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Sarkar R, Katoch S. Chemical Peels in Treatment of Melasma. Dermatol Clin 2024; 42:21-32. [PMID: 37977681 DOI: 10.1016/j.det.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Superficial chemical peels are one of the most popular skin resurfacing procedures in a dermatologists' clinic today due to quick application process, fast recovery, good patient acceptance, and excellent cosmetic results. The role of various peeling agents like glycolic acid, salicylic acid, trichloroacetic acid, Jessner's solution, retinoic acid, and lactic acid in the management of melasma has been established as that of an additional or maintenance therapy. This article details the current evidence and recommendations for the use of chemical peels in the treatment of melasma, a chronic and recurrent hyperpigmentary disorder.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and SSK and KSC Hospital, New Delhi 110001, India.
| | - Saloni Katoch
- Dr. KN Barua Institute of Dermatological Sciences, Guwahati, Assam, India
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Trichloroacetic Acid With Microneedling Versus Trichloroacetic Acid Alone for Treating Melasma. Dermatol Surg 2023; 49:66-71. [PMID: 36533799 DOI: 10.1097/dss.0000000000003641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Melasma is a common acquired disorder of hyperpigmentation which is difficult to treat. OBJECTIVE We aim to evaluate the efficacy and safety of combined microneedling with trichloroacetic acid in the treatment of melasma. PATIENTS AND METHODS Forty women with facial melasma were included and randomly classified into 2 groups. Group A included 20 patients treated with bimonthly session of trichloroacetic acid 25% peeling (8 sessions) combined with a monthly session of microneedling (4 sessions). Group B included the other 20 patients that were treated by bimonthly trichloroacetic acid 25% peeling session (8 sessions) alone. RESULTS After 1 and 3 months of treatment, the mean melasma area and severity index, modified melasma area and severity index, and melasma severity index scores showed significant improvement in each group (p < .05 for each). At 1 and 3 months, the mean percentages of change of all scores were significantly higher in group A than group B (p < .05). CONCLUSION Combined trichloroacetic acid peel with microneedling is effective and a safe option for treating melasma.
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Clinical and Dermoscopic Evaluation of Trichloroacetic Acid 20% Versus Long-Pulsed 1064-nm Nd-YAG Laser in the Treatment of Keratosis Pilaris. Dermatol Surg 2022; 48:838-842. [DOI: 10.1097/dss.0000000000003488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sahu P, Dayal S. Most worthwhile superficial chemical peel for melasma of skin of color: Authors' experience of glycolic, trichloroacetic acid, and lactic peel. Dermatol Ther 2021; 34:e14693. [PMID: 33372385 DOI: 10.1111/dth.14693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
Glycolic acid (GA), lactic acid (LA) and trichloroacetic acid (TCA) peels have been used in various combinations for treating melasma patients, but none of the studies have compared their therapeutic efficacy and improvement in quality of life (QOL) index with these three peeling agents in melasma. Our study aims to compare the clinical efficacy, safety, tolerability and improvement in QOL index between 30% GA, 92% LA, and 15% TCA peeling in epidermal melasma. Ninety patients were divided into three groups with 30 in each. First group was treated with 30% GA peel, second with 92% LA peel, and third with 15% TCA peel at every 2 weeks interval for 12 weeks. Melasma area severity index (MASI) and QOL index (Melasma quality of life and Health related quality of life index) were used for clinical evaluation. Patients were observed for side effects and tolerability. The mean MASI score after therapy was significantly lower in patients treated with GA and TCA peels as compared with the group receiving LA peel. However, there was no significant difference in the mean MASI scoring at 12 weeks between GA peel and TCA peel groups. The improvement in QOL index was higher among patients undergoing GA peel followed by TCA and LA peel. Adverse effects were noted mostly with TCA peels followed by GA and LA peel. Thus, GA and TCA peels were equally efficacious and more effective than LA peels. LA peel had minimum side effects and better tolerability than GA and TCA peels.
