Available via license: CC BY-NC-SA 4.0
Content may be subject to copyright.
122 Medical Journal of Dr. D.Y. Patil University | July-December 2012 | Vol 5 | Issue 2
Address for correspondence:
Supriya P. Deshmukh, 401 - Gaurangi CHS, Opposite Damani Estate Post Office, L B S Marg, Thane (West) - 400601, Maharashtra, India.
E-mail: drsupriya.15@gmail.com
Introduction
Number of patients visiting dermatologists for prevention
and treatment of aging of skin is increasing day by day.
Many patients also seek advice from non-dermatologists
for the same; hence, the idea of our study was to sensitize
the physicians from other disciplines about the concept
and efficacy of chemical peeling. The most common
consequence of photo damage in the Indian skin is
hyperpigmentation, with other less common ones being
wrinkles, laxity, roughness, and telangiectasia.[1] The
concept of chemical peeling intends to improve the
Evaluation of efficacy of chemical peeling with glycolic
acid in hyperpigmentation disorders of the skin
Supriya P. Deshmukh, Nitin C. Chaudhari, Kedarnath Dash, Yugal K. Sharma, Kirti S. Deo
Department of Dermatology, Dr D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
ABSTRACT
Background: Chemical peeling entails application of chemical
agents to the skin causing a controlled chemical burn, thereby
achieving improved texture and quality of skin. Aim: To
evaluate the effi cacy of glycolic acid in melasma and other
causes of hyperpigmentation. Materials and Methods: A total
of 20 patients were included in the study. After adequate priming,
application of glycolic acid in various concentrations in biweekly
interval for a period of 16 weeks was done. Post-treatment
photographs were taken and were subjected to analysis. Results:
Melasma constituted 11 patients and hyperpigmentation, ie, post
acne marks and freckles due to sun exposure accounted nine
patients. Complete resolution of melasma was possible only
in one (9%) patient and good improvement in four (36.3%),
whereas fi ve (45.5%) patients showed fair improvement. In
cases of hyperpigmentation, three (33%) patients showed
excellent improvement, one (11%) showed good improvement,
and fi ve (55.5%) patients showed fair improvement. The patients
of melasma took an average of 7.33 number of peels to show
improvement and those of hyperpigmentation took 4.2 peels.
Conclusions: Melasma shows fair to good improvement and
requires more number of peels as compared to other causes of
hyperpigmentation in skin. Postinfl ammatory pigmentation
shows excellent improvement in the majority of patients.
Keywords: Chemical peeling, glycolic acid, melasma
Access this article online
Quick Response Code:
Website:
www.mjdrdypu.org
DOI:
10.4103/0975-2870.103335
Original Article
texture of the skin and lighten the complexion. In ancient
Egypt, Cleopatra used sour milk, now known to contain
lactic acid, which is an alpha hydroxy acid, while French
women used old wine containing tartaric acid to enhance
the appearance of their skin.[2] Chemical peeling is the
application of a chemical agent to the skin, which causes
controlled destruction of a part or entire epidermis, with
or without the dermis, leading to exfoliation, removal
of superfi cial lesions, followed by regeneration of new
epidermal and dermal tissues. Chemical peeling is a
common offi ce procedure that has evolved over the years,
using the scientifi c knowledge of wound healing after
controlled chemical skin injury.[3]
Chemical peeling has been classifi ed depending on the
level/depth achieved by the peeling agent. There are two
classifi cation systems as shown in Table 1.[2]
Materials and Methods
A total of 20 patients attending our outpatient department
in Dr. D. Y. Patil Hospital and Research Hospital, Pune,
with melasma and post-infl ammatory hyperpigmentation
were included in our study. Patients’ clinical details and
the nature and severity of lesions were noted. Clinical
photographs were taken at week 0 (baseline) and week 16
(completion of study).
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 86.82.50.232]
Medical Journal of Dr. D.Y. Patil University | July-December 2012 | Vol 5 | Issue 2 123
Deshmukh, et al.: Glycolic acid in hyperpigmentation disorders
Following an informed consent for the procedure and
clinical photographs, a test peel was done and all patients
were primed with tretinoin cream (0.025%) and a broad-
spectrum sunscreen for a total of two weeks. Serial glycolic
acid (GA) peels were then undertaken at fortnightly
intervals. Superfi cial chemical peels (up to the level of
stratum granulosum) were attempted according to Brody’s
and Mark Rubin’s classifi cation. We started with 35% GA
for a period of 1-2 minutes, serially increasing the duration
and concentration of 50% GA for fi ve minutes was used. All
patients were advised total sun protection with a broad-
spectrum sunscreen. Side effects, if any, were also recorded.
At 16 weeks, the patients were evaluated and the response to
therapy was graded on a fi ve-point scale as excellent (>80%
improvement), good (50-80%), fair (<50%), and no change
or worse. The fi nal assessment was recorded on the basis of
the opinion of the clinician, perception of the patient, and
photographic analysis.
Results
Among 20 patients included in the study, 16 were female and
4 male. The patients were in the age group of 16-56 years.
Melasma constituted 11 patients and hyperpigmentation, ie,
post acne marks and freckles due to sun exposure, accounted
nine patients. Complete resolution of melasma was possible
only in one patient (9%) [Figures 1a and b] and good
improvement in four (36.3%), while fi ve (45.5%) patients
showed fair improvement. In cases of hyperpigmentation,
three (33%) patients [Figures 2a and b] showed excellent
improvement, one (11%) showed good improvement, and
fi ve (55.5%) patients showed fair improvement [Table 2].
