Comparison between efficacy of serial glycolic acid peel and triple combination cream vs. triple combination cream alone in treatment of melasma

Background Melasma is a common disorder of facial hyperpigmentation among Asian women. Many modalities of treatment are available but none is satisfactory. Objective To determine if serial glycolic acid peels provide additional improvement when combined with a time-tested triple combination cream (0.05% tretinoin, 4.0% hydroquinone, and 0.01% fluocinolone acetonide). Patients and methods Eighty melasma patients were divided into two groups of 40 each. One group received serial glycolic acid peels combined with a topical triple combination cream. The other, a control group, received only triple combination cream. The results were evaluated both subjectively (decrease in size and pigmentation) and with photographs taken at baseline, 4, 8 and 12 weeks (2 weeks after the sixth peel). Results A significant improvement from baseline to 12 weeks was observed in both groups (P 0.001). The group receiving the glycolic acid peels showed a trend toward more rapid and greater improvement, with statistically significant results (p 0.001). Only a few side effects were observed in the peel group. Conclusion This study demonstrates that serial glycolic acid peels provide an additional effect to a topical regimen for treating melasma if used judiciously and under supervision.