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Affiliation(s)
- Priyadarshini Sahu
- Department of Dermatology, Venereology, and Leprology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Surabhi Dayal
- Department of Dermatology, Venereology, and Leprology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Dorgham NA, Hegazy RA, Sharobim AK, Dorgham DA. Efficacy and tolerability of chemical peeling as a single agent for melasma in dark‐skinned patients: A systematic review and meta‐analysis of comparative trials. J Cosmet Dermatol 2020; 19:2812-2819. [DOI: 10.1111/jocd.13725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Nevine A. Dorgham
- Dermatology Department Faculty of Medicine Cairo University Giza Egypt
| | - Rehab A. Hegazy
- Dermatology Department Faculty of Medicine Cairo University Giza Egypt
| | | | - Dina A. Dorgham
- Dermatology Department Faculty of Medicine Cairo University Giza Egypt
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Kutlubay Z, Cesur SK, Aşkın Ö, Tüzün Y. The color of skin: brown diseases of the skin, nails, and mucosa. Clin Dermatol 2020; 37:487-506. [PMID: 31896404 DOI: 10.1016/j.clindermatol.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.
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Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | | | - Özge Aşkın
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Rouvrais C, Baspeyras M, Mengeaud V, Rossi AB. Antiaging efficacy of a retinaldehyde-based cream compared with glycolic acid peel sessions: A randomized controlled study. J Cosmet Dermatol 2018; 17:1136-1143. [PMID: 30027612 DOI: 10.1111/jocd.12511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Glycolic acid (GA) chemical peels are a popular treatment for photoaged skin rejuvenation, but retinaldehyde (RAL)-based cosmetic creams have also demonstrated efficacy in improving photoaging, and are potentially better tolerated than chemical peels. AIMS To compare the efficacy and safety of an antiaging cream containing 0.1% RAL associated with Glycylglycine Oleamide (GGO, Relastide® ) and Pre-tocopheryl® , to GA peels sessions in the treatment of photoaging. PATIENTS AND METHODS Fifty-five women with photoaging were randomized in 2 treatment groups: (1) Daily application of the antiaging cream for 8 weeks or (2) Three sequential GA peels (20%, 50%, and 70%), 2-3 weeks apart. Skin surface texture, length of wrinkles, complexion radiance, and evenness of pigmentation and texture were assessed by profilometry using skin replicas, computer image analysis, and self-assessment. RESULTS Efficacy of both treatments was similar in reducing crow's feet wrinkles depth (STm -7.61%, P = .0007 vs -4.34%, P = .0348; P = .3049 intergroup) and volume, crow's feet and periorbital wrinkle length, and number of fine lines and wrinkles at end of treatments. The efficacy of the cream in refining skin texture was superior to the peels (contrast: -5.61%, P = .0025 vs +3.54, P = .08; P intergroup = .0252). The 8-week treatment with the antiaging cream was well tolerated; adverse events were fewer and of milder intensity than with the peels, (12-fold lower incidence of physical signs). CONCLUSION A dermocosmetic cream containing 0.1% RAL, GGO (Relastide® ) and Pre-tocopheryl® is as effective as 3 sequential GA peels, better tolerated, and is an alternative in the management of photoaged skin.
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Affiliation(s)
- Céline Rouvrais
- Skin Clinical Research Center, Pierre Fabre Dermo-Cosmetique, Toulouse, France
| | | | - Valérie Mengeaud
- Skin Clinical Research Center, Pierre Fabre Dermo-Cosmetique, Toulouse, France
| | - Ana Beatris Rossi
- Skin Clinical Research Center, Pierre Fabre Dermo-Cosmetique, Toulouse, France.,Dermatology Department, Larrey University Hospital, Toulouse, France
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Sarma N, Chakraborty S, Poojary SA, Rathi S, Kumaran S, Nirmal B, Felicita J, Sarkar R, Jaiswal P, D'Souza P, Donthula N, Sethi S, Ailawadi P, Joseph B. Evidence-based Review, Grade of Recommendation, and Suggested Treatment Recommendations for Melasma. Indian Dermatol Online J 2017; 8:406-442. [PMID: 29204385 PMCID: PMC5707834 DOI: 10.4103/idoj.idoj_187_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Treatment of melasma is known to be less satisfactory, often incomplete, and relapse is frequent. Although many treatment options are available, they are either known to be unsafe on long-term use or their long-term safety profile is unknown. Patients often use various drugs, even topical steroid-based preparation without any medical supervision for long period of time, making the skin unsuitable for many of the drugs available. Thus, there has been gross disparity among the treating physician about what drugs and what regimen are best suitable for various categories of melasma patients and in different situations. With this background, numerous newer drugs, mostly combinations of some proprietary molecules or even unknown plant extracts, have flooded the market for the management of melasma. Information on efficacy or safety of these products are almost unknown. Studies on Asian people, especially Indian population, are far less commonly available. Therapeutic guideline for use on Indian patients with melasma is almost missing. Extrapolation of data from Caucasian people for use on Asian people may not be scientifically justifiable because Caucasian and Asian people are known to have inherent difference in their response as well as tolerance to the drugs used for melasma. With this background, we have extensively evaluated, following a strict, scientifically designed protocol, all the available studies on melasma management till May 2016 and prepared this document on level of evidence, grade of recommendation and suggested therapeutic guideline for melasma as per the method proposed by Oxford Centre of Evidence-Based Medicine. Various ethical, social, logical, regional, and economic issues in the context of Indian and similar populations were given due importance while preparing the suggested therapeutic recommendation.
