Article

Glycolic Acid Peels Versus Salicylic-Mandelic Acid Peels in Active Acne Vulgaris and Post-Acne Scarring and Hyperpigmentation: A Comparative Study

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Abstract

Many clinicians have used glycolic acid (GA) peels for facial acne, scarring, and hyperpigmentation, mainly in lighter skin types. Salicylic-mandelic acid combination peels (SMPs) are a newer modality, and there have been no well-controlled studies comparing them with other conventional agents. To compare the therapeutic efficacy and tolerability of 35% GA peels and 20% salicylic-10% mandelic acid peels in active acne and post-acne scarring and hyperpigmentation. Forty-four patients with facial acne and post-acne scarring and hyperpigmentation were divided into two groups, with one receiving GA peels and the other SMPs at fortnightly intervals for six sessions. The treating physician performed objective evaluation of treatment outcomes. The patients, the treating physician, and an independent observer made subjective assessments. Side effects of both agents were also noted. Both the agents were effective, but SMPs had a higher efficacy for most active acne lesions (p<.001) and hyperpigmentation (p<.001). Side effects were also lesser with SMPs. Both the agents were effective and safe in Indian patients, with SMPs being better for active acne and post-acne hyperpigmentation.

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... 5,23 Because of the resurfacing of the epidermis, the melanin content is decreased and redistributed improving hyperpigmentation. 11 These results agreed with some previous studies. 11,21,24 Patients' satisfaction is a subjective method for assessment of the therapeutic response. ...
... 11 These results agreed with some previous studies. 11,21,24 Patients' satisfaction is a subjective method for assessment of the therapeutic response. In the present study, it almost matched the therapeutic response according to MAS and QGS. ...
... The least side effects occurred in the sides treated by SM combination peels in groups B and C with no downtime and patients could continue their usual daily activity. Similar side effects were reported by Puri 21 and Garg etal 11 They added the occurrence of itching, There is no consensus about the numbers of sessions or intervals between treatment sessions. We preferred to choose the two-week In conclusion, combination peels are safe, effective, and superior to a single peel in the treatment of mild-to-moderate acne vulgaris in skin types III and IV. ...
Article
Background Successful management of acne involves choosing proper medication. Chemical peeling is a well‐known option in treatment of acne vulgaris. Objective To evaluate and compare the clinical efficacy and safety of combination chemical peels vs single peel in treatment of mild‐to‐moderate acne. Methods The study included 45 patients with mild‐to‐moderate acne divided into three equal groups. Group A underwent combination sequential peels with modified Jessner's solution (MJ) followed by trichloro acetic acid (TCA20%) on the right (Rt) side of the face vs TCA 30% on the left (Lt) side. Group B was treated by combination peels of salicylic (20%) mandelic (10%) (SM) mixture on the Rt half vs salicylic acid 30% on the Lt half. Group C underwent combination sequential peeling of MJ and TCA on the Rt side vs SM combination peels on the Lt side. All patients received six sessions with 2‐week intervals and followed up for 3 months after the last session. Side effects were reported. Results Both sides of the face showed significant improvement of acne lesions but improvement was significantly higher and earlier in sides treated by combination peels. Side effects were minimal. Conclusion In conclusion, combination peels achieved a higher and earlier therapeutic response with a reasonable cost that is maintained for a relatively long periods than single peel. Combination sequential peels gave the best results.
... Eleven studies (N = 11/33) investigated the efficacy of chemical peels (Table 2 and Fig. 2). The chemical peeling agents were as follows: salicylic acid 20-30%, [35][36][37][38][39]45 glycolic acid 10-70%, [38][39][40][41][42][43] Jessner solution, 35,36,42 trichloroacetic acid (TCA) 25%, 37 mandelic acid 10%, 39 amino fruit acid 20-60% 43 and lipo-hydroxy acids 0.3-10%. 44,45 The majority of the studies (N = 8/11) compared two peeling agents to each other. ...
... Eleven studies (N = 11/33) investigated the efficacy of chemical peels (Table 2 and Fig. 2). The chemical peeling agents were as follows: salicylic acid 20-30%, [35][36][37][38][39]45 glycolic acid 10-70%, [38][39][40][41][42][43] Jessner solution, 35,36,42 trichloroacetic acid (TCA) 25%, 37 mandelic acid 10%, 39 amino fruit acid 20-60% 43 and lipo-hydroxy acids 0.3-10%. 44,45 The majority of the studies (N = 8/11) compared two peeling agents to each other. ...
... Eleven studies (N = 11/33) investigated the efficacy of chemical peels (Table 2 and Fig. 2). The chemical peeling agents were as follows: salicylic acid 20-30%, [35][36][37][38][39]45 glycolic acid 10-70%, [38][39][40][41][42][43] Jessner solution, 35,36,42 trichloroacetic acid (TCA) 25%, 37 mandelic acid 10%, 39 amino fruit acid 20-60% 43 and lipo-hydroxy acids 0.3-10%. 44,45 The majority of the studies (N = 8/11) compared two peeling agents to each other. ...
Article
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Background: Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence based support in the efficacy and safety of non-pharmacological therapies is lacking. Objective: To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris. Methods: A systematic literature review, including a best-evidence synthesis was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017. Results: Thirty three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified: laser and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction on acne lesions. However, only 7 studies had a high methodologic quality. Based on these 7 trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), IPL (400-700nm and 870 - 1200nm) and the diode laser (1450nm). Initially, conflicting evidence was found for pulsed dye laser (585-595nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient. Conclusion: Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated. This article is protected by copyright. All rights reserved.
... 7,18 It is a large molecule that penetrates the skin slowly and possesses antibacterial properties. 18,26 Therefore, mandelic acid is better tolerated on the skin and is often used as alternative to GA peel. 18 Mandelic acid peel is formulated in a combination peel with SA (20% SA,10% mandelic acid). ...
... Furthermore, Garg et al found that both 35% GA peel and 20% SA/10% mandelic acid peels (SMPs) were effective in reducing acne lesions and postacne hyperpigmentation in Asians, although the SMPs had slightly better results. 26 Mild and transient side effects such as burning, stinging sensation, dryness, or photosensitivity were reported. In these studies, GA peel led to a statistically significant reduction in the number of active acne lesions. ...
Article
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Acne vulgaris is the most common skin disorder in adolescents and young adults. It carries a significant psychological and economic burden to patients and society. A wide range of therapeutic options are available, including topicals and systemic therapies. Chemical peeling is a skin resurfacing procedure intended to regenerate normal skin from the application of exfoliative agents. It has been used for the treatment of acne vulgaris and other skin disorders for decades. There are several chemical agents with variable mechanisms of action, usually classified as superficial, medium, and deep peels. When selecting the patient and the appropriate peel, the dermatologist individualizes therapy, and performs an extensive interview, including past medical history and physical exam. Several host factors can affect the outcome of this procedure, including current psychological state, medications, history of surgery, and immune system, among others. The physician must also be confident that the peel is safe and effective for the target patient. The Fitzpatrick skin type scale is a useful tool to classify patients based on skin color and ability to tan, but also can be used to evaluate preoperative risk of postpeel response and complications. Dark-skinned patients (Fitzpatrick skin type IV–VI), including blacks, Asian, and Hispanic/Latino, are at higher risk of postinflammatory/postpeel hyperpigmentation. When treating these populations, deep chemical peels should be avoided, and preoperative preparation emphasized. There are many studies available in the literature supporting the use of superficial to medium depth peels as adjuvant therapy for acne vulgaris. This review article aims to present the most important factors when selecting a patient for a chemical peel, the evidence behind its safety and efficacy, and special considerations when choosing a specific agent.
... Acne vulgaris is one of the most prevalent skin disorders and the single most common reason for visits to dermatologists. [1] This condition usually starts in adolescence, peaks at 14-19 years and frequently resolves by mid-twenties. It develops earlier in females which may be explained by early onset of puberty in females. ...
... Garg et al. [1] compared 35% glycolic acid and the combination of 20% salicylic acid -10% mandelic acid peel in active acne, postacne scarring, and hyperpigmentation. They found that salicylic-mandelic combination peel was significantly better than glycolic acid peel in treatment of acne because of the unique lipophilic and anti-inflammatory properties of both salicylic and mandelic acid. ...
... 12,14 In our study, we used a concentration of 50 % for GA and 30 % for SA peel as this was the highest possible concentration of these peels with superficial peel action and are frequently used in acne vulgaris. 15 Kessler et al, although find they have used the 30 % concentrations of both the peel in acne vulgaris. 11 Although GA and SA peel has been widely used in clinical practice, but there were very few studies comparing the efficacy and safety of these peeling agents. ...