The patients with melasma took an average of 7.33
number of peels to show improvement and those with
hyperpigmentation took 4.2 number of peels [Table 3].
No side effects were encountered. Better skin texture and
smoothness was found in all patients who underwent peeling.
Discussion
Glycolic acid is an alpha hydroxy acid derived from
sugarcane. Glycolic acid is one of the most commonly used
and versatile peeling agents. It has been used in various skin
disorders, including disorders of keratinisation apart from
common skin problems such as pigmentary changes (post-
infl ammatory hyperpigmentation, melasma), acne, wrinkles,
warts, actinic and seborrheic keratoses, etc, with the most
common indication being skin rejuvenation.[4]
Melasma is a common disorder characterised by symmetric,
hyperpigmented patches with an irregular outline that occur
most commonly on the face.[5] Exacerbating factors include
pregnancy, oral contraceptives, and sun exposure.[5] Freckles
are hyperpigmented macules occurring on face mainly due
Table 1: Classifi cations pertaining to chemical peeling
Brody’s
classifi cation
Depth Mark
Rubin’s
classifi cation
Depth
Superficial Very light:
stratum
granulosum
Ver y
superficial
Stratum corneum
Light:
papillary
dermis
Intermediate Upper
reticular
dermis
Superficial Stratum
granulosum to
basal cell layer
Deep Mid-reticular
dermis
Medium Epidermis and
papillary dermis
Deep Epidermis +
papillary dermis
+ reticular dermis
Figure 1: Patient with melasma over forehead and malar area of face
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 86.82.50.232]
124 Medical Journal of Dr. D.Y. Patil University | July-December 2012 | Vol 5 | Issue 2
Deshmukh, et al.: Glycolic acid in hyperpigmentation disorders
Figure 2: (a) Patient showing hyperpigmentation over bilateral nasolabial folds and forehead; (b) Excellent improvement in the pigmentation
with overall lightening of complexion
ab
Table 2: Number of patients with the skin condition and the percentage improvement obtained at the end of 16 weeks
Disease Total number >80% improvement 50-80% improvement <50% improvement No improvement
Melasma 11 1 (9.09%) 4 (36.36%) 5 (45.45%) 0
Hyperpigmentation 09 3 (33.33%) 1 (11.11) 5 (55.55%) 0
Table 3: Range of number of peels required for patients of melasma
and hyperpigmentation and the average amount of peels required to
improve the same
Condition Range for number of peels Average
Melasma 6-8 7.33
Hyperpigmentation 3-8 4.2
to sun exposure in fair-skinned individuals.[6] Acne vulgaris
on resolution can leave hyperpigmented spots, especially
in dark-skinned individuals, they may be aggravated due
to sun exposure.[7] Pigmentation on face is of great concern
cosmetically; hence, large numbers of affected individuals
seek treatment for it.
In our study on patients of melasma, a majority of patients
(81.82%) had good to fair improvement, which is in agreement
with the fi nding by Lim
et al
. and Grover
et al
. in their study
of melasma.[4,8] Burns
et al.
[7] and Grover
et al
.[4] reported a
more rapid and better improvement in postinfl ammatory
hyperpigmentation with the use of GA peels. This was
refl ected in our study as well, as melasma improved with an
average 7.33 number of peels as compared to an average of 4.2
peels in cases of other hyperpigmentation disorders.
Conclusions
In our small, non-blinded study, we conclude that chemical
peeling with GA gives better and faster results with post-
acne hyperpigmentation and freckles as compared to
melasma. Moreover, we report this study to create awareness
among physicians of all disciplines that chemical peeling is
a simple, offi ce-based procedure for effectively addressing
common hyperpigmentation disorders of skin.
References
1. Ting W. Tretinoin for the treatment of photodamaged skin. Cutis
2010;86:47-52.
2. Savant SS. Superfi cial and medium depth chemical peeling. In:
Text book of dermatosurgery and cosmetology. In: Savant SS,
editor. 2nd ed. ASCAD, Pune; 2005. p. 177-95.
3. Khunger N. Standard guidelines of care for chemical peels.
Indian J Dermatol Venereol Leprol 2008;74:5-12.
4. Grover C, Reddu BS. The therapeutic value of glycolic acid
peels in dermatology. Indian J Dermatol Venereol Leprol
2003;69:148- 50.
5. Chang MW. Disorders of hyperpigmentation. In: Bolognia JL,
Rapini RP, editors. Dermatology, 2nd ed. Spain: Mosby Elsevier
Publishers; 2008. p. 939-64.
6. Barnhill R, Rabinovitz H. Benign melanocytic neoplasms. In:
Bolognia JL, Rapini RP, Jorizzo JL, editors. Dermatology, 2nd ed.
Spain: Mosby Elsevier Publishers; 2008. p. 1757-58.
7. Burns RL, Prevost- Blank PL, Lawry MA, Lawry TB,
Faria DT, Fivenson DP. Glycolic acid for postinfl ammatory
hyperpigmentation in black patients. Dermotol Surg
1997;23:171- 5.
8. Lim JT, Tham SN. Glycolic acid peels in the treatment of
melasma among Asian women. Dermatol Surg 1997;23:177-9.
How to cite this article: Deshmukh SP, Chaudhari NC, Dash K,
Sharma YK, Deo KS. Evaluation of effi cacy of chemical peeling with
glycolic acid in hyperpigmentation disorders of the skin. Med J DY
Patil Univ 2012;5:122-4.
Source of Support: Nil. Confl ict of Interest: None declared.
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 86.82.50.232]
