Evaluation of role of priming agents in salicylic acid peel: A comparative study

Introduction: Salicylic acid is increasingly used as a superficial peeling agent for acne. Widespread use has caused increasing awareness about the adverse events associated with SA like erythema, exfoliation, itching, redness etc. Appropriate use of priming agents like retinoids, hydroquinone etc., can help in reduction of ADRs and can affect final treatment result. Aim: Evaluation of efficacy and safety of salicylic acid (SA) peel with or without priming agents in patients of acne. Methodology: A prospective, randomized, open-label, parallel-group study was carried out in patients with acne. Total 72 patients were randomized in to three groups A, B and C to receive 30% salicylic acid (SA) peel with either 0.05% tretinoin or 4% hydroquinone or without any priming agent. Objective and subjective assessment in improvement in acne was compared. For safety analysis, all reported adverse drug events were compared. Results: Mean age of patients was 22.46±5.32 years. Both non-inflammatory and inflammatory acne lesions reduced with SA peel in all three groups. Improvement in total acne score is significantly higher in SA peel with priming agents (p<0.05). The change in total acne score (Week 0-12) was 81.45% with SA alone, 94.3% with isotetinoin and 90.2% with hydroquinone priming (p<0.05). Total adverse event reported were 10(58.82%), 4 (23.53%) and 3(17.65%) in SA peel without priming agent, with isotetinoin and with hydroquinone respectively. Rate of occurrence of adverse events was significantly high in SA without priming agent (p<0.05). Mean visual analogue score was 91.47, 94.31 and 83.46 in group A, B and C respectively. SA peel with priming agent was rated as significantly more effective by patients rather than SA without priming agent (p<0.05). Conclusion: Appropriate priming agents should always be used with superficial peeling agents like SA in management of acne which enhances the effectiveness and reduces the adverse effects of therapy.