... Our results are in concordance with the study by Garg et al., which concluded that SA had better efficacy and lesser side effect in most of the active acne lesions and post acne pigmentation. 15 Kessler et al., although found no significant differences in effectiveness between the two peels but SA showed sustained effectiveness and lesser adverse events as compared to GA peel. 11 In a recent study by Sarkar et al., comparing 35 % glycolic acid, 20 % salicylic, 10 % mandelic acid, and phytic acid peels, the authors concluded that the inflammatory lesions responded better to salicylic-mandelic acid peel as compared to other agents. ...
BACKGROUND Acne vulgaris is a commonly encountered disorder at dermatology clinics. For decades, chemical peeling has been used as an effective therapeutic option in the treatment of active acne lesions. Although various peeling agents are available, studies comparing their efficacy in active acne are lacking. The aim of the study was to evaluate the comparative efficacy of 50 % glycolic acid (GA) peel and 30 % salicylic acid (SA) peel in mild to moderate acne. METHODS This is an interventional, split face study involving thirty patients aged more than 12 years with active acne. The patients underwent peeling sessions every 2 weeks with 50 % glycolic acid and 30 % salicylic acid in the right and left half respectively, for a total of six sessions. Lesion count was recorded at baseline and at every follow-up session. Acne severity scoring was noted at each visit to evaluate the response. Patient VAS and Physician VAS were also used to measure the response. Photographic record was maintained. RESULTS The mean acne severity scores improved significantly as compared to baseline on both the sides at each of the follow ups (p = 0.000). On inter group comparison; the fall on SA side was significantly better than the GA side at all the follow ups. VAS-patient and VAS-physician scores also showed a significantly better response on SA side as compared to GA side. No serious side effects were noted on either side. Six sessions of both GA 50 % and SA 30 % peels at 2 week intervals showed good response in the management of mild to moderate acne measured by Acne severity score, Patient VAS and Physician VAS. However, SA peel showed a still better and faster response probably owing to its penetration into the sebaceous glands by virtue of its lipophilic nature. No significant side effects were noted by either peel. CONCLUSIONS Both GA 50 % and SA 30 % peels are effective in mild to moderate acne vulgaris. SA 30 % peel is more effective and provides faster response in treatment of mild to moderate acne vulgaris.
... Acne vulgaris is an inflammatory disease of pilosebaceous unit, characterised by seborrhoea, comedones, papules, pustules, nodules and cysts, with occasional scarring [1]. Acne is one of the most prevalent skin disorder and single most common cause for visit to a dermatologist [1]. ...
... Acne vulgaris is an inflammatory disease of pilosebaceous unit, characterised by seborrhoea, comedones, papules, pustules, nodules and cysts, with occasional scarring [1]. Acne is one of the most prevalent skin disorder and single most common cause for visit to a dermatologist [1]. Acne, considered as a "Stigma of Adolescence", causes significant psychological, social and emotional distress along with a self-perception of poor health [2,3]. ...
... Acne vulgaris is one of the most prevalent skin disorders and the single most common reason for visits to dermatologists. [1] This condition usually starts in adolescence, peaks at 14-19 years and frequently resolves by mid-twenties. It develops earlier in females which may be explained by early onset of puberty in females. ...
... Garg et al. [1] compared 35% glycolic acid and the combination of 20% salicylic acid -10% mandelic acid peel in active acne, postacne scarring, and hyperpigmentation. They found that salicylic-mandelic combination peel was significantly better than glycolic acid peel in treatment of acne because of the unique lipophilic and anti-inflammatory properties of both salicylic and mandelic acid. ...
Article
Background: Various modalities of treatment have been used in the treatment of acne and nowadays, clinicians seek to employ new technologies in acne care like chemical peeling. Objectives: The objective of this study is to compare the efficacy of salicylic acid and mandelic acid peel in the treatment of mild to moderately severe acne vulgaris. Methodology: A total of fifty patients with mild to moderately severe acne graded based on Global Acne Grading System were divided randomly into two groups of 25 patients each. Group A patients were treated with 20% salicylic acid and Group B patients were treated with 30% mandelic acid every 15 days for six sessions. Pre- and post-peel sunscreen and moisturizer were prescribed. Percentage of improvement in inflammatory and noninflammatory lesions at the end of six sessions was the primary endpoint measure. The improvement was graded as mild, moderate, good, and significant. Results: All the patients showed improvement of acne at the end of the treatment. The mean improvement of inflammatory acne in Group A was 73.3% and in Group B was 65.4%. The mean improvement of noninflammatory acne in Group A was 39.4%, and Group B was 27.9%. In both groups, the improvement in both inflammatory and noninflammatory lesions was found to be statistically significant ( P Conclusion: Salicylic acid peel was found to be more efficacious than mandelic acid peel. However, the side effects were less common with no postinflammatory hyperpigmentation with mandelic acid peel.
... Celem takiego działania jest uzyskanie silniejszego efektu i/lub szerszego spektrum działania całego preparatu kosmetycznego. Choć dobrze zaprojektowane badania kliniczne (z kontrolowanym placebo) są w tym zakresie nieliczne [2,7], a łączenie składników w większości wypadków stosowane jest zgodnie z uznanymi tradycyjnie rolami niektórych surowców kosmetycznych, w literaturze przedmiotu wskazuje się dowody naukowe wskazujące większą skuteczność pewnych kompilacji kilku składników kosmetycznych. Pokazały to między innymi badania przeprowadzone na grupie 44 osób z trądzikiem pospolitym i przebarwieniami. ...
... Analiza otrzymanych wyników wskazała, że peeling złożony przynosił szybsze oraz bardziej zadawalające efekty (ocena subiektywna klientów), niż peeling kwasem glikolowym. Skuteczność proponowanych zabiegów oceniana w sposób obiektywny była taka sama: doszło do zmniejszenia nasilenia zmian skórnych oraz nie odnotowano niepożądanych skutków terapii (oprócz delikatnego wysuszenia skóry) [7]. ...
Article
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Mandelic acid belongs to α-Hydroxy Acids. Its natural sources are bitter almonds, cherry and apricot kernels. It has a wide spectrum of activities after topical application. Mandelic acid is very popular in cosmetology and dermatology. It is used as an active ingredient in many cosmetic preparations, both professional and generally available. It is one of the safest AHA used, but it can also cause some cutaneous complications. The aim of this work was to analyze the composition of selected cosmetic preparations containing mandelic acid. The analysis was performed in terms of physicochemical forms, the applied concentration of mandelic acid and combinations with other active ingredients. The analysis included 30 random products, both professional and generally available, using cosmetic databases and available literature. Cosmetic forms included: cream, gel, tonic, peeling and serum. Concentrations used in the cosmetics were different, and information about this subject was usually given in professional preparations. Mostly, mandelic acid was combined with: hyaluronic acid, lactobionic acid, salicylic acid, azelaic acid and vitamin B5. The occurrence of plant raw materials in cosmetics with the addition of mandelic acid was varied.
... Many studies have evaluated the beneficial effects of glycolic acid and salicylic acid peel in the treatment of active acne in Asian population. [4] However, only a single study has evaluated the efficacy of salicylic-mandelic acid combination in active acne, [5] whereas none has studied the efficacy of phytic acid peel in the active acne. Alpha hydroxy acid peels have been the most extensively studied in the treatment of acne. ...
... Mandelic acid along with salicylic acid have been used in previous studies and have shown significant reduction in the acne score. [5] Salicylic acid is a beta hydroxy acid peel. It has a comedolytic effect owing to its lipophilic action. ...
Article
Full-text available
Background: Acne is a commonly encountered disorder in the dermatological practice. Chemical peeling is one of the treatment modalities in acne and postacne pigmentation. Although various peeling agents are available, studies comparing their efficacy are lacking. Moreover, there is a paucity of studies comparing the efficacy of combination peels in Asian population. Materials and methods: Forty-five patients with mild to moderate acne were divided into three groups of fifteen each. Groups A, B, and C underwent peeling sessions biweekly with 35% glycolic acid, 20% salicylic-10% mandelic acid, and phytic acid peels, respectively, for a total of six sessions. All other anti-acne treatments were stopped. Lesion count was carried out at baseline and at each follow-up visit. Acne scoring and postacne hyperpigmentation index were noted at each visit. Photographic record was maintained. Results: Significant reduction in inflammatory and noninflammatory lesion count was noted at 12 weeks in all the three study groups. Reduction in acne score at the end of 12 weeks in the three study groups was 70.55%, 74.14%, and 69.7%, respectively. A significant decline was observed in the postacne hyperpigmentation index in all the three study groups at the end of 12 weeks (P = 0.034). Conclusion: All three chemical peels are effective in the treatment of mild to moderate acne in Asian population. No significant adverse effects were noted.
