2-hydroxy-5-octanoyl benzoic acid (beta-lipohydroxy acid, LSA) and 0.05% all-trans-retinoic acid (RA). Women volunteers treated one forearm twice daily with one of the active products and the other one with the vehicle. Comparative evaluations of efficacy were made using histochemistry and quantitative immunohistochemistry. Improvement in the various epidermal compartments was the most prominent finding at the RA-treated site. The LSA-treated site also exhibited similar positive changes, although to a lesser degree. GA showed no significant effect. In the presently tested concentrations and formulations, RA had a beneficial impact upon the aging epidermis. LSA mimicked RA but with somewhat lesser efficacy. By contrast, GA appeared almost inactive.