Comparison of Therapeutic Efficacy of Chemo-exfoliation with Tri-Chloroacetic Acid, Glycolic Acid & Placebo in Melasma

Melasma, is a commonly acquired symmetric hypermelanosis, characterized by irregular light to dark brown macules, involving the cheeks, forehead, upper lip, nose, and chin. Various combinations of topical medications are being used to treat melasma but chemical peels like Glycolic Acid (GA) and Tri-Chloroacetic Acid (TCA) are proving to be safer, faster and more result oriented options. We compared the efficacy of GA peel, TCA Peel and Placebo in treating Melasma. Initially, priming of facial skin was done by Modified Kligman’s regimen for 2 weeks. Chemo-exfoliation was done every 14 days for 4 sittings and patient was advised daily sunscreen application. Two groups were made, one group of 20 patients receiving GA (50-70%) on right side of face and TCA (10-20%) on the left side (same patient). Second group was of 12 patients receiving Normal Saline (Placebo). Response was assessed by the following criteria - photographs, subjective and clinical improvement. Overall response, evaluated by MASI scoring after 10 weeks, was 64.67 % - GA, 38.09 % - TCA, 33.33 % - Placebo (only sunscreen). Individual response to various chemicals was 61.90 % - GA, 35.0 % - TCA, 26.82 % - Placebo. GA showed better results, tolerability & had an advantage of facial rejuvenation over TCA. Minimal improvement was seen in placebo group.