... [12,13] Mandelic acid 10% in combination with salicylic acid 20% (salicylic-mandelic peel, i.e., SMP) has been compared with 35% GA peel. [14] Modest improvement was observed in ice pick scars, boxcars, and rolling scars in both the groups, but the former was safer and more efficacious in PIH. A modified form of phenol peel (Exoderm) has been tried with good improvement, but considerable side effects such as dyspigmentation, prolonged erythema, and milia formation were seen. ...
... The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Chemical peel Superficial scars III C [8][9][10][11][12][13][14][15] Post-acne hyperpigmentation II B TCA CROSS Used in ice pick scars II B [16][17][18][19][20][21][22][23][24][25] Dermabrasion Superficial and small scars II B [26] Microdermabrasion Mild to moderate scar II B [27][28][29][30] Microneedling Mild to moderate I A [31][32][33][34][35][36][37][38] Fractional radiofrequency devices Mild to moderate scars I A [39][40][41][42][43][44][45] Lasers and light sources Ablative non-fractional CO 2 laser 10,600 nm II B [50] Ablative Er:YAG II, III B, C [47][48][49] Fractional CO 2 laser I A [54][55][56][57][58] Fractional Er:YAG I A [60,61] Fractional 1,540 Er:glass II B [63] 1,550 nm erbium-doped laser II B ...
Article
Acne scars are the reason for significant morbidity among dermatology outpatients. With more modalities being introduced every year, it is important to choose the best one suited for a particular type of scar for each patient to obtain an optimum result. Guidelines on acne scar management in the skin of color are not available where the therapeutic effect and side effect profile of the modalities can vary significantly. This narrative review looked at critical evaluation of the available modalities to find the level of evidence and therapeutic ladder of management of different types of acne scars. Treatment options for different types of scars have been described. Evidence level for each type of modality for the individual type of scar was calculated using the Strength of Recommendation Taxonomy (SORT) developed by editors of the US family medicine and primary care journals. In addition, various newer and emerging treatment options, such as dermal cell suspension, jet volumetric remodeling, and radiofrequency subcision, have been discussed. The highest level of evidence is available for microneedling, fractional radiofrequency, fractional CO 2 , and erbium:yttrium aluminum garnet laser for mild to moderate grade scars. Trichloroacetic acid chemical reconstruction of skin scars showed efficacy in ice pick scars. Grade 4 scars improve poorly with resurfacing procedures, where punch excision and punch elevation can be tried. Platelet-rich plasma therapy was effective in combination with lasers and microneedling. Overall there is lack of high-quality data in the management of post acne scars. Combination treatment has shown better efficacy compared to single modalities.
... 14 Chemical peeling is the process of applying chemicals to the skin in order to destroy the outer damaged layers, thus accelerating the normal process of exfoliation, leading to tissue remodelling, thereby decreasing scar appearance. 15 Different agents have different depths of penetration and can be categorised into four different groups: very superficial; superficial; medium; and deep (Table 3). 1 Deep peels require sedation and have the potential to cause cardiotoxicity and hypo-/hyperpigmentation. 16 Pre-treatment with tretinoin and other desquamating agents is often used prior to medium and deep peeling in order to enhance the even penetration of peeling agents and minimise the risk of post-peel hyperpigmentation. 17 ...
... In a different study, 44 patients were treated with active acne or post-acne scarring. 15 The patients were divided into two age-and sexmatched groups. Group A comprised 22 patients who received fortnightly 35% GA peels, and group B comprised 22 patients who received fortnightly 20% salicylic-10% mandelic acid peels (SPM). ...
Article
Full-text available
Introduction Acne is a common condition that can result in permanent scarring. Acne scars can be broken down into three categories: atrophic; hypertrophic; and keloidal. Atrophic scars can be further sub-classified into: ice pick; rolling; and boxcar. Objectives and Methods We have performed a comprehensive literature search of the last ten years in order to determine the efficacy and adverse reactions of commonly used treatments against post-acne scarring. Results A total of 36 relevant articles were identified on the following interventions: subcision (n = 10), dermabrasion (n = 1), microneedling (n = 8), dermal fillers (n = 5), and chemical peeling (n = 12). Discussion Improvement in the appearance of post-acne scarring following subcision is in the range of 10–100%. Microdermabrasion achieved the least significant results. A total of 27.3% patients did not achieve any benefit despite eight treatment sessions, and only 9.1% achieved good results. All patients treated with microneedling achieved some improvement in scar appearance in the range of 31–62%. Dermal fillers also led to favourable outcomes. In particular, treatment with PPMA led to improvement in 84% of patients. Utilising chemical peels, trichloroacetic acid (TCA) CROSS achieved >70% improvement in 73.3% of patients, whereas 20% glycolic acid did not lead to any improvement in 25%. Conclusion Post-acne scarring is a common and challenging condition with no easy and definitive solution. The above interventions have been used with varying degrees of efficacy, each having both pros and cons. All have been deemed to be safe with few and transient adverse reactions. However, further trials with a larger number of patients are necessary in order to reach more concrete conclusions regarding their efficacy.
... chemical peels are used to treat small, depressed scars but not icepick or deep boxcar scars. 79 they induce injury to the skin that stimulates collagen remodeling and are categorized as superficial, medium, and deep based on the depth of the injury. 78 superficial peels, such as lactic acid, salicylic acid, glycolic acid, Jessner solution, and 10 to 25% trichloroacetic acid, only affect the epidermis. ...
Article
Acne vulgaris is a ubiquitous problem affecting 80 percent of people ages 11 to 30 years, with many patients experiencing some degree of scarring. This review focuses on atrophic scars, the most common type of acne scar. We briefly address the cellular sequelae that lead to scar formation and the initial evaluation of patients with acne scars. We then discuss an algorithmic approach to the treatment of acne scarring based on the classification of scars into erythematous and atrophic types. Lastly, we discuss the future treatment of acne scars and ongoing clinical trials.
... Bermejo et al. studied in detail the coordination of α-hydroxycarboxylic acids with first-row transition ions [3]. Mandelic acid, another AHA of increased lipophilicity, holds properties between glycolic acid and benzilic acid, and this acid can be used as a basic ingredient in preparing formulations to treat xerosis and photo aging [4]. Nedaplatin is a platinum-based antineoplastic drug complex consists of two ammine ligands and the dianion derived from glycolic acid [5]. ...
Article
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Determination of pKa values, especially for OH groups of α-hydroxycarboxylic acids, is challenging and rarely reported. Here, successive pKa values for COOH, and more importantly for OH groups of the nine biologically important α-hydroxycarboxylic acids (glycolic, lactic, methyl lactic, α-hydroxybutyric, mandelic, atrolactic, benzilic, malic, and citramalic) were calculated computationally. We benchmarked the accuracy for predicting pKa values by HF, MP2, B3LYP, B97D, B2PLYP, M06-2X, G3 and CBS-QB3 levels of theory combined with CPCM and SMD solvation models applied to lactic acid whose experimental pKa values are reported in the literature. Also, we considered six thermodynamic cycles in combination with a number of DFT methods and some cavity sets, such as, UAKS, Pauling and Bondi to obtain the reasonable results. Finally, we employed two best methods to predict the pKa values of the remaining eight α-hydroxycarboxylic acids. Estimated pKa values of OH groups are reported for these α–hydroxycarboxylic acids that were not yet determined experimentally.
... However, adequate control of the peeling depth may be difficult to achieve [16]. 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]. ...
Preprint
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.
... Our results disagreed with Garg et al., [31] who conducted a study on forty-four patients by using glycolic acid 35% for six sessions for two weeks in that glycolic acid gave no results in rolling scar, poor results in Icepick and good results in boxcar type. In our study all patients with rolling acne scar showed mild and good improvement. ...
... While in our study, patients with acne scar showed mild and good improvement, this may be due to the low number of patients in our study. Our results disagreed with Garg et al,14 and they used GA 35% for six sessions with 2-week interval, in that GA gave no results in rolling scar, poor results in ice pick, and good results in boxcar type. In our study, all patients with rolling acne scar showed mild and good improvement. ...
