Comparative study of efficacy of glycolic acid (50%) peel and lactic acid (92%) peel in the treatment of melasma

Background: Melasma is difficult to treat in Fitzpatrick skin type IV-VI and recurrence is a big problem.It causes emotional distress to the patient. There is paucity of controlled trials comparing efficacy of two chemical peels Glycolic acid (50%) Vs Lactic acid (92%) with Hydroquinone 2% cream in melasma treatment.Our goal was to determine efficacy and safety of these peels in melasma. Methods: A total 50 newly diagnosed patients of melasma were included in the study, over a duration of 1 year in department of Skin and V.D, M.P. Shah Medical college, Guru Gobindsingh Government Hospital, Jamnagar. All patients were advised daily application of Hydroquinone (2%) cream at night for priming. Patients were divided into two groups.Group1 had 2 weekly lactic acid (LA) peel, while Group 2 had 2weekly Glycolic acid (GA) peel with standard application method. Overall severity was assessed via the pre and post treatment melasma area and severity index (MASI) score. Evaluation for clinical improvement was done by graded score. Results: It was seen in study that at the end of 6 sittings, grade 4 improvement, that is reduction in MASI score by >60% was seen in 27.27% patients in GA peel while 22.72% in LA peel. Amongst the complication noted, in GA peel burning was most common (72.72%) followed by erythema (45.45%). In LA peel only 18.18% showed erythema. Conclusions: Lactic acid peel has almost equal efficacy to Glycolic acid peel, but LA peel has much lesser side effects, leads to increasing the patient compliance, hence making it new peeling agent of choice for treatment of melasma.