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The Best of the Best
December 20, 2010

Top-Accessed Article: Glycolic Acid Peels in the Treatment of Melasma

Arch Dermatol. 2010;146(12):1439. doi:10.1001/archdermatol.2010.352

Hurley ME, Guevara IL, Gonzales RM, Pandya AG. Efficacy of glycolic acid peels in the treatment of melasma. Arch Dermatol. 2002;138(12):1578-1582.

Although small (18 patients), this study is notable because it was the first randomized, investigator-blinded, controlled, split-faced study in melasma to compare the use of hydroquinone alone with hydroquinone plus glycolic acid peels in a homogeneous (Hispanic) population using objective (photography, mexameter readings, and Melasma Area and Severity Index) and subjective measures.

The study confirms that monotherapy and combination therapies significantly improve melasma; however, there were no significant differences in skin lightening between regimens. Other studies have shown that combination therapy does improve melasma faster than therapy with hydroquinone alone, including recalcitrant cases.13 Certainly, I have found that combination therapy works better in certain patients. Hurley and colleagues' use of low glycolic acid concentrations over a relatively short period (8 weeks) may explain these differences.

Chemical peels are routine elements of the dermatologist's armamentarium. The rigorous design of this study should be applied in larger patient populations using standard regimens to provide firm evidence for their use in combination therapy.

From June 2004 through August 2009, this article was viewed 2266 times on the Archives of Dermatology Web site.

Contact Dr Rendon at the Department of Dermatology, University of Miami, Miami, FL (skincareresearch@bellsouth.net).

Rendon  MCardona  LMBussear  EWBenitez  ALColón  LEJohnson  LA Successful treatment of moderate to severe melasma with triple-combination cream and glycolic acid peels: a pilot study.  Cutis 2008;82 (5) 372- 378PubMed
Sarkar  RKaur  CBhalla  MKanwar  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 (9) 828- 832, discussion 832PubMed
Erbil  HSezer  ETaştan  BArca  EKurumlu  Z Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma.  J Dermatol 2007;34 (1) 25- 30PubMedArticle