Abstract
BACKGROUND: Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Chemical peeling is a common office procedure which has evolved over the years. Peeling has stood the test of time as a simple procedure to rejuvenate the skin. AIM AND OBJECTIVES: To evaluate and compare the therapeutic efficacy and safety of lactic acid peel 90% versus pyruvic acid peel 40% in epidermal melasma. PATIENTS AND METHODS: A total of 60 patients were enrolled and randomly divided into two groups of 30 patients each. Priming was done by 0.025% tretinoin cream daily for 2 weeks prior to the peeling. Group A received 90% lactic acid peel every 2 weekly, while group B received 40% pyruvic acid peel every 2 weekly for 12 weeks. Patient evaluation was done using Melasma Area and Severity Index (MASI) and Melasma Quality of Life (MELASQoL) scores. Photographic records were kept. RESULTS: The mean age of presentation in group A was 33.57 years, and that in group B was 33.36 years. The most common pattern noted was centrofacial in 56.7% of patients in group A and 63.33% patients in group B. The mean MASI score decreased from 10.42 at baseline to 4.59 in group A, while in group B, it decreased from 9.65 at baseline to 4.53. At the 24-week mark, the percentage reduction was 55.44% in group A and 52.07% in group B. The mean baseline MELASQol was 36.83 in group A and 37.7 in group B. At 24 weeks, MELASQol reduced to 21.3 and 20.10 in groups A and B, respectively. LIMITATION: Small sample size. CONCLUSION: There was significant reduction in MASI and MELASQol scores as compared to baseline using both lactic acid and pyruvic acid peel, but lactic acid 90% peel showed slightly better results compared to pyruvic acid 40% peel, though not statistically significant. Both peels were safe. Mild burning sensation was reported by a few patients.