Article
Background Many methods have been performed to achieve a satisfying outcome in acne scars but some of them were high cost and also were associated with low results and some complications. Objectives To evaluate and compare the efficacy and safety therapy of glycolic acid (GA) peel, microneedling with dermapen and a combination of both procedures in treatment of atrophic acne scars. Patents and methods This study was conducted on 30 patients suffering from acne scars. They were randomly assigned into three groups, each group included 10 patients; group I was treated with GA peel, group II treated was with microneedling. Group III received a combination of both procedures. All patients received six sessions with 2‐week intervals. The clinical assessment was based on the qualitative global scar grading system before and after treatment, quartile grading scale, and degree of patient satisfaction. Results There was a statistically significant decrease in acne scars grade after treatment among the studied groups (P = 0.04) but it was higher in group III. There was improvement in boxcar, ice pick, and rolling scars in all groups, respectively (P = 0.03, P = 0.04, P = 0.04). Patients' satisfaction was higher in group III (P = 0.04). Conclusion The combination of dermapen and GA peel is more effective than monotherapy.
... Comparison of GA peels with other modalities In a study by Garg et al., [19] comparing the efficacy and tolerability of 35% GA peels and 20% salicylic-10% mandelic acid (SMPs) peels in active acne and postacne scarring and hyperpigmentation found that SMPs had a higher efficacy for active acne and postacne hyperpigmentation with lesser sideeffect profile. In yet another study by Godse and Sakhia, [20] who had studied triple combination of 2% hydroquinone, 0.05% tretinoin, and 0.01% flucinolone acetonide cream with GA peels in treatment of postacne hyperpigmentation, revealed that addition of GA peel with triple combination enhances the overall improvement in hyperpigmentation. ...
Article
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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.
... All the patients were applied with superficial peeling either commercially available or freshly prepared as standard method of application [15]. ...
... In a study conducted by Manuskiatti et al. 8 with FCO 2 on acne scars at 6 month follow up , 85% patients reported 25-50% improvement and mild PIH as most common side effect. Garg et al. 11 study showed percentage improvement in ice pick scars (week 0 to week 24) was 13.2% with SMP. Improvement in boxcar scars was 23.3%. ...
... 36 Many clinical studies have demonstrated the efficacy of improving PIH with chemical peels in patients with SOC. 52 A study of 44 Indian individuals with facial acne, postacne scarring and PIH were divided into two groups who received six peels of either GA 35% or SA 20%-mandelic acid (MA) 10% at 2-week intervals. Both peels led to a highly significant reduction and improvement in the total acne score (GA 27.3% versus SA-MA 52.3%) as well as in post-acne hyperpigmentation (GA 46.3% versus SA-MA 59.8%). ...
Article
Acne vulgaris is a prevalent dermatological condition worldwide but is especially challenging to treat in individuals with skin of colour (SOC). Corresponding to Fitzpatrick skin phototypes III-VI, people of African, Asian, Middle Eastern and Hispanic ethnicity are considered to have SOC. With the additional risk of postinflammatory hyperpigmentation (PIH) as a consequence of inflammatory acne or its respective treatment, managing acne in this population holds significant importance. PIH adversely impacts self-esteem and quality of life and, thus, is usually the patient's priority of treatment. Available acne treatments are similar for all skin types. However, some are more beneficial for individuals with SOC, in particular by targeting both active acne lesions and PIH. The acne treatment literature was searched for topical and systemic treatments that were specifically studied in the SOC population. These treatments included topical agents, such as retinoids and azelaic acid, in addition to topical antibiotics and benzoyl peroxide. Newer formulations and combined regimens reported effective in reducing lesions are less likely to induce PIH and may treat pre-existing PIH. Moisturiser use, titrating doses and patient education are strategies to minimize irritation and improve adherence. In addition, systemic therapies, including oral antibiotics, isotretinoin, oral contraceptives and spironolactone, are efficacious for refractory acne or more severe cases but specific studies in SOC are lacking. Chemical peels may improve acne and target PIH directly. Overall, based on limited evidence, topical and systemic therapies are well tolerated in the SOC population but efficacy should be balanced with the risk of adverse effects. This narrative review aims to highlight formulations and combination therapies that are effective and safe for treating acne and PIH in patients with SOC.
... 3,[7][8][9][10][11][12] Application of superficial combination peels, such as salicylic-mandelic acid peels (SMPs) and retinoic acid-glycolic acid (RAGA) peels, have shown to be even more effective for treating acne scars when compared to chemical peels used as monotherapies. 13,14 Combining Jessner's peel or glycolic acid with 35% TCA can further enhance penetration to treat more severe acne scars, effectively serving as an enhanced medium-depth peel. 15,16 Due to their limited depth of penetration, superficial and medium-depth peels have largely been limited to mild atrophic scarring or acne-related hyperpigmentation. ...
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Curtis Tam,1 Jeffrey Khong,1 Kevin Tam,1 Ruslan Vasilev,1 Wesley Wu,2 Salar Hazany1 1Salar Hazany M.D. Inc, Beverly Hills, CA, USA; 2Department of Dermatology, Veterans Affairs Medical Center, Seattle, WA, USACorrespondence: Curtis Tam, Salar Hazany M.D. Inc, Beverly Hills, CA, USA, Tel +1 310 571 8435, Fax +1 855 569 5698, Email drsalar@hazanyderm.comAbstract: Scarring is a dire consequence of acne vulgaris. Particularly, atrophic acne scarring is highly prevalent among young adults, and its physical and psychological effects can persist throughout their lives if left untreated. This literature review will analyze various non-energy-based approaches to treating atrophic acne scarring, emphasizing recent advances within the last 5 to 10 years. To accomplish this, we performed a PubMed search for various acne scar treatments such as chemical peels, dermabrasion, microdermabrasion, subcision, microneedling, punch techniques, dermal fillers, and thread lifting. Our findings and analysis show that there is no panacean solution to treating atrophic acne scars, which explains the evolving trend towards developing unique combinatorial treatments. Although a fair comparison of each treatment approach is difficult to achieve due to the studies’ varying sample sizes, strength of evidence, treatment execution, etc, there still remains a level of consensus on what treatments are well suited for particular scar types.Keywords: TCA, subcision, microdermabrasion, microneedling, fillers, excision
... In the last 30 years different authors proposed and demonstrated the safety of 30/50% mandelic acid in active and chronic scars, dyschromia and photoaging with high percentage of success [42][43][44]. ...
... Comparison of GA peels with other methods: In the study of Garg et al., 18 the efficacy and tolerance of 35% GA peel and 20% SA-10% mandelic acid (SMP) peel in active acne were compared. Although SMP had better results on post-acne scars, active acne, and postacne pigmentation at the end of the study, 35% GA and SMP both showed comparable and significant improvement in PIH after acne. ...
Article
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.
Chapter
Peelings are one of the oldest and most widespread cosmetic procedures worldwide and became very popular among dermatologists. Superficial chemical peels, also called “refreshening peels” or “light peels,” are defined by the application of one or more agents to the skin aiming a mild desquamation. Superficial peelings are safe and suitable for the face and, some of them, also for any part of the body. In recent years several new superficial peelings were developed. They usually combine alpha hydroxy acids or retinoic acid and other depigmenting agents. In this chapter we are going to discuss peeling’s classification, its indications, the procedure, side effects, and its management.
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Familial dyskeratotic comedones is an inherited disorder with characteristic clinical features characterized by disseminated, hyperkeratotic papules and comedones with evidence of dyskeratosis on histopathology. In the light of unrewarding treatment and rarity of this entity, herein we report this rare disorder in a female patient having positive family history.
Chapter
Chemical peels have always been the most economical therapeutic modality for skin rejuvenation and classified as superficial, medium, or deep based on their depth of penetration into the epidermis and dermis. Non-facial chemical peelings are best confined to light to medium peels because of the paucity of adnexal structures. These regimens of light to medium peels may yield significant improvement but must be performed conservatively and serially over time until results are satisfactory. The results are heavily dependent on concentration, contact time with the skin, and the manner of prepeel preparation. Deeper peels confer the risk of scarring, dyschromia, creation of a demarcation line between the treated and untreated area, and prolonged erythema.
Chapter
Chemical peel, which is also known as chemical exfoliation, consists on the application of one or more exfoliating skin agents, leading to the destruction of some layers of the epidermis or dermis, followed by the regeneration of the skin. Different substances are used to promote chemical exfoliation, and they should be chosen according to the skin phototypes, to the area, and to the dermatoses to be treated. Usually chemical peels promote skin rejuvenation through the improvement of the skin texture, fine lines, and pigmentation. It can also reduce actinic keratosis and some superficial scars. In this chapter, we are going to discuss different types of peels, mechanism of action, steps of the procedures, indications and contraindication, side effects, and its management.
