Efficacy and safety of glycolic acid 40% peel in the management of melasma: A prospective, interventional study

Background: Melasma is a common, chronic, refractory acquired hyperpigmentation of the skin that significantly affects quality of life. Treatment is often a multimodality approach. Chemical peels are a well-known treatment modality and can serve as an adjuvant in managing melasma. Aim: This study aimed to assess the efficacy and safety of a 40% glycolic acid (GA) gel peel in the management of melasma. Methods: Following a priming regimen that included broad-spectrum sunscreen (sun protection factor 30) applied on the whole face and neck during the daytime, and a topical kojic acid (2%) containing cream applied over the lesions at night for 2 weeks before the procedure, each patient received five serial sessions of a 40% GA peel, spaced 2 weeks apart. The modified Melasma Area and Severity Index (mMASI) score was calculated at baseline and at each follow up. A paired t -test was used to compare the differences between the means. Results: Out of the 31 patients enrolled, 27 completed the study and 4 patients were lost to follow up. The majority were females with n = 25/27. The mean age was 33.3 ± 7.2 years, and the mean duration of illness was 3.8 ± 2.6 years. A paired t -test revealed a statistically significant difference between the baseline and final mMASI scores when comparing their mean ± standard deviation. Majority of the patients experienced mild irritation following the application of the peeling agent, which subsided after wash-off. Conclusion: A 40% GA gel peel is a safe and effective adjuvant in the management of melasma in Indian patients.