Original Research Article DOI: 10.18231/2455-6769.2017.0021 Indian Journal of Clinical and Experimental Dermatology, April-June 2017;3(2):85-87 85 Evaluation of various chemical peels in facial melanosis Sanjiv Choudhary 1 , Shivani Dhande 2,* , AL Singh 3 1,3 Professor, 2 Resident, JNMC, DMIMS, Wardha, Maharashtra *Corresponding Author: Email: shivanidhande1504@gmail.com Abstract Introduction: Chemical peeling is a preferred, generally safe and relatively economic day procedure for pigmentary skin disorders and for skin revival. Aim: Evaluation of various chemical peels (Salicylic acid, Trichloroacetic acid & Glycolic Acid) in facial melanosis (Melasma, Photomelanosis & Post Acne Pigmentation). Materials and Method: It was a randomized parallel control single blind study consisting of total of 36 cases, 12 cases each of melasma, photomelanosis and post acne pigmentation, enrolled after considering various inclusion and exclusion criteria. Before applying the peel, a written informed consent was obtained and a post auricular test peel was implemented. Patients were divided into three groups, containing 12 patients each of melasma, photomelanosis and post acne pigmentation. Out of 12 patients of each facial melanosis, groups of four were formed and first group was treated with SA peel 20% (done once in 2 weeks), second group with GA peel 50% (done once in 3 weeks) and third group with TCA 15% (done once in 3 weeks) respectively with total six settings. Post peel topical sunscreen application was mandatory. Investigator’s Global Improvement Assessment and Patient’s satisfaction grading scale was used on basis of clinical photographs taken at baseline and at end of six weeks to assess improvement in all the three facial melanosis. Results: For the 36 patients enrolled, an marked improvement was seen in 10(27.77%) patients, 13(36.11%) patients showed moderate improvement while it was mild improvement for the remaining 13(36.11%) patients. Conclusions: In our study GA(50%),TCA(15%) & SA(20%) peels showed excellent response in melasma, photomelanosis and post-acne pigmentation respectively. All the 3 peeling agents were well tolerated without any significant side-effects in the above specified concentrations. Limitations: Sample size is limited. Further study with large sample size is required to further validate the findings of present study. Keywords: Facial melanosis, Gycolic acid, Salicylic acid, Trichloroacetic acid Key Messages: GA(50%), TCA(15%) & SA(20%) peels have excellent response in melasma, photomelanosis and post-acne pigmentation respectively and a good safety profile. Introduction Chemical peeling is the application of chemical agent to the skin that causes controlled destruction of a part of the epidermis, leading to exfoliation of epidermis and remodeling of the dermis. It is a preferred, generally safe and relatively economic day procedure for pigmentary skin disorders and for skin revival. By the level of necrosis, they are classified into superficial, medium, and deep peels. Causes of facial melanosis can be multiple like post inflammatory pigmentation due to acne vulgaris, melasma, perioral and periorbital melanosis, amylodosis, lichen planus pigmentosus, photomelanosis, Reihl’s melanosis. Facial melanosis is also one of the cause for psychological stress, necessitating its safe and effective treatment. Quite a variety of peels are available with distinct mechanisms of actions, which can be modulated by changing concentrations. Agents of very superficial peels include glycolic acid (30-50%) and trichloroacetic acid (10%); superficial peels include salicylic aci (20-30%), glycolic acid (50-70%) and trichloroacetic acid (10-30%), medium depth peels include glycolic acid (70%) and trichloroacetic acid (30-50%), deep peels include phenol (88%) and Baker Gordon peel. In this study, we have used only superficial peel to see its effect on different facial melanosis. Aim Evaluation of various chemical peels (Salicylic acid, Trichloroacetic acid & Glycolic Acid) in facial melanosis (Melasma, Photomelanosis & Post Acne Pigmentation). Materials and Method It was a randomized parallel control single blind study with duration of 1 year from May 2014 – May 2015. Ethical clearance was taken from institutional ethics committee before enrolling patients for the study. Total 36 cases,12 cases each of epidermal melasma, photo melanosis and post acne pigmentation were enrolled after considering various inclusion criterias (age between 20 to 50 years, Fitzpatricks skin type 3, 4 & 5 and patients with realistic expectations) and exclusion criterias (dermal melasma, pregnant and lactating mothers, patients with keloidal tendency, active herpes simplex infection or past history of the same, patients with hypersensitivity to salicylic acid, trichloroacetic acid and glycolic acid, patients on systemic isotretinoin). Woods lamp examination was done to confirm the epidermal type of melasma. Clinical photographs at the beginning of therapy and then serially, were taken to assess the clinical response.