418 J. Cosmet. Sci., 72, 418–431 (July/August 2021) Comparative Efficacy of 35% Glycolic Acid Peel vs. ­ Jessner Peel as an Adjuvant to Topical Triple Combination (2% Hydroquinone, 0.025% Tretinoin, 0.01% Fluocinolone Acetonide) Therapy in Melasma Females Cases AVANI MODI, SWETA PARMAR, and YOGESH MARFATIYA Gmers Medical College, Vadnagar, Gujarat, India (A.M., S.P.), Department of Skin and V.D., Gmers Medical College, Vadnagar 384355, Gujarat, India Department of Skin & V.D., Medical College and S.S.G. Hospital Vadodara 390001, Gujarat, India Accepted for publication June 30, 2021. Synopsis Melasma is a common, acquired, circumscribed hypermelanosis of sun-exposed skin. It presents as symmetric, hyperpigmented macules having irregular, serrated, and geographic borders. Compare the efficacy of 35% gycolic acid (GA) peel vs. Jessner peel (JP) as an adjuvant to topical triple combination (2% Hydroquinone, 0.025% tretinoin, 0.01% Fluocinolone acetonide) therapy in Melasma in females. Sixty cases of Melasma attending Skin- VD OPD, Baroda Medical College from September 1, 2016 to July 30,/2017 were enrolled. Among them, 12% cases had history of menstrual irregularity, 5% cases had past history of oral contraceptive (OC) pill intake, and 10% cases had history of working outdoors. Most common pattern of melasma was centrofacial 32 cases (53%) which was followed by malar pattern in 27 cases (47%) and mandibular pattern in one case (2%). Fifty cases who completed study were evaluated for comparative efficacy of GA peel versus JP as an adjuvant to topical triple combination therapy. Average reduction in Melasma Area and Severity Index (MASI) score in cases treated with GA peel group was 58.56% with Jessner peel group was 59.12%. In GA peel group, 84% cases had moderate to good improvement, whereas in JP group 92% cases had moderate to good improvement. According to present study, safety and efficacy profile of 35% GA peel vs. JP was almost same. Both can be used as an adjuvant to topical triple combination therapy of 2% hydroquinone, 0.025% tretinoin, and 0.01% fluocinolone acetonide in females suffering from melasma. We recommend that it will be safer for the pregnant women to get the GA peel rather than the treatment containing hydroquinone and tretinoin since the activity/performance is very similar. INTRODUCTION Melasma is an acquired, circumscribed, pigmentary disorder characterized by more or less symmetrically distributed and medium to dark brown macules with defined geographic Address all correspondence to Sweta Parmar at drswetaparmar@gmail.com

419 COMPARATIVE EFFICACY OF 35% GLYCOLIC ACID PEEL borders affecting the sun-exposed area, particularly to forehead, cheeks, temples, and upper lip. It is more commonly seen in females than in males (1,2). Incidence • 50–70% of pregnant women • 8–29% of women on oral contraceptive (OC) pills (3,4) Hydroquinone (HQ) and triple combination creams (TCCs) remain the gold standard of treatment. There have been concerns about the side effects and long-term safety of HQ hence the need to develop alternate treatment options. No single therapeutic modality is sufficient to achieve total clearance of pigmentation in melasma and maintenance of response. Therefore, therapies need to be combined to optimize the outcome. AIMS AND OBJECTIVES To compare the efficacy of 35% glycolic acid (GA) peel vs. Jessner peel (JP) as an adjuvant to topical triple combination (2% Hydroquinone, 0.025% tretinoin, and 0.01% Fluoci- nolone acetonide) therapy in Melasma females cases. To determine the efficacy in terms of 1. Decrease in Melasma Area and Severity Index (MASI) Score 2. Presence of any ADR MATERIALS AND METHODS The study was carried out in the department of Skin-VD, Medical College Baroda, after approval of the Institutional Ethics Committee for Human Research, Medical College Baroda & SSG Hospital, Vadodara (16/12/2016), GUJARAT, INDIA. Study Design: Interventional Randomized clinical study Sample Size and Study Population: A total of 60 clinically diagnosed patients of Melasma attending the Skin-VD OPD from September 1, 2016, to June 30, 2017, were enrolled as per the inclusion and exclusion criteria. Inclusion criteria: • Women (menstruating*) of 20–50 age group with melasma having malar, centrofa- cial, and/or mandibular pattern melasma. *Regular menstruation definition (23–39 days and for 2 to 7 days and 25 to 39 mL) Exclusion criteria: • Pregnant or nursing women, • Women on contraceptive pills at the time of the study or in the past 6 months. • Patients on any concurrent therapy, • Patients with hypersensitivity to the formulations, concurrent illnesses, • None of the patients had used topical steroids or hydroquinone 2 weeks before study entry and systemic steroids for 1 month. • Any chronic medical illness