Chapter
Chemical peel, which is also known as chemical exfoliation, consists on the application of one or more exfoliating skin agents, leading to the destruction of some layers of the epidermis or dermis, followed by the regeneration of the skin. Different substances are used to promote chemical exfoliation, and they should be chosen according to the skin phototypes, to the area, and to the dermatoses to be treated. Usually chemical peels promote skin rejuvenation through the improvement of the skin texture, fine lines, and pigmentation. It can also reduce actinic keratosis and some superficial scars. In this chapter, we are going to discuss different types of peels, mechanism of action, steps of the procedures, indications and contraindication, side effects, and its management.
Chapter
Chemical peels are an increasingly popular method for skin rejuvenation and removal of hyperpigmentation. In skin of color, superficial to medium-depth peels are most typically used to reduce the risk of scarring and dyspigmentation. Common peeling agents include alpha-hydroxy acids, beta-hydroxy acids, trichloroacetic acid, Jessner’s solution, and retinoids. Taking into account the patient’s phototype, race, ethnicity, treatment indication, and response to prior procedures, clinicians can carefully choose a peeling agent with appropriate titration concentrations to maximize clinical benefit while minimizing the risk of complications.
Chapter
Chemical peels have always been the most economical therapeutic modality for skin rejuvenation and classified as superficial, medium, or deep based on their depth of penetration into the epidermis and dermis. Non-facial chemical peelings are best confined to light to medium peels because of the paucity of adnexal structures. These regimens of light to medium peels may yield significant improvement but must be performed conservatively and serially over time until results are satisfactory. The results are heavily dependent on concentration, contact time with the skin, and the manner of prepeel preparation. Deeper peels confer the risk of scarring, dyschromia, creation of a demarcation line between the treated and untreated area, and prolonged erythema.
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Acne vulgaris is an extremely common condition affecting the pilosebaceous unit of the skin and characterized by presence of comedones, papules, pustules, nodules, cysts, which might result in permanent scars. Acne vulgaris commonly involve adolescents and young age groups. Active acne vulgaris is usually associated with several complications like hyper or hypopigmentation, scar formation and skin disfigurement. Previous studies have targeted the efficiency and safety of local and systemic agents in the treatment of active acne vulgaris. Superficial chemical peeling is a skin-wounding procedure which might cause some potentially undesirable adverse events. This study was conducted to review the efficacy and safety of superficial chemical peeling in the treatment of active acne vulgaris. It is a structured review of an earlier seven articles meeting the inclusion and exclusion criteria. The clinical assessments were based on pretreatment and posttreatment comparisons and the role of superficial chemical peeling in reduction of papules, pustules and comedones in active acne vulgaris. This study showed that almost all patients tolerated well the chemical peeling procedures despite a mild discomfort, burning, irritation and erythema have been reported; also the incidence of major adverse events was very low and easily manageable. In conclusion, chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in active acne vulgaris while salicylic acid peels is a more convenient for treatment of darker skin patients and it showed significant and earlier improvement than glycolic acid
Article
Acne vulgaris is an extremely common condition affecting the pilosebaceous unit of the skin and characterized by presence of comedones, papules, pustules, nodules, cysts, which might result in permanent scars. Acne vulgaris commonly involve adolescents and young age groups. Active acne vulgaris is usually associated with several complications like hyper or hypopigmentation, scar formation and skin disfigurement. Previous studies have targeted the efficiency and safety of local and systemic agents in the treatment of active acne vulgaris. Superficial chemical peeling is a skin-wounding procedure which might cause some potentially undesirable adverse events. This study was conducted to review the efficacy and safety of superficial chemical peeling in the treatment of active acne vulgaris. It is a structured review of an earlier seven articles meeting the inclusion and exclusion criteria. The clinical assessments were based on pretreatment and posttreatment comparisons and the role of superficial chemical peeling in reduction of papules, pustules and comedones in active acne vulgaris. This study showed that almost all patients tolerated well the chemical peeling procedures despite a mild discomfort, burning, irritation and erythema have been reported; also the incidence of major adverse events was very low and easily manageable. In conclusion, chemical peeling with glycolic acid is a well-tolerated and safe treatment modality in active acne vulgaris while salicylic acid peels is a more convenient for treatment of darker skin patients and it showed significant and earlier improvement than glycolic acid.
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Early rapid treatment of acne vulgaris is mandatory for improving the psychological behavior of acne patients and to avoid the occurrence of post acne scars that are still more frustrating and challenging condition in their treatment up till now. The current first line of treatment of acne vulgaris is the conventional pharmacological therapy including; keratolytics, topical or oral antibiotics, retinoids, and hormonal agents. Meanwhile, the use of this pharmacological therapy is not always beneficial because of poor compliance of the patients, occurrence of side effects of drugs and antibiotic resistance to Cutibacterium (C.) acne with high rate of recurrence. Therefore, non-pharmacological treatment is developed as safe and effective options for treating acne vulgaris. They are applied either as independent treatment modality, an adjunct to pharmacological therapy, or as maintenance therapy. There is no sufficient data on the classification of this treatment category. This review discusses the non-pharmacological therapy in management of acne vulgaris besides efficacy and safety of each type of treatment modality. The most commonly applied non-pharmacological therapies are diet control, counseling, dermocosmetics, comedo extraction, chemical peeling, cryotherapy, chemical peels, platelets rich plasma (PRP), botulinum neurotoxin A (BoNTA), light-based therapy and laser and photodynamic therapy (PDT). Regarding lasers and light sources, they can be subclassified according to their mechanism of action into devices targeting levels of C. acnes , function of the sebaceous unit, or both.
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Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.
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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of interventions for treating facial acne scars.
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Background: Multiple approaches are used to treat acne scars, but some are expensive, ineffective, and cause complications. We aimed to evaluate the efficacy and safety of ultra-pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid in the treatment of acne scars in a prospective split-face control study. Methods: Twenty patients with facial symmetrical acne scars were enrolled. One side of face was randomly treated with 30% supramolecular salicylic acid, and two sides were treated with ultra-pulsed CO2 fractional laser. The Echelle d'evaluation clinique des cicatrices d'acne (ECCA) scale was used to evaluate the clinical efficacy before and three months after treatment, and a quartile scale was used to self-evaluate the improvement of patients. A visual analog scale was used to record pain scores after each treatment, and side effects and other adverse reactions on the face were recorded. Results: All the patients completed treatment and follow-up. There was statistical difference in ECCA scores of bilateral facial acne scars after three treatments (P<0.001). ECCA scores on the combined side were lower after three treatments than those on the laser side (P=0.003). The patient satisfaction quartile scale on the combined side was higher than that on the laser side alone (P=0.015). Conclusion: Ultra-pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid has better efficacy in the treatment of acne scars than laser alone, and patient self-assessment of combined treatment has a greater degree of improvement in acne scars, and does not increase patient pain scores and related adverse reactions. This article is protected by copyright. All rights reserved.
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Background: Acne scar is one of the most common skin diseases, and although there are many treatments available, these treatments have complications and problems. Therefore, in this study, we aimed to investigate the effectiveness of acne scar pealing with salicylic acid 30% in polyethylene glycol vehicle. Methods: In this randomized clinical trial study, 32 patients with scar following acne that did not respond to medication therapy were included. Patients were divided into two groups of placebo (not treated with peeling and received only medication) and intervention (under peeling with 30% salicylic acid at polyethylene glycol vehicle for 4 sessions over a period of 6 weeks). Weighing the severity of their lesions was done before the intervention, using weighted scale, and after treatment using the quartile grading scale. Findings: There was no significant difference in the depth of the weighted scale before the intervention between the two groups (P = 0.37). After intervention, there was a significant difference between the two groups based on quartile grading scale, so that the recovery rate in the intervention group was better than placebo (P = 0.01). In the intervention group, 25% of the patients had at least one drug complication that had a significant difference with placebo group (P = 0.03). Conclusion: Salicylic acid is not only effective in the treatment of acne, but has also been used to improve the acne scar.
Chapter
Superficial skin resurfacing is a process causing controlled injury to the epidermis. Processes can be chemical or mechanical and classified as laser or nonlaser. Although our armamentarium for skin resurfacing ranges from topical medicaments to ablative lasers, superficial skin resurfacing with chemical peels and microdermabrasion (MDA) has maintained its popularity. These well-established therapies have proven safe and effective, offer minimal risk, low cost, and are well-tolerated by patients often with little to no post-procedure downtime. Potential benefits extend to all Fitzpatrick skin types and if done appropriately are highly unlikely to cause significant dyspigmentation or scarring. Indications for treatment are acne vulgaris, rosacea, post-inflammatory hyperpigmentation, melasma, and photodamage including lentigines, fine rhytides, and actinic keratoses. Superficial resurfacing with chemical peels or MDA can be used in combination with other therapies (e.g., laser) and may enhance the efficacy of other topical treatments. A superficial depth of penetration may be of significant benefit to the patient but does have limitations. It is important for patients to understand the likely need for a series of treatments, the importance of pre- and post-care regimens, and expected outcomes.