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Affiliation(s)
- Nilendu Sarma
- Department of Dermatology, Dr B C Roy Post Graduate Institute of Pediatric Science, Kolkata, West Bengal, India
| | | | - Shital A Poojary
- Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India
| | | | - Sendhil Kumaran
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Balakrishnan Nirmal
- Department of Dermatology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Joan Felicita
- Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Prashansa Jaiswal
- ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Paschal D'Souza
- ESI- Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
| | - Nagaraju Donthula
- Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumit Sethi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Pallavi Ailawadi
- Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, Basaidarapur, New Delhi, India
| | - Bebisha Joseph
- Department of Dermatology, Dr. Somervell Memorial CSI Medical College, Karakonam, Trivandrum, Kerala, India
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Abstract
Mesotherapy, microneedling, and chemical peels are minimally invasive techniques used to combat facial aging. Chemical peeling is one of the oldest methods of facial rejuvenation. By using different chemicals in various combinations, strengths, and application techniques, plastic surgeons can tailor a patient's treatment for optimal, safe, and consistent results. Mesotherapy and microneedling have emerged in the plastic surgery literature with increasingly complex indications. Both techniques have increased in popularity although research into efficacy and long-term results is lagging. With a thorough understanding of patients and the modalities available, plastic surgeons can use the appropriate minimally invasive technique to provide patients with desired skin changes.
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Affiliation(s)
- Johnson C Lee
- Private Practice, Enhance Medical Center, 462 North Linden Drive, Suite 333, Beverly Hills, CA 90212, USA.
| | - Mark A Daniels
- Division of Plastic Surgery, Albany Medical Center, 50 New Scotland Avenue, MC-190, Albany, NY 12208, USA
| | - Malcolm Z Roth
- Division of Plastic Surgery, Albany Medical Center, 50 New Scotland Avenue, MC-190, Albany, NY 12208, USA
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Wu DC, Fitzpatrick RE, Goldman MP. Confetti-like Sparing: A Diagnostic Clinical Feature of Melasma. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2016; 9:48-57. [PMID: 27047632 PMCID: PMC4771390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diagnostic uncertainty when a patient presents with melasma-like Undings can lead to suboptimal treatment and inaccurate prognostic expectations. In this study, the authors present a unique clinical feature of melasma that they term the "Fitzpatrick macule" and test its Utility in establishing diagnostic certainty. The "Fitzpatrick macule" is a confetti-like macule of regularly pigmented skin located within a larger patch of melasma hyperpigmentation. To test its diagnostic Utility, the authors compared clinical photography of known cases of melasma with common mimickers, such as poikiloderma of Civatte and solar lentiginosis, and determined the positivity rate of the Fitzpatrick macule in each scenario. Their results show that 89.1 percent of clinical photographs of melasma were positive for the presence of Fitzpatrick macules compared to 1.1 percent that were negative. In contrast, 37.5 and 56.3 percent of clinical photographs of poikiloderma of Civatte were positive and negative for Fitzpatrick macules, respectively. Solar lentiginosis showed a 5.6 percent positivity and a 77.8 percent negativity for Fitzpatrick macules. The sensitivity and specificity of Fitzpatrick macules for melasma was 99 and 83 percent, respectively. In summary, the authors report a highly sensitive and specific clinical feature of melasma. In cases of diagnostic uncertainty, the presence of Fitzpatrick macules may aid in establishing a diagnosis of melasma.
