Comparison Between Efficacy of Serial Glycolic Acid Peel with Modified Kligman’s Regimen Vs Modified Kligman’s Regimen Alone in Epidermal Melasma
Glycolic Acid Peel with Modified Kligman’s Regimen Vs Modified Kligman’s Regimen
DOI:
https://doi.org/10.54393/pjhs.v5i03.1284Keywords:
Epidermal Melasma, Modified Kligman's Regimen, Glycolic Acid Peel, MASI ScoreAbstract
The background of melasma involves its psychological impact and multifactorial etiology, encompassing genetic, hormonal, and environmental factors. Management strategies include sun protection and targeted treatments like glycolic acid peels and the modified Kligman's regimen to mitigate hyperpigmentation. Objective: To compare the clinical outcome specifically in terms of MASI score in epidermal melasma patients treated with the Modified Kligman's regimen alone versus combined with 35% Glycolic acid peels. Methods: In this randomized controlled trial, a total of 90 patients of epidermal melasma (with MASI score over 10) aged 18-55 years, visiting out-patient Dermatology department of Sheikh Zayed Hospital, Rahim Yar Khan were enrolled via non-probability consecutive sampling. The patients were divided into two groups (group A and group B), each having 45 patients. Patients in group A received the Modified Kligman's regimen (hydroquinone 4%, 0.05% tretinoin, and fluocinolone acetonide 0.01%), and those in group B received serial 35% Glycolic acid peels plus Modified Kligman's regimen over 3 months. Outcomes were measured at 4, 8, and 12-weeks post-treatment in terms of the MASI score. Results: Most of the patients i: e.75.5 % in group B showed moderate clinical improvement while most of the patients in group A i: e. 53.3% observed only mild improvement. In terms of the mean MASI score improvement, the Group B patients exhibited a significantly greater reduction from baseline compared to the Group A (8.91±2.42 vs. 7.05±4.05, p=0.010). Conclusions: The combination of Glycolic acid peels plus Modified Kligman's regimen is relatively more efficacious as compared to Modified Kligman's regimen alone.
References
Sarkar R, Choubey V, Devadasan S. Hyperpigmentary skin disorders. Atlas of Dermatology, Dermatopathology and Venereology: Inflammatory Dermatoses. 2022 Oct: 223-41. doi: 10.1007/978-3-319-53808-2_38. DOI: https://doi.org/10.1007/978-3-319-53808-2_38
Aghaei S and Moradi A. Introductory Chapter: Quality of Life in the Patients with Melasma. In Pigmentation Disorders-Etiology and Recent Advances in Treatments. 2023 Mar. IntechOpen. doi: 10.5772/intechopen.109828. DOI: https://doi.org/10.5772/intechopen.109828
Jiang J, Akinseye O, Tovar-Garza A, Pandya AG. The effect of melasma on self-esteem: A pilot study. International Journal of Women's Dermatology. 2018 Mar; 4(1): 38-42. doi: 10.1016/j.ijwd.2017.11.003. DOI: https://doi.org/10.1016/j.ijwd.2017.11.003
Edalatkhah H, Sadeghieh‐Ahary S, Abbasnejad F, Karimollahi M. In search of lost beauty: Experiences of Iranian women with melasma. Journal of Cosmetic Dermatology. 2022 Aug; 21(8): 3438-43. doi: 10.1111/jocd.14657. DOI: https://doi.org/10.1111/jocd.14657
Abdalla MA. Melasma Clinical Features, Diagnosis, Epidemiology and Etiology: An Update Review. Siriraj Medical Journal. 2021 Dec; 73(12): 841-50. doi: 10.33192/Smj.2021.109. DOI: https://doi.org/10.33192/Smj.2021.109
Mpofana N, Chibi B, Visser T, Paulse M, Finlayson AJ, Ghuman S et al. Treatment of Melasma on Darker Skin Types: A Scoping Review. Cosmetics. 2023 Jan; 10(1): 25. doi: 10.3390/cosmetics10010025. DOI: https://doi.org/10.3390/cosmetics10010025
Piętowska Z, Nowicka D, Szepietowski JC. Understanding melasma-how pharmacology and cosmetology procedures and prevention can help to achieve optimal treatment results? A narrative review. International Journal of Environmental Research and Public Health. 2022 Sep; 19(19): 12084. doi: 10.3390/ijerph191912084. DOI: https://doi.org/10.3390/ijerph191912084
Kim H, Choi HR, Kim DS, Park KC. Topical hypopigmenting agents for pigmentary disorders and their mechanisms of action. Annals of Dermatology. 2012 Feb; 24(1): 1-6. doi: 10.5021/ad.2012.24.1.1. DOI: https://doi.org/10.5021/ad.2012.24.1.1
Dayal S, Kaur R, Sahu P. Efficacy of Microneedling With 35% Glycolic Acid Peels Versus Microneedling With 15% Trichloroacetic Acid Peels in Treatment of Atrophic Acne Scars: A Randomized Controlled Trial. Dermatologic Surgery. 2022 May: 10-97. doi: 10.1097/DSS.0000000000003556. DOI: https://doi.org/10.1097/DSS.0000000000003556
Grover C, Reddu BS. The therapeutic value of glycolic acid peels in dermatology. Indian Journal of Dermatology, Venereology and Leprology. 2003 Jan; 69: 148.
