Comparative efficacy of 10-20% trichloroacetic acid and 35-70% glycolic acid peel in 60 cases of melasma, freckles, lentigines and postinflammatory hyperpigmentation

Background Melasma, freckles, lentigines and post-inflammatory hyperpigmentation arecommon disorders of cutaneous hyperpigmentation, which present in Dermatology clinics.Despite the availability of a large number of skin lightening treatments, hyperpigmentation ofskin remains a therapeutic challenge. Chemical peeling has been widely used for thetreatment of cutaneous hyperpigmentation. The present study compares the effects of 10-20%trichloroacetic acid and 35-70% glycolic acid peel in these common disorders of skinhyperpigmention.Patients and methods The study included 60 patients of melasma, freckles, lentigines andpost-inflammatory hyperpigmentation of both sexes, in 15-45 year age group. Patients wererandomly divided into two equal groups A and B. Pre-peel priming was carried out with 3%hydroquinone for two weeks. Group A was treated with trichloroacetic acid (TCA, 10-20%)peel and group B with glycolic acid (GA, 35-70%) peel. Four peels were done at serialintervals of 15 days. Full-face peel was done for melasma and regional or spot peeling forfreckles, lentigines and post inflammatory hyperpigmentation. Patients were followed everymonth for three months after the last peel. Clinical photographs were taken at the beginningof the therapy and then serially to assess the response.Results Glycolic acid showed better response compared to trichloroacetic acid at end of fourpeels, but this difference was not statistically significant (p>0.05). Chemical peeling withtrichloroacetic acid produced significantly more erythema (p<0.05) and burning sensation(p<0.01) compared to glycolic acid. Also, tricholoroacetic acid peel was associated withhigher incidence of post peel hyperpigmention (p< 0.05).Conclusion Chemical peeling with both tricholoroacetic acid (10-20%) and glycolic acid (35-70%) is safe and effective for the treatment of the skin pigmentary disorders. Glycolic acid isa superior peeling agent with better patient tolerance and lesser side effects.