Solution of Azelaic Acid (20%), Resorcinol (10%) and Phytic Acid (6%) Versus Glycolic Acid (50%) Peeling Agent in the Treatment of Female Patients with Facial Melasma

Faghihi, Gita; Taheri, Azam; Shahmoradi, Zabihollah; Nilforoushzadeh, Mohammad Ali

Solution of Azelaic Acid (20%), Resorcinol (10%) and Phytic Acid (6%) Versus Glycolic Acid (50%) Peeling Agent in the Treatment of Female Patients with Facial Melasma

Document Type : Original Article

Authors

¹ Skin Disease and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran

² Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Melasma, a common acquired disorder of hyperpigmentation, especially in women, is often resistant to therapy. This study was aimed to evaluate the efficacy and safety of azelaic acid, resorcinol and phytic acid solution in chemical peeling of melasma in comparison to 50% glycolic acid. Materials and Methods: This clinical trial was performed, on 42 female patients with bilateral melasma. Severity of melasma was assessed by melasma area and severity index (MASI). Combination of (20% azelaic acid + 10% resorcinol + 6% phytic acid) was used as a new peeling agent on the right side of the face and 50% glycolic acid on the left side every 2 weeks for 6 times. Follow-up was carried out for 3 months after the last session. Any decrease in MASI score and unwanted complications following peeling were evaluated and compared during the trial. Results: Patients showed marked improvement as calculated with MASI score before and after treatment in both sides of the face. The efficacy of combination formula (azelaic acid, resorcinol and phytic acid) was similar to glycolic acid, but with fewer complications. There was no statistically difference in improvement between two groups (P > 0.05). However, the patient's discomfort following procedures was significantly lower with azelaic acid, resorcinol and phytic compared with the glycolic acid peels (P < 0.05) and there was the same duration in the beginning of the therapeutic response in both groups. Conclusion: Results showed that triple-combination was found to be an effective and safe peeling agent in the treatment of melasma and it was as effective as 50% glycolic acid peel.

Keywords

References

1.	Grimes PE. Melasma. Etiologic and therapeutic considerations. Arch Dermatol 1995;131:1453-7.
2.	Kroon MW, Wind BS, Beek JF, van der Veen JP, Nieuweboer-Krobotová L, Bos JD, et al. Nonablative 1550-nm fractional laser therapy versus triple topical therapy for the treatment of melasma: A randomized controlled pilot study. J Am Acad Dermatol 2011;64:516-23.
3.	Grimes PE, Bhawan J, Guevara IL, Colón LE, Johnson LA, Gottschalk RW, et al. Continuous therapy followed by a maintenance therapy regimen with a triple combination cream for melasma. J Am Acad Dermatol 2010;62:962-7.
4.	Balkrishnan R, McMichael AJ, Camacho FT, Saltzberg F, Housman TS, Grummer S, et al. Development and validation of a health-related quality of life instrument for women with melasma. Br J Dermatol 2003;149:572-7.
5.	Dominguez AR, Balkrishnan R, Ellzey AR, Pandya AG. Melasma in Latina patients: Cross-cultural adaptation and validation of a quality-of-life questionnaire in Spanish language. J Am Acad Dermatol 2006;55:59-66.
6.	Ennes SB, Paschoalick RC, Mota M. A double-blinde, comparative, placebo-controlled study of the efficacy and tolerability of 4% hydroquinone as a depigmenting agent in melasma. J Dermatlo Treat 2000;11:173-9.
7.	Taylor SC, Torok H, Jones T, Lowe N, Rich P, Tschen E, et al. Efficacy and safety of a new triple-combination agent for the treatment of facial melasma. Cutis 2003;72:67-72.
8.	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. Dermatol Surg 2002;28:828-32.
9.	Gupta AK, Gover MD, Nouri K, Taylor S. The treatment of melasma: A review of clinical trials. J Am Acad Dermatol 2006;55:1048-65.
10.	Bansal C, Naik H, Kar HK, Chauhan A. A Comparison of Low-Fluence 1064-nm Q-Switched Nd: YAG Laser with Topical 20% Azelaic Acid Cream and their Combination in Melasma in Indian Patients. J Cutan Aesthet Surg 2012;5:266-72. [PUBMED]
11.	Kolbe L, Mann T, Gerwat W, Batzer J, Ahlheit S, Scherner C, et al. 4-n-butylresorcinol, a highly effective tyrosinase inhibitor for the topical treatment of hyperpigmentation. J Eur Acad Dermatol Venereol 2013;27 Suppl 1:19-23.
12.	Levy JL, Pons F, Agopian L, Besson R. A double-blind controlled study of a nonhydroquinone bleaching cream in the treatment of melasma. J Cosmet Dermatol 2005;4:272-6.
13.	Gilchrest BA, Fitzpatrick TB, Anderson RR, Parrish JA. Localization of malanin pigmentation in the skin with Wood's lamp. Br J Dermatol 1977;96:245-8.
14.	Sheth VM, Pandya AG. Melasma: A comprehensive update: Part II. J Am Acad Dermatol 2011;65:699-714.
15.	Lawrence N, Cox SE, Brody HJ. Treatment of melasma with Jessner's solution versus glycolic acid: A comparison of clinical efficacy and evaluation of the predictive ability of Wood's light examination. J Am Acad Dermatol 1997;36:589-93.
16.	Cotellessa C, Peris K, Onorati MT, Fargnoli MC, Chimenti S. The use of chemical peelings in the treatment of different cutaneous hyperpigmentations. Dermatol Surg 1999;25:450-4.
17.	Javaheri SM, Handa S, Kaur I, Kumar B. Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol 2001;40:354-7.
18.	Lim JT, Tham SN. Glycolic acid peels in the treatment of melasma among Asian women. Dermatol Surg 1997;23:177-9.
19.	Hurley ME, Guevara IL, Gonzales RM, Pandya AG. Efficacy of glycolic acid peels in the treatment of melasma. Arch Dermatol 2002;138:1578-82.
20.	Garcia A, Fulton JE Jr. The combination of glycolic acid and hydroquinone or kojic acid for the treatment of melasma and related conditions. Dermatol Surg 1996;22:443-7.
21.	Lim JT. Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. Dermatol Surg 1999;25:282-4.
22.	Gupta RR, Mahajan BB, Garg G. Chemical peeling – Evaluation of glycolic acid in varying concentrations and time intervals. Indian J Dermatol Venereol Leprol 2001;67:28-9. [PUBMED]
23.	Erbil H, Sezer E, Taştan B, Arca E, Kurumlu Z. Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma. J Dermatol 2007;34:25-30.
24.	Lynde CB, Kraft JN, Lynde CW. Topical treatments for melasma and postinflammatory hyperpigmentation. Skin Ther Lett 2006;11:1-6.
25.	Johnston GA, Sviland L, McLelland J. Melasma of the arms associated with hormone replacement therapy. Br J Dermatol 1998;139:932.

Advanced Biomedical Research