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Affiliation(s)
- Douglas C. Wu
- Goldman, Butterwick, Groff, Fabi and Wu Cosmetic Laser Dermatology, San Diego, California
| | - Richard E. Fitzpatrick
- Goldman, Butterwick, Fitzpatrick, Groff and Fabi: Cosmetic Laser Dermatology, San Diego, California
| | - Mitchel P. Goldman
- Goldman, Butterwick, Fitzpatrick, Groff and Fabi: Cosmetic Laser Dermatology, San Diego, California
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Mahajan R, Kanwar AJ, Parsad D, Kumaran MS, Sharma R. Glycolic Acid peels/azelaic Acid 20% cream combination and low potency triple combination lead to similar reduction in melasma severity in ethnic skin: results of a randomized controlled study. Indian J Dermatol 2015; 60:147-52. [PMID: 25814702 PMCID: PMC4372906 DOI: 10.4103/0019-5154.152510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Numerous therapeutic options have been tried in the management of melasma. Aims and Objectives: This prospective randomized study was planned to assess the efficacy of low potency triple combination (TC) cream (TC-hydroquinone 2%/tretinoin 0.05%/fluocinolone 0.01%) versus glycolic acid (GA) peels/azelaic acid (AA) 20% cream (GA/AA) combination in melasma. Materials and Methods: Forty patients with melasma were recruited into this study and randomized into two groups. Group A consisting 20 patients received TC cream once a day for night time application for 3 months. Group B comprising of 20 patients received GA/AA 20% cream combination for 3 months. The disease severity was monitored with digital photography, melasma area and severity index (MASI) score, which was calculated at baseline, 6 weeks and 12 weeks, and visual analog scale (VAS) score, which was calculated at baseline and 12 weeks. Results: Of 40 patients, 38 were completed the study. A significant reduction in MASI and VAS was recorded after 6 weeks and 12 weeks of treatment in both groups A and B (P = 0.001). However, there was no significant difference in the mean MASI scores between the two groups at baseline, 6 weeks and 12 weeks. Similarly, there was no difference in the mean VAS scores between the two groups at baseline and 12 weeks. Four patients in group A and 3 in group B experienced adverse effects such as irritation, dryness, and photosensitivity. Conclusion: Both low potency TC cream and GA/AA 20% cream combination are effective in treating melasma among Indian patients.
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Affiliation(s)
- Rahul Mahajan
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amrinder Jit Kanwar
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Sharma
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Evaluation of 70% glycolic peels versus 15% trichloroacetic peels for the treatment of photodamaged facial skin in aging women. Dermatol Surg 2014; 40:883-91. [PMID: 25068547 DOI: 10.1097/01.dss.0000452669.84787.bf] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic solar irradiation results in both morphological and functional changes in affected skin. Superficial peels have been shown to improve all symptoms of photodamaged skin. OBJECTIVE This study was designed to compare the efficacy and tolerability of glycolic acid (GA, 70%) with trichloroacetic acid (TCA, 15%) for the treatment of photoaging. MATERIALS AND METHODS Twenty female patients affected by photodamage were treated with graded concentrations of 70% GA and 15% TCA peel. Each patient was submitted to 5 sessions of these peels, with an interval of 14 days between each session. Four clinical parameters of surface evaluation of the living skin (hydration, elasticity, melanin, and erythema) were measured. The records were made before each treatment and 3 months after the last application. RESULTS The statistical significance in each group of patients was observed with elasticity and hydration. Decrease in melanin content in the skin occurred significantly after the application of a series of treatments with GA. Increase in severity of erythema showed statistical significance after the treatment with TCA. CONCLUSION Superficial peels, such as 70% GA and 15% TCA, proved to be an effective treatment modality for photodamaged facial skin. Both acids contribute to improvement of the photodamaged skin's parameters. Glycolic acid increases skin's hydration faster.
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Abstract
Chemical peels have been time-tested and are here to stay. Alpha-hydroxy peels are highly popular in the dermatologist’s arsenal of procedures. Glycolic acid peel is the most common alpha-hydroxy acid peel, also known as fruit peel. It is simple, inexpensive, and has no downtime. This review talks about various studies of glycolic acid peels for various indications, such as acne, acne scars, melasma, postinflammatory hyperpigmentation, photoaging, and seborrhea. Combination therapies and treatment procedure are also discussed. Careful review of medical history, examination of the skin, and pre-peel priming of skin are important before every peel. Proper patient selection, peel timing, and neutralization on-time will ensure good results, with no side effects. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the time for which it is applied. Hence, it can be used as a very superficial peel, or even a medium depth peel. It has been found to be very safe with Fitzpatrick skin types I–IV. All in all, it is a peel that is here to stay.
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