430 JOURNAL OF COSMETIC SCIENCE The darkness of melasma (D) is compared to the normal skin and graded on the scale of 0–4 as follows: 0 = normal skin color without evidence of hyperpigmentation 1 = barely visible hyperpigmentation 2 = mild hyperpigmentation 3 = moderate hyperpigmentation 4 = severe hyperpigmentation Homogeneity of the hyperpigmentation (H) is also graded on the scale of 0–4 as follows: 0 = normal skin color without evidence of hyperpigmentation 1 = specks of involvement 2 = small patchy areas of involvement 1.5 cm diameter 3 = patches of involvement 2 cm diameter 4 = uniform skin involvement without any clear areas To calculate the MASI score, the sum of the severity grade for darkness (D) and homo- geneity (H) is multiplied by the numerical value of the area (A) involved and by the percentage of the four facial areas (10–30%). MASI = 0.3(Df + Hf)Af + 0.3(Drm + Hrm)Arm +0.3(Dlm + Hlm)Alm + 0.1(Dc + Hc)Ac (f = forehead, mr = right malar, ml = left malar, c = chin) • Subjects were queried at each visit about the effect of drug and signs of improve- ment. • Adverse event: nature and type of event was recorded in the proforma. • Finally, all findings were analyzed statistically, and attempt was made to compare the results of the present study. TREATMENT PROTOCOL Evaluation, MASI score, test pre peel either GA (Odd No.) or JP (Even No.) TC application alternate night for 1 week Then daily at night for 1 week, to stop TC before 1 day of next visit 2 First visit 2 week Evaluation, MASI score Add peel either GA (Odd No.) or JP (Even No.) Restart TC on next day. Stop TC before 1 day of next visit. Second 4 week Evaluation, MASI score Do peel according to previous peel

431 COMPARATIVE EFFICACY OF 35% GLYCOLIC ACID PEEL Restart TC on next day. Stop TC before 1 day of next visit. Third 4 week Evaluation, MASI score. Do peel according to previous peel. Restart TC on next day. Fourth 4 week Stop all treatment. Continue sunscreen in day time. Recurrence • After two months of observation period, out of 50 cases who completed treatment, five cases came with recurrence. Among them, 12% cases were in GA peel group and 8% cases were in JP group. CONCLUSION According to present study, safety and efficacy profile of 35% GA peel versus 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. REFERENCES (1) Handel AC, Lima PB, Tonolli VM, Miot LD, Miot HA. Risk factors for facial melasma in women: A case-control study. Br J Dermatol. 2014 171:588–94. (2) M. E. Hadly, C. B. Howard, and V. J. Hruby, in Pigment Cell 1981. Phenotypic Expression in Pigment Cells, M. sSeiji. Ed. (University of Tokyo press, Tokyo, 1981), pp. 323–330. (3) P. E. Grimes, Melasma etiology and therapeutic consideration, Arch. Dermatol., 131, 1453–1457 (1995). (4) J. H. Gikes, G. A. Bloomfield, A. P. Scott et al., Studies on the release and degradation of the human melanocyte stimulating hormone, Proc. R. Soc. Med., 67, 40 (1974). (5) S. Resnik, Melasma induced by oral contraceptive drugs, JAMA., 199, 95–99 (1967). (6) J. P. Ortonne, I. Arellano, M. Berneburg, T. Cestari, H. Chan, P. Grimes et al., A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma, J. Eur. Acad. Der- matol. Venereol., 23, 1254–1262 (2009). (7) S. Sonthalia and R. Sarkar, Etiopathogenesis of melasma, Pigment. Int., 2, 21–27 (2015). (8) A. Tamega Ade, L. D. Miot, C. Bonfietti, T. C. Gige, M. E. Marques, H. A. Miot, Clinical patterns and epidemiological characteristics of facial melasma in Brazilian women, J. Eur. Acad. Dermatol. Vene- reol., 27, 151–156 (2013). (9) A. Achar, S. K. Rathi, Melasma: a clinico-epidemiological study of 312 cases, Indian. J. Dermatol., 56, 380–382 (2011). (10) C. L. Goh and C. N. Dlova, A retrospective study on the clinical presentation and treatment outcome of melasma in a tertiary dermatological referral centre in Singapore, Singapore. Med. J., 40, 455–458 (1999).