González-Molina V, Martí-Pineda A, González N. Topical treatments for melasma and their mechanism of action. The Journal of Clinical and Aesthetic Dermatology. 2022 May; 15(5): 19.
Charoo NA. Hyperpigmentation: Looking beyond hydroquinone. Journal of Cosmetic Dermatology. 2022 Oct; 21(10): 4133-45. doi: 0.1111/jocd.14746. DOI: https://doi.org/10.1111/jocd.14746
Zasada M, Budzisz E. Retinoids: Active molecules influencing skin structure formation in cosmetic and dermatological treatments. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2019 Aug; 36(4): 392-7. doi: 10.5114/ada.2019.87443. DOI: https://doi.org/10.5114/ada.2019.87443
Zhong C, Liang G, Li P, Shi K, Li F, Zhou J et al. Inflammatory response: The target for treating hyperpigmentation during the repair of a burn wound. Frontiers in Immunology. 2023 Feb; 14: 1009137. doi: 10.3389/fimmu.2023.1009137. DOI: https://doi.org/10.3389/fimmu.2023.1009137
Hussain S, Raihan M, Jha AK, Ganguly S, Jaykar KC, Banerjee PK. Comparative evaluation of hydroquinone, tretinoin and mometasone versus glycolic acid versus trichloroacetic acid peel in melasma. Journal of Pakistan Association of Dermatologists. 2016 Nov; 26(1): 31-4.
Badabagni P, Birudala R. A comparative study of 35% glycolic acid peel versus modified Kligman’s regimen in treating Melasma in patients with dark skin. Drugs. 2021 Jan; 4(1): 94-98. doi: 10.33545/26649411.2021.v4.i1b.74. DOI: https://doi.org/10.33545/26649411.2021.v4.i1b.74
Ahmad Nasrollahi S, Sabet Nematzadeh M, Samadi A, Ayatollahi A, Yadangi S, Abels C et al. Evaluation of the safety and efficacy of a triple combination cream (hydroquinone, tretinoin, and fluocinolone) for treatment of melasma in Middle Eastern skin. Clinical, Cosmetic and Investigational Dermatology. 2019 Jun: 437-44. doi: 10.2147/CCID.S202285. DOI: https://doi.org/10.2147/CCID.S202285
Modi A, Parmar S, Marfatiya Y. Comparative Efficacy of 35% Glycolic Acid Peel vs. Jessner Peel as an Adjuvant to Topical Triple Combination (2% Hydroquinone, 0.025% Tretinoin, 0.01% Fluocinolone Acetonide) Therapy in Melasma Females Cases. Journal of Cosmetic Science. 2021 Jul; 72(4): 418.
Basil A, Akula ML, Najmuddin F, Shetty NJ, Shetty M. A comparative study between the efficacy of 35% glycolic acid peel and triple combination cream in the treatment of Melasma. IP Indian Journal of Clinical and Experimental Dermatology. 2023 Jan; 4(2): 123-31. doi: 10.18231/2581-4729.2018.0029. DOI: https://doi.org/10.18231/2581-4729.2018.0029
Godse KV. Triple combination of hydroquinone, tretinoin and mometasone furoate with glycolic acid peels in melasma. Indian Journal of Dermatology. 2009 Jan; 54(1): 92. doi: 10.4103/0019-5154.49005. DOI: https://doi.org/10.4103/0019-5154.49005
Kamal K, Paracha MM, Idrees N, Bakhtiar R, Ullah I, Nadeem M. Effectiveness of triple combination cream and 30% glycolic acid peel versus triple combination cream alone in the treating epidermal melasma. Medical Forum Monthly. 2020; 31(3): 13–6.
Sarkar R, Kaur C, Bhalla M, Kanwar AJ. The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark‐skinned patients: a comparative study. Dermatologic Surgery. 2002 Sep; 28(9): 828-32. doi: 10.1097/00042728-200209000-00009. DOI: https://doi.org/10.1097/00042728-200209000-00009
Chaudhary S, Dayal S. Efficacy of combination of glycolic acid peeling with topical regimen in treatment of melasma. Journal Of Drugs in Dermatology: JDD. 2013 Oct; 12(10): 1149-53.
Sarkar R, Parmar NV, Kapoor S. Treatment of post inflammatory hyperpigmentation with a combination of glycolic acid peels and a topical regimen in dark-skinned patients: a comparative study. Dermatologic Surgery. 2017 Apr ; 43(4): 566-73. doi: 10.1097/DSS.0000000000001007. DOI: https://doi.org/10.1097/DSS.0000000000001007
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
