Glycolic Acid

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Glycolic acid, an alpha-hydroxy acid (AHA), has become the most widely used organic car-boxylic acid for skin peeling. Glycolic acid formulations include buffered, partially neutralized, and esterified products. Concentrations for peeling range from 20 to 70%. Several published studies have assessed the efficacy of gly-colic acid peels in darker-skinned racial-ethnic groups. A series of ten Asian women with me-lasma and fine wrinkles were treated with 2% hydroquinone and 10% glycolic acid applied to both sides of the face [13]. A series of 20-70% glycolic peels were performed on one side for comparison. Greater improvement with minimal side effects was noted on the side treated with the series of glycolic acid peels. Forty Asian patients with moderate to moderately severe acne were treated with a series of 35-70% glycolic acid peels [14]. The investigators noted significant improvement in skin texture and acne. Side effects were reported in 5.6% of patients.

Nineteen black patients with post-inflammatory hyperpigmentation were treated with glycolic acid peeling [15].The control group was treated with 2% hydroquinone/10% glycolic acid twice a day and tretinoin 0.05% at bedtime, whereas the active peel group received the same topical regimen plus a series of six serial glycol-ic acid peels. Although not statistically significant, greater improvement was noted in the chemical peel group.

The safety and efficacy of a series of glycolic acid facial peels were investigated in 25 Indian women with melasma [16]. Patients were treated with 50% glycolic acid peels monthly for 3 months. Improvement was noted in 91% of patients with maximal clearing occurring in patients classified with epidermal melasma. Side effects were observed in one patient who developed brow hyperpigmentation.

In a separate study, the combination of gly-colic acid peels with a topical regimen for the

treatment of melasma was assessed in a series of dark-skinned patients with melasma [17]. The authors compared the efficacy of serial gly-colic acid peeling with a series of 3-30% glycol-ic peels and 3-40% peels in combination with a modified Kligman bleaching regimen (hydro-quinone 5%, hydrocortisone acetate 1% and tretinoin 0.05%) to the use of the modified Kligman formulation alone. Forty women were included in each group. Both groups showed a statistically significant improvement in the Me-lasma Area Severity Index (MASI) score at 21 weeks. However, maximal improvement occurred in the group treated with the series of glycolic acid peels in combination with the topical bleaching regimen.

Glycolic acid peels are well tolerated in darker skinned racial-ethnic groups (Figs. 13.3a, b and 13.4a, b). Side effects are substantially minimized when concentrations are gradually titrated from the lower concentrations of 20-35% to the full-strength 70% peel. Glycolic acid peels are most advantageous when treating darker skin types with sensitive skin.

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