Efficacy and Safety of 25% Trichloroacetic Acid Peel Versus 30% Salicylic Acid Peel in Mild-to-Moderate Acne Vulgaris: A Comparative Study
Keywords:
Acne vulgaris, trichloroacetic acid, salicylic acid, Michaelsson acne scoresAbstract
Background: Both salicylic acid (SA) and trichloroacetic acid (TCA) have proven efficacy with good
safety profiles in the treatment of acne vulgaris.
Objectives: This study compared the clinical efficacy and safety of 25% TCA and 30% SA peels in the
treatment of mild and moderate acne vulgaris.
Methods: Patients with mild or moderate acne vulgaris were randomized into 2 groups of 25 persons
each, and treated with either the TCA peel or the SA peel at 2-week intervals for 12 weeks. Evaluation
of active acne was done by individual lesion counts (comedones, papules and pustules) and calculation
of the Michaelsson acne score (MAS).
Results: Both peels led to significant decrease in individual lesion counts and MAS compared to baseline
values, without significant differences between the treatment groups. Thus, the peels had equivalent
efficacy against acne vulgaris. The TCA peel was better in treating non-inflammatory lesions,
while the SA peel was better for inflammatory lesions, but the differences were not significant. No
serious adverse effects were recorded, but more patients in the TCA peel group experienced burning
and stinging sensations.
Conclusion: The efficacy of 25% TCA is comparable to that of 30% SA in mild-to-moderate acne
vulgaris, but safety and tolerability were better with the SA peel than TCA peel.
References
Layton AM, Eady EA, Zouboulis CC. Acne. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, eds. Rook’s Textbook of Dermatology. 9th ed. Oxford: Blackwell Publishing; 2016:90.1-65.
Arshdeep, De D. What’s new in the management of acne? Indian J Dermatol Venereol Leprol. 2013;79(3):279-287. DOI: 10.4103/0378-6323.110748. PMID: 23619432.
Vaishampayan S, Baveja S, Garg S. Acne, rosacea and perioral dermatitis. In: Valia RG, Valia AR, eds. IADVL Textbook of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2016:1400-1447.
Del Duca E, Manfredini M, Petrini N, et al. Daylight Photodynamic Therapy with 5-aminolevulinic acid 5% gel for the treatment of mild-to-moderate inflammatory acne. G Ital Dermatol Venereol. 2019 Sep 12. DOI: 10.23736/S0392-0488.19.06392-2. PMID: 31525842.
Fabbrocini G, Fardella N, Monfrecola A, Proietti I, Innocenzi D. Acne scarring treatment using skin needling. Clin Exp Dermatol. 2009;34(8):874-879. DOI: 10.1111/j.1365-2230.2009.03291.x. PMID: 19486041.
You HJ, Kim DW, Yoon ES, Park SH. Comparison of four different lasers for acne scars: resurfacing and fractional lasers. J Plast Reconstr Aesthet Surg. 2016;69(4):e87-95. DOI: 10.1016/j.bjps.2015.12.012. PMID: 26880620.
Cannarozzo G, Silvestri M, Tamburi F, et al. A new 675-nm laser device in the treatment of acne scars: an observational study. Lasers Med Sci. 2021;36(1):227-231. DOI: 10.1007/s10103-020-03063-6. PMID: 32533470.
Thiboutot D, Gollnick H, Bettoli V, et al; Global Alliance to Improve Outcomes in Acne. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009;60(5Suppl):S1‑S50. DOI: 10.1016/j.jaad.2009.01.019. PMID: 19376456.
Abdel Meguid AM, Elaziz Ahmed Attallah DA, Omar H. Trichloroacetic acid versus salicylic acid in the treatment of acne vulgaris in Dark-skinned patients. Dermatol Surg. 2015; 41(12):1398-1404. DOI: 10.1097/DSS.0000000000000522. PMID: 26551771.
Abdel Hay R, Hegazy R, Abdel Hady M, Saleh N. Clinical and dermoscopic evaluation of combined (salicylic acid 20% and azelaic acid 20%) versus trichloroacetic acid 25% chemical peel in acne: an RCT. J Dermatolog Treat. 2019;30(6):572-577. DOI: 10.1080/09546634.2018.1484876. PMID: 29862871.
Dayal S, Amrani A, Sahu P, Jain VK, Jessner’s solution vs. 30% salicylic acid peels: a comparative study of the efficacy and safety in mild-to-moderate acne vulgaris. J Cosmet Dermatol. 2017;16(1):43-51. DOI: 10.1111/jocd.12266. PMID: 27557589.
Dayal S, Kalra KD, Sahu P. Comparative study of efficacy and safety of 45% mandelic acid versus 30% salicylic acid peels in mild-to-moderate acne vulgaris. J Cosmet Dermatol. 2020;19(2):393-399. DOI: 10.1111/jocd.13168. PMID: 31553119.
Khunger N; IADVL Task Force. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol. 2008;74 Suppl:5-12. PMID: 18688104.
Michaelsson G, Juhlin L, Vahlquist A. Oral zinc sulphate therapy for acne vulgaris. Acta Derm Venereol. 1977;57(4):372. PMID: 70937.
Keri J, Shiman M. An update on the management of acne vulgaris. Clin Cosmet Investig Dermatol. 2009;2:105-111. DOI: 10.2147/CCID.S3630. PMID: 214369
Khunger N, Vedamuthy M, Arsiwala S, Vedamurthy A. Tretinoin peels. In: Khunger N, ed. Step by Step Chemical Peels. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2009:159-178.
Levesque A, Hamzavi I, Seite S, Rougier A, Bissonnette R. Randomized trial comparing a chemical peel containing a lipophilic hydroxy acid derivative of salicylic acid with a salicylic acid peel in subjects with comedonal acne. J Cosmet Dermatol. 2011;10(3):174-178. DOI: 10.1111/j.1473-2165.2011.00566.x. PMID: 21896127.
Khunger N. Trichloroacetic acid peels. In: Khunger N, ed. Step by Step Chemical Peels. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers Ltd; 2014:79-110.
Chun EY, Lee JB, Lee KH. Focal trichloroacetic acid peel method for benign pigmented lesions in dark-skinned patients. Dermatol Surg. 2004;30(4 Pt 1):512-516. DOI: 10.1111/j.1524-4725.2004.30166.x. PMID: 15056140.
Ahn HH, Kim IH. Whitening effect of salicylic acid peels in Asian patients. Dermatol Surg. 2006;32(3):372-375.
Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74(5):945-973. DOI: 10.1016/j.jaad.2015.12.037. PMID: 26897386.
Zakopoulou N, Kontochristopoulos G. Superficial chemical peels. J Cosmet Dermatol. 2006;5(3):246-253. DOI: 10.1111/j.1473-2165.2006.00254.x. PMID: 17177748.
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