Evaluation of various chemical peels in facial melanosis

Introduction: Chemical peeling is a preferred, generally safe and relatively economic day procedure for pigmentary skin disorders and for skin revival. Aim: Evaluation of various chemical peels (Salicylic acid, Trichloroacetic acid & Glycolic Acid) in facial melanosis (Melasma, Photomelanosis & Post Acne Pigmentation). Materials and Method: It was a randomized parallel control single blind study consisting of total of 36 cases, 12 cases each of melasma, photomelanosis and post acne pigmentation, enrolled after considering various inclusion and exclusion criteria. Before applying the peel, a written informed consent was obtained and a post auricular test peel was implemented. Patients were divided into three groups, containing 12 patients each of melasma, photomelanosis and post acne pigmentation. Out of 12 patients of each facial melanosis, groups of four were formed and first group was treated with SA peel 20% (done once in 2 weeks), second group with GA peel 50% (done once in 3 weeks) and third group with TCA 15% (done once in 3 weeks) respectively with total six settings. Post peel topical sunscreen application was mandatory. Investigator's Global Improvement Assessment and Patient's satisfaction grading scale was used on basis of clinical photographs taken at baseline and at end of six weeks to assess improvement in all the three facial melanosis. Results: For the 36 patients enrolled, an marked improvement was seen in 10(27.77%) patients, 13(36.11%) patients showed moderate improvement while it was mild improvement for the remaining 13(36.11%) patients. Conclusions: In our study GA(50%),TCA(15%) & SA(20%) peels showed excellent response in melasma, photomelanosis and post-acne pigmentation respectively. All the 3 peeling agents were well tolerated without any significant side-effects in the above specified concentrations. Limitations: Sample size is limited. Further study with large sample size is required to further validate the findings of present study.