Article
Background: Glycolic acid (GA) and salicylic acid (SA) peels have been used separately for acne treatment, not as a sequential peel. Aim: To evaluate the efficacy and safety of sequential peeling with 70% GA and 20% SA as a monotherapy and as an adjuvant to systemic doxycycline in treatment of mild to moderate acne and the effect on serum interleukin (IL) 17 and tissue IL-1α. Patients/methods: Forty-five mild to moderate acne vulgaris patients were randomly assigned into three groups. Group [A] underwent sequential application of 70% GA followed by 20% SA biweekly for three months. Group [B] underwent sequential peeling and doxycycline PO100 mg BD for 1 month followed by 100 OD for 2 months. Group [C] received oral doxycycline. Acne grading, lesion counting, and patient satisfaction were assessed. Serum samples and perilesional skin biopsies were obtained at onset and 2 weeks after finishing the treatment for assessment of serum IL-17 and tissue IL-1α. Results: All groups showed statistically significant decrease in acne grading and lesion count, increase in patient satisfaction, and decrease in serum IL-17 and tissue IL-1 α after treatment. There was no significant difference between the 3 groups before or after treatment, except regarding patient satisfaction after treatment, which was significantly higher in groups [A] and [B] than group [C] (P = .001). Conclusions: This study recommends using sequential GA 70% and SA 20% peels in the treatment of mild or moderate acne vulgaris as a new cost-effective mode, with low-down time and potential safety, in noncompliant patients on medical therapy.
Article
Background: Depending on disease severity, standard acne treatments can vary from topical to systemic therapy. However, poor compliance caused by adverse events and antibiotic resistance is a major cause of treatment failure. Aims: To determine the effectiveness of photodynamic therapy (PDT) with intense pulsed light (IPL) in the treatment of acne when combined with a cream containing licochalcone A, L-carnitine and decanediol (so-called, 'active formulation') versus PDT alone. Patients/methods: Twenty-nine volunteers, aged 21-39 years (26 women and 3 men, mean age 29.41 ± 5.24 years), with mild to severe facial acne, were enrolled. Each subject's face sides were randomized in a split-face manner to either receive PDT (IPL with a 400-720 nm cut-off filter, at 4 sessions with two-week intervals) combined with the active formulation cream twice daily for 10 weeks on one face side; or PDT and the vehicle cream on the other side, with the same treatment protocol. Reduction in acne quantity, melanin index and erythema index were assessed 2 weeks after the second treatment (day 28), 1 week after the fourth treatment (day 49), and 1 month after the fourth treatment (day 70). Results: Compared to baseline, patients in the active formulation group demonstrated a faster onset of reduction in the number of lesions at 2 weeks after the second treatment (p=0.010 for inflammatory acne and p=0.001 for non-inflammatory acne). A significantly greater reduction in lesion count was observed in the active formulation group compared with the vehicle group at all timepoints of evaluation for noninflammatory acne (day 28, day 49, and day 70; p=0.003, 0.005 and 0.002 respectively), and at 1 month after the fourth treatment for inflammatory acne (p=0.036). Compared to the vehicle group, the melanin index of the active formulation group decreased significantly at 1 month after the fourth treatment (p=0.015). Conclusion: PDT is more effective in treating acne when combined with a topical cream containing licochalcone A, L-carnitine and decanediol, than PDT alone. Significant acne reduction and improvements in post-inflammatory hyperpigmentation were observed, which offers acne patients a better therapeutic option. It is a safe and effective combination treatment for patients with moderate and severe acne.
Article
Mandelic acids are valuable products which are used in a broad field of applications. The enzyme hydroxymandelate synthase (HMS) is a non-heme iron dioxygenase which converts para-hydroxyphenylpyruvate and other 3-aryl pyruvates by decarboxylation to the corresponding mandelates. In the present work, the gene hms encoding the hydroxymandelate synthase from Amycolatopsis mediterranei was cloned and overexpressed in Escherichia coli BL21(DE3) for in vivo cascade catalysis taking advantage of resident aromatic amino acid transaminases. The resulting recombinant cells were used for whole cell biotransformations. We successfully accomplished the production of para-hydroxymandelate exclusively by using the aromatic amino acid l-tyrosine in biotransformation. Furthermore, by utilizing different phenylalanine derivatives (including chloro-, fluoro- and hydroxylated amino acids), the corresponding S-mandelic acids were obtained with high conversion (21–87 %) and high ee (38–97%). This process is an alternative and attractive way to get access to a variety of mandelic acids.
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Background: Acne is an inflammatory disorder with a high global burden. It is common in adolescents and primarily affects sebaceous gland-rich areas. The clinical benefit of the topical acne treatments azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, and alpha-hydroxy acid is unclear. Objectives: To assess the effects of topical treatments (azelaic acid, salicylic acid, nicotinamide, zinc, alpha-hydroxy acid, and sulphur) for acne. Search methods: We searched the following databases up to May 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers. Selection criteria: Clinical randomised controlled trials of the six topical treatments compared with other topical treatments, placebo, or no treatment in people with acne. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Key outcomes included participants' global self-assessment of acne improvement (PGA), withdrawal for any reason, minor adverse events (assessed as total number of participants who experienced at least one minor adverse event), and quality of life. Main results: We included 49 trials (3880 reported participants) set in clinics, hospitals, research centres, and university settings in Europe, Asia, and the USA. The vast majority of participants had mild to moderate acne, were aged between 12 to 30 years (range: 10 to 45 years), and were female. Treatment lasted over eight weeks in 59% of the studies. Study duration ranged from three months to three years. We assessed 26 studies as being at high risk of bias in at least one domain, but most domains were at low or unclear risk of bias. We grouped outcome assessment into short-term (less than or equal to 4 weeks), medium-term (from 5 to 8 weeks), and long-term treatment (more than 8 weeks). The following results were measured at the end of treatment, which was mainly long-term for the PGA outcome and mixed length (medium-term mainly) for minor adverse events. Azelaic acid In terms of treatment response (PGA), azelaic acid is probably less effective than benzoyl peroxide (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.72 to 0.95; 1 study, 351 participants), but there is probably little or no difference when comparing azelaic acid to tretinoin (RR 0.94, 95% CI 0.78 to 1.14; 1 study, 289 participants) (both moderate-quality evidence). There may be little or no difference in PGA when comparing azelaic acid to clindamycin (RR 1.13, 95% CI 0.92 to 1.38; 1 study, 229 participants; low-quality evidence), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). Low-quality evidence indicates there may be no differences in rates of withdrawal for any reason when comparing azelaic acid with benzoyl peroxide (RR 0.88, 95% CI 0.60 to 1.29; 1 study, 351 participants), clindamycin (RR 1.30, 95% CI 0.48 to 3.56; 2 studies, 329 participants), or tretinoin (RR 0.66, 95% CI 0.29 to 1.47; 2 studies, 309 participants), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). In terms of total minor adverse events, we are uncertain if there is a difference between azelaic acid compared to adapalene (1 study; 55 participants) or benzoyl peroxide (1 study, 30 participants) (both very low-quality evidence). There may be no difference when comparing azelaic acid to clindamycin (RR 1.50, 95% CI 0.67 to 3.35; 1 study, 100 participants; low-quality evidence). Total minor adverse events were not reported in the comparison of azelaic acid versus tretinoin, but individual application site reactions were reported, such as scaling. Salicylic acid For PGA, there may be little or no difference between salicylic acid and tretinoin (RR 1.00, 95% CI 0.92 to 1.09; 1 study, 46 participants; low-quality evidence); we are not certain whether there is a difference between salicylic acid and pyruvic acid (1 study, 86 participants; very low-quality evidence); and PGA was not measured in the comparison of salicylic acid versus benzoyl peroxide. There may be no difference between groups in withdrawals when comparing salicylic acid and pyruvic acid (RR 0.89, 95% CI 0.53 to 1.50; 1 study, 86 participants); when salicylic acid was compared to tretinoin, neither group had withdrawals (both based on low-quality evidence (2 studies, 74 participants)). We are uncertain whether there is a difference in withdrawals between salicylic acid and benzoyl peroxide (1 study, 41 participants; very low-quality evidence). For total minor adverse events, we are uncertain if there is any difference between salicylic acid and benzoyl peroxide (1 study, 41 participants) or tretinoin (2 studies, 74 participants) (both very low-quality evidence). This outcome was not reported for salicylic acid versus pyruvic acid, but individual application site reactions were reported, such as scaling and redness. Nicotinamide Four studies evaluated nicotinamide against clindamycin or erythromycin, but none measured PGA. Low-quality evidence showed there may be no difference in withdrawals between nicotinamide and clindamycin (RR 1.12, 95% CI 0.49 to 2.60; 3 studies, 216 participants) or erythromycin (RR 1.40, 95% CI 0.46 to 4.22; 1 study, 158 participants), or in total minor adverse events between nicotinamide and clindamycin (RR 1.20, 95% CI 0.73 to 1.99; 3 studies, 216 participants; low-quality evidence). Total minor adverse events were not reported in the nicotinamide versus erythromycin comparison. Alpha-hydroxy (fruit) acid There may be no difference in PGA when comparing glycolic acid peel to salicylic-mandelic acid peel (RR 1.06, 95% CI 0.88 to 1.26; 1 study, 40 participants; low-quality evidence), and we are uncertain if there is a difference in total minor adverse events due to very low-quality evidence (1 study, 44 participants). Neither group had withdrawals (2 studies, 84 participants; low-quality evidence). Authors' conclusions: Compared to benzoyl peroxide, azelaic acid probably leads to a worse treatment response, measured using PGA. When compared to tretinoin, azelaic acid probably makes little or no difference to treatment response. For other comparisons and outcomes the quality of evidence was low or very low. Risk of bias and imprecision limit our confidence in the evidence. We encourage the comparison of more methodologically robust head-to-head trials against commonly used active drugs.
