Clinical Efficacy and Safety on Combining 20% Trichloroacetic Acid Peel with Topical 5% Ascorbic Acid for Melasma

Abstract

Introduction: Trichloroacetic Acid (TCA) is a versatile peeling agent for treatment of melasma. However, Post-Inflammatory Hyperpigmentation (PIH) is reported to be the most common side-effect associated with TCA peel. Topical Ascorbic Acid (AA) due to its effect as antioxidant and tyrosinase inhibitor helps to prevent PIH and maintains the response.

Aim: To assess the clinical efficacy, safety and reduction in Melasma Quality of Life (MELASQOL) on combining 20% TCA peel with 5% ascorbic acid cream in epidermal melasma.

Materials and methods: This study was conducted in the Department of Dermatology, Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak. This was an open labelled prospective randomized study in which 60 patients of epidermal melasma were enrolled for 12 weeks. Patients were divided into two groups: Combination group received 20% TCA peel every two weeks with once daily 5% ascorbic acid cream and Control group received only 20% TCA peel. Melasma Area Severity Index (MASI) was used for evaluating clinical improvement of melasma. Improvement in Quality Of Life (QoL) was assessed by MELASQOL scale in both groups. Adverse effects were evaluated at each visit. All statistical analysis was carried out with SPSS 20^th version. The difference in change in mean MASI scoring and MELASQOL scores between the two groups were analysed using Mann-Whitney test. The side effects between the two groups were compared using Chi-square test.

Results: The combination group demonstrated a statistically significant improvement in MASI, percentage decrease in MASI and quality of life as compared to control group after treatment. At the baseline there was no statistically significant difference in MASI between the two groups (i.e., MASI in combination group and control group were 23.55±4.61 and 23.613±4.088 respectively). However, it was statistically significant at the end of therapy (i.e., MASI in combination group was 9.50±5.31 and in control group was 15.10±4.44). When the results were analysed in terms of percentage decrease in MASI from baseline, there was statistically significant difference in combination group (i.e., 10.87±4.11) as compared to control group (i.e., 6.3±1.97) after 2^nd week of therapy. When the mean MELASQOL scores were compared between the two groups at the end of therapy (i.e., 12 weeks), it was found to be statistically significantly lower in combination group (16.60±8.03) as compared to control group (25.90±8.17). Minor adverse effects like post peel erythema, pruritus, burning and stinging sensation were observed in some of the patients, which didn't necessitate termination of the therapy.

Conclusion: Combination of 20% TCA peel with topical 5% ascorbic acid is a highly effective, safe and promising therapeutic option in treatment of melasma which significantly improves the QoL.

Keywords: MASI; Peel; Quality of life; Topical vitamin C.

[Table/Fig-3]:

Melasma before and after treatment in combination group.

[Table/Fig-4]:

Melasma before and after treatment in control group.

[Table/Fig-5]:

Trend of mean MASI score over the weeks.

[Table/Fig-6]:

Percentage decrease in Mean MASI score over the treatment period.

[Table/Fig-7]:

Box and Whiskers Plot: MELASQOL scores before and after therapy.