The Clinical Study Of Melasma And The Efficacy And Safety Of The Glycolic Acid In The Treatment Of Melasma

Objective To investigate the indications and procedures of glycolic acid peeling in the treatment of melasma and assess the therapeutic efficacy and safety of chemical peeling.Also we analyze the triggering factors of recruited cases of melasma.Methods Sixty-four patients with melasma were recruited in the study.A detailed history and clinical examination under natural light and Wood's light were taken before treatment.The glycolic acids with four different concentrations(20%,35%,50%,70%) were applied to treat the patients twice a month.One course includes four treatments.The severity of melasma was assessed by two dermatologists using the Melasma Area Severity Index(MASI).At regular intervals and at the end of the follow-up period(3 months) after the last peel,the degree of improvement in pigmentation was assessed by remeasuring MASI and color photographs were taken of all patients.Side-effects,if any,were also recorded.The data obtained were statistically analyzed using paired t-test and Mann-Whitney U test.Results Sixty-three patients completed at least one course of the therapy.One patient defaulted from the study after the first therapy.After eight weeks treatment,reduction in MASI was 4.46 and the improvement in melasma was observed in 74.6%.Fourty-one patients completed the second course.Reducion in MASI was 4.01 at the first course and 6.97 at the second.Improvement in melasma was 65.85%at the fist course and 92.68%at the second. Patients who completing two courses of the therapy demonstrated a better response to treatment than those completing only one course(P＜0.05).After eight weeks treatment,reduction in MASI was 6.12 and the the rate of efficacy was 93.94%in patients with epidermal-type melasma.Relatively,in the patients with mixed-type melasma the reduction was 2.63,the rate of efficacy was 53.33%.Patients with epidermal-type melasma demonstrated a better response to treatment than those with mixed-type melasma(P＜0.05).Reduction in MASI was3.02 and the the rate of efficacy was 56.52%in skin-typeⅢmelasma patients and reduction in MASI was 5.28 and the the rate of efficacy was 85%in skin-typeⅣmelasma patients.Skin-typeⅢmelasma patients demonstrated a better response to treatment than those with skin-typeⅢmelasma patients(P＜0.05).Conclusion Glycolic acid peeling proved to be an effective modality in the treatment of melasma without any significant side-effects.Patients with epidermal-type melasma or skin-typeⅣshowed a better response to the treatment.