Article
Objective: The effects of topical azelaic acid, salicylic acid, nicotinamide, sulfur, zinc, and fruit acid (alpha-hydroxy acid) for acne are unclear. We aimed to assess the effects of these topical treatments by collecting randomized controlled trials. Methods: We searched The Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS up to May 2019. We also searched five trials registers. Two review authors independently extracted data and assessed risk of bias. Meta analyses were performed by using Review Manager 5 software. Results: We included a total of 49 trials involving 3880 participants. In terms of treatment response (measured using participants' global self-assessment of acne improvement, PGA), azelaic acid was probably less effective than benzoyl peroxide (RR = 0.82, 95% CI 0.72-0.95). However, there was probably little or no difference in PGA when comparing azelaic acid to tretinoin (RR = 0.94, 95% CI 0.78-1.14). There may be little or no difference when comparing salicylic acid to tretinoin (RR = 1.00, 95% CI 0.92-1.09). There were no studies measured PGA when evaluating nicotinamide. With respect to alpha-hydroxy acid, there may be no difference in PGA when comparing glycolic acid to salicylic-mandelic acid (RR = 1.06, 95% CI 0.88-1.26). We were uncertain about the effects of sulfur and zinc. Adverse events associated with these topical treatments were always mild and transient. Conclusions: Moderate-quality evidence was available for azelaic acid and low- to very-low-quality evidence for other topical treatments. Risk of bias and imprecision limit our confidence in the evidence.
Article
Pigmentary disorders and hyperpigmentation are widespread. Dark skin types in particular show a tendency to formation of melasmas and to hyperpigmentation. Light skin types have a tendency to ephelides and solar lentigines. In addition to topical treatment with lightening substances, superficial chemical peeling as well as combined procedures of topical treatment with chemical peeling play an important role in the treatment of hyperpigmentation. A strict avoidance of UV light and consequent daily application of sun protectíon factor 50+ are mandatory for successful treatment.
Chapter
Common inflammatory disorders of the skin may have unique morphologies and clinical or therapeutic considerations in individuals with skin of color. These include acne vulgaris, atopic dermatitis, and seborrheic dermatitis. In addition, several multi-system inflammatory disorders with cutaneous manifestations – such as lupus erythematosus, dermatomyositis, and scleroderma – are more prevalent in populations of African ancestry. Recognizing racial/ethnic variations in the clinical presentation and approach to treatment of these disorders is key to optimizing patient outcomes.
Article
Background Acanthosis nigricans (AN) is a common dermatosis that presents with hyperpigmented, velvety thick plaques over intertriginous areas. Though a number of treatment modalities including chemical peels have been used, none provide long-term and sustained improvement. Aim and objectives Our study evaluated the efficacy and safety of regular sessions of salicylic acid-mandelic acid peeling over axillary AN lesions, which was followed by daily application of a topical combination of glycolic acid, urea, and cetylated fat esters for maintenance of effect for 9 months. Methodology A retrospective pilot study was conducted in Indian patients (Fitzpatrick skin type 4 or 5), aged 18–50 with benign hereditary AN involving the underarms, with or without affection of other typical sites. Data were retrieved of seventeen patients with AN involving the axillae. Patients were started on combination salicylic-mandelic acid peel given every 2 weeks for a total of 6 sessions. Maintenance was done by night application of combination cream of glycolic acid, urea, and cetylated fat esters, which was continued for 9 months after completion of peeling sessions. Lesions were evaluated every 3 months of 9 months for improvement in pigmentation and skin thickening. Results All the patients (100%) showed significant improvement in both pigmentation and thickening of lesions. In terms of improvement in skin thickening, very good improvement was seen in 41%, while 29% patients had moderate improvement. In terms of improvement in pigmentation, 35% each had very good and moderate improvement. Post peel erythema (100%) and burning sensation (90%) were the most common encountered adverse effects which lasted for only 1–2 days. Patients were followed up for another 9 months during which no relapses were seen. Conclusion Combination of keratolytic chemical peels and topical mild keratolytic application ensures better therapeutic outcome in patients of AN with long lasting effect.
Article
Post‐inflammatory hyperpigmentation (PIH) is a common cosmetic complaint affecting patient quality of life. PIH has been proven to disproportionately affect skin of color. While several treatment options exist, special consideration must be given when managing PIH in patients of color, as topical treatments and aesthetic procedures, such as chemical peels and lasers, may either exacerbate or prove ineffective against PIH.
Article
Pigmentary disorders and hyperpigmentation are widespread. Dark skin types in particular show a tendency to formation of melasmas and to hyperpigmentation. Light skin types have a tendency to ephelides and solar lentigines. In addition to topical treatment with lightening substances, superficial chemical peeling as well as combined procedures of topical treatment with chemical peeling play an important role in the treatment of hyperpigmentation. A strict avoidance of UV light and consequent daily application of sun protectíon factor 50+ are mandatory for successful treatment.
Article
Chemical peeling is a widely used procedure in the management of acne and acne scars. It causes controlled destruction of a part or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. The most frequently used peeling agents are salicylic acid (SA), glycolic acid (GA), pyruvic acid (PA), lactic acid (LA), mandelic acid (MA), Jessner's solution (JS), trichloroacetic acid (TCA), and phenol. Choosing the appropriate peel is based on patient's skin type, the acne activity and the type of acne scars. Combination peels minimize side effects. In acne scars, chemical peels may be combined with other procedures in order to achieve better clinical results. A series of chemical peels can give significant improvement over a short period of time, leading to patient satisfaction and maintenance of clinical results.
Article
BACKGROUND Patients with skin of color demand treatment modality suitable for their skin. Salicylic acid peel has effectiveness for both of acne and postinflammatory hyperpigmentation that are common in patients with skin of color. OBJECTIVE To assess the whitening effect of salicylic acid peels in Asian patients with acne objectively by the colorimetric method. METHODS Twenty-four healthy adult patients with acne participated voluntarily in the study. Any other systemic and topical acne treatments were prohibited. They had undergone full-face peels with 30% salicylic acid in absolute ethanol bi-weekly for 3 months. Colorimetric changes of the face were recorded with reflectance spectrophotometer. RESULTS Paired comparisons with pretreatment CIE L*a*b* showed abrupt descent of L* value after first peel (p=.0286). Then there was continued increase of mean L* value, even though the final L* value did not reach a statistically significant level. The mean a* value decreased continually, and the a* values recorded after the second, third, fourth, fifth, and final peel showed significantly lowered levels (p=.0027,.0005, <.0001, <.0001, <.0001). CONCLUSION Salicylic acid peels are beneficial in whitening the face of Asian patients with acne. The whitening effect would be an important factor in choosing the superficial peeling agent for them.
Article
• The effects of oral zinc sulfate (corresponding to 135 mg of zinc daily) alone and in combination with vitamin A (300,000 international units) daily on acne lesions have been compared with those of vitamin A alone and of a placebo. The number of comedones, papules, pustules, and infiltrates were counted at each visit. After four weeks, there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. The effect of zinc plus vitamin A was not better than zinc alone. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The mechanism for the effect of zinc therapy in acne, to our knowledge, is not presently known. (Arch Dermatol 113-31-36, 1977)
Article
The effects of oral zinc sulfate (corresponding to 135 mg of zinc daily) alone and in combination with vitamin A (300,000 international units) daily on acne lesions have been compared with those of vitamin A alone and of a placebo. The number of comedones, papules, pustules, and infiltrates were counted at each visit. After four weeks, there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. The effect of zinc plus vitamin A was not better than zinc alone. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The mechanism for the effect of zinc therapy in acne, to our knowledge, is not presently known.¿
Article
This investigation was prompted by our ignorance of the way in which salicyclic acid aids desquamation. Salicyclic acid in aqueous cream or white soft paraffin and in concentrations of 2-12% was applied to normal skin of twenty-three subjects while the vehicle alone was applied to the contralateral sites. Biopsies and skin surface biopsies were taken from the test and control sites after 1 week. Histological examination showed that there was less horny layer on the test specimens but that there were no qualitative or quantitative differences in the structure of the viable epidermis. Portions of the biopsies were incubated in the presence of tritiated precursor compounds and subsequent autoradiographic examination showed no difference in the incorporation of thymidine, cytidine or histidine between test and control preparations. Scanning electron microscopy of skin surface biopsies showed some changes in all specimens--presumably due to hydration--but also showed striking differences between test and control sites and were especially marked with higher concentrations of salicylic acid. It is suggested that salicylic acid causes desquamation by dissolution of intercellular cement material.
Article
In 1972, direct expenditures related to diseases of the skin and connective tissue accounted for approximately 2% of total national health expenditures (Tables XIII and XIV). Data for specific disease categories are not yet available for 1981. By extrapolation of the 2% of the 1972 expenditures to 2% of the 1981 expenditures ($255 billion), the corresponding 1981 expenditure is set at $5.1 billion. By using the methods of a previous report, indirect morbidity losses are estimated to be $1.5 billion and mortality losses $204 million, a total of $6.8 billion as the annual cost of dermatologic disease in the U.S.
Article
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.
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
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.
Article
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.
Article
Acne is a common condition experienced by up to 80% of people between 11 and 30 years of age and by up to 5% of older adults. In some patients, the severe inflammatory response to Propionibacterium acnes results in permanent, disfiguring scars. Over the past several decades, numerous descriptive terms and surgical techniques have been used to diagnose the types, and improve the appearance, of scarring in those persons with acne. We propose a descriptive, simple, universally applicable acne scar classification system that includes 3 scar types: icepick, rolling, and boxcar. We also have developed an effective treatment algorithm for reconstructing and improving the appearance of acne scars including punch excision, punch elevation, subcutaneous incision (Subcision), and laser skin resurfacing. This new classification system for acne scars enables the physician to more precisely identify scar subtypes. Once the scar type has been defined, appropriate and effective treatment protocols can be developed.
Article
Melasma continues to be a difficult condition to treat, especially in dark-skinned patients, although various topical modalities including hydroquinone, tretinoin, and/or topical steroids have been used singly or in combination with variable results. To determine if serial glycolic acid peels provide additional improvement when combined with a time-tested topical regimen, a modification of Kligman's formula (hydroquinone 5%, tretinoin 0.05%, hydrocortisone acetate 1% in a cream base). All cases had epidermal melasma as detected by Wood's light examination. Forty Indian melasma patients were divided into two groups of 20 each. One group received serial glycolic acid peel combined with a topical regimen, modified Kligman's formula. The other, a control group, received only modified Kligman's formula. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 (before the fourth peel), and 21 (3 weeks after the sixth peel) weeks. For clinical evaluation, the Melasma Area and Severity Index (MASI) was used. A significant decrease in the MASI score from baseline to 21 weeks was observed in both groups (P <.001). The group receiving the glycolic acid peels showed a trend toward more rapid and greater improvement, with statistically significant results (P <.001). Only a few side effects were observed in the peel group. This study demonstrates that serial glycolic acid peels provide an additional effect to a topical regimen which is a modification of the time-tested Kligman's regimen for treating melasma in dark-complexioned individuals if used judiciously and under supervision. It demonstrates that superficial chemical peels are beneficial in the treatment of melasma.
Article
Acne vulgaris is a distressing condition related to the pilo sebaceous follicle and which is considered as an ‘adolescent’ disorder. It is characterized by spontaneous resolution in the late teens or early twenties in the majority of cases. The first publication about the epidemiology of acne was in 1931 by Bloch [1]. Already at this time, the onset of acne was noted slightly earlier in girls (12.1 ± 1.5) compared to boys (12.8 ± 1.7 years), retentional lesions being the earliest lesions (13&percnt; at 6 years and 32&percnt; at 7 years of age). Since this publication, no significant evolution has been noted concerning the age of onset of acne. According to different studies of the literature performed in different countries in the world, the mean onset of acne is 11 years in girls and 12 years in boys, remaining earlier in girls (1 or 2 years) with mainly retentional lesions (open and closed comedones). However, adult acne has also been described recently.
Article
Salicylic acid peels have been introduced as a useful modality in acne treatment. Few studies have examined its efficacy and safety, especially in darker skin. To assess the efficacy and safety of salicylic acid peels as a treatment for acne vulgaris in Asian patients. Thirty-five Korean patients with facial acne were treated with 30% salicylic acid peels biweekly for 12 weeks. Lesion counts and Dr. Cunliffe's score were assessed by a blinded evaluator. Safety assessments and patient's evaluations were also recorded. Both inflammatory and noninflammatory acne lesion counts were decreased in proportion to the duration of treatment. Dr. Cunliffe's acne grade was statistically significantly decreased after treatment. The side effects were tolerable in most cases, and all patients were pleased with their peel results. Stratum corneum hydration, skin surface lipid, skin pH, and transepidermal water loss were unchanged from baseline levels. Salicylic acid peels are an effective and safe therapy for acne vulgaris in Asian patients.
Article
Patients with skin of color demand treatment modality suitable for their skin. Salicylic acid peel has effectiveness for both of acne and postinflammatory hyperpigmentation that are common in patients with skin of color. To assess the whitening effect of salicylic acid peels in Asian patients with acne objectively by the colorimetric method. Twenty-four healthy adult patients with acne participated voluntarily in the study. Any other systemic and topical acne treatments were prohibited. They had undergone full-face peels with 30% salicylic acid in absolute ethanol bi-weekly for 3 months. Colorimetric changes of the face were recorded with reflectance spectrophotometer. Paired comparisons with pretreatment CIE L*a*b* showed abrupt descent of L* value after first peel (p=.0286). Then there was continued increase of mean L* value, even though the final L* value did not reach a statistically significant level. The mean a* value decreased continually, and the a* values recorded after the second, third, fourth, fifth, and final peel showed significantly lowered levels (p=.0027, .0005, <.0001, <.0001, <.0001). Salicylic acid peels are beneficial in whitening the face of Asian patients with acne. The whitening effect would be an important factor in choosing the superficial peeling agent for them.
Article
Chemical peeling or chemexfoliation has become increasingly popular in recent years for treatment of a number of cosmetic skin problems. Topical glycolic acid in the concentration of 10-30% for 3-5 minutes at fortnightly intervals was investigated as a therapeutic peeling agent in 41 patients having acne (39%), melasma (36.5%), post inflammatory hyperpigmentation (12%) and superficial scarring of varied etiology (12%). A final evaluation done at 16 weeks revealed that this modality is useful especially in superficial scarring and melasma, moderately successful in acne patients with no response in dermal pigmentation. No significant untoward effects were seen.
Article
Melasma continues to be a therapeutic challenge. 100 patients of melasma not responding to conventional depigmenting agents were divided into 2 groups, one treated with 55-75% glycolic acid (68 patients) and the other with 10-15% trichloroacetic acid (32 patients). Applications were made after every 15 days and response assessed clinically along with relapse or hyperpigmentation after 3 month follow up period. More than 75% improvement was seen in 30%, and 50-75% improvement in 24% patients. Response with TCA was more rapid as compared to GA. Chronic pigmentation responded more favourably to TCA. Relapse and hyperpigmentation was more-25% in TCA as compared to 5.9% GA. Sun exposure was the most important precipitating factor followed by pregnancy and drugs.
GA versus Jessner's solution
  • Kim SW
  • Moon SE
  • Kim JA
  • Kim SW
  • Moon SE
  • Kim JA
GA versus Jessner's solution: which is better for facial acne patients?
  • Sw Kim
  • Se Moon
  • Ja Kim
GA versus Jessner's solution
  • Kim