tretinoin and glycolic-acid

Acne is an inflammatory disorder with a high global burden. It is common in adolescents and primarily affects sebaceous gland-rich areas. The clinical benefit of the topical acne treatments azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, and alpha-hydroxy acid is unclear.. To assess the effects of topical treatments (azelaic acid, salicylic acid, nicotinamide, zinc, alpha-hydroxy acid, and sulphur) for acne.. We searched the following databases up to May 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers.. Clinical randomised controlled trials of the six topical treatments compared with other topical treatments, placebo, or no treatment in people with acne.. We used standard methodological procedures expected by Cochrane. Key outcomes included participants' global self-assessment of acne improvement (PGA), withdrawal for any reason, minor adverse events (assessed as total number of participants who experienced at least one minor adverse event), and quality of life.. We included 49 trials (3880 reported participants) set in clinics, hospitals, research centres, and university settings in Europe, Asia, and the USA. The vast majority of participants had mild to moderate acne, were aged between 12 to 30 years (range: 10 to 45 years), and were female. Treatment lasted over eight weeks in 59% of the studies. Study duration ranged from three months to three years. We assessed 26 studies as being at high risk of bias in at least one domain, but most domains were at low or unclear risk of bias. We grouped outcome assessment into short-term (less than or equal to 4 weeks), medium-term (from 5 to 8 weeks), and long-term treatment (more than 8 weeks). The following results were measured at the end of treatment, which was mainly long-term for the PGA outcome and mixed length (medium-term mainly) for minor adverse events. Azelaic acid In terms of treatment response (PGA), azelaic acid is probably less effective than benzoyl peroxide (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.72 to 0.95; 1 study, 351 participants), but there is probably little or no difference when comparing azelaic acid to tretinoin (RR 0.94, 95% CI 0.78 to 1.14; 1 study, 289 participants) (both moderate-quality evidence). There may be little or no difference in PGA when comparing azelaic acid to clindamycin (RR 1.13, 95% CI 0.92 to 1.38; 1 study, 229 participants; low-quality evidence), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). Low-quality evidence indicates there may be no differences in rates of withdrawal for any reason when comparing azelaic acid with benzoyl peroxide (RR 0.88, 95% CI 0.60 to 1.29; 1 study, 351 participants), clindamycin (RR 1.30, 95% CI 0.48 to 3.56; 2 studies, 329 participants), or tretinoin (RR 0.66, 95% CI 0.29 to 1.47; 2 studies, 309 participants), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). In terms of total minor adverse events, we are uncertain if there is a difference between azelaic acid compared to adapalene (1 study; 55 participants) or benzoyl peroxide (1 study, 30 participants) (both very low-quality evidence). There may be no difference when comparing azelaic acid to clindamycin (RR 1.50, 95% CI 0.67 to 3.35; 1 study, 100 participants; low-quality evidence). Total minor adverse events were not reported in the comparison of a. Compared to benzoyl peroxide, azelaic acid probably leads to a worse treatment response, measured using PGA. When compared to tretinoin, azelaic acid probably makes little or no difference to treatment response. For other comparisons and outcomes the quality of evidence was low or very low. Risk of bias and imprecision limit our confidence in the evidence. We encourage the comparison of more methodologically robust head-to-head trials against commonly used active drugs.

Topics: Acne Vulgaris; Adapalene; Adolescent; Adult; Anti-Bacterial Agents; Benzoyl Peroxide; Bias; Child; Clindamycin; Dermatologic Agents; Dicarboxylic Acids; Erythromycin; Female; Glycolates; Humans; Keratolytic Agents; Male; Mandelic Acids; Niacinamide; Patient Dropouts; Pyruvic Acid; Quality of Life; Salicylic Acid; Sulfur; Tretinoin; Young Adult; Zinc

Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.

Topics: Caustics; Chemexfoliation; Drug Combinations; Ethanol; Glycolates; Humans; Keratolytic Agents; Lactic Acid; Phenol; Resorcinols; Salicylates; Salicylic Acid; Skin Diseases; Tretinoin; Trichloroacetic Acid

Postinflammatory hyperpigmentation (PIH) has posed a substantial challenge for patients with higher Fitzpatrick skin types, specifically types III to VI. Treatment modalities pose a number of limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating PIH in patients with skin of color. This article will review some of these modalities and procedures for this common patient concern.

Topics: Chemexfoliation; Dermatitis; Dermatologic Agents; Dicarboxylic Acids; Drug Combinations; Ethanol; Glycolates; Humans; Hydroquinones; Hyperpigmentation; Inflammation; Keratolytic Agents; Lactic Acid; Pyrones; Resorcinols; Salicylates; Salicylic Acid; Skin Pigmentation; Tretinoin

Stretch marks are a common disfiguring skin condition that can have a deep psychological impact on affected patients. Although there are a variety of treatments available, no consistently effective therapies have been established. In this systematic review, we evaluate 8 randomized controlled trials (RCTs) to assess the efficacy and safety of currently available therapies for the treatment of stretch marks. Due to the limited number of patients and high or unclear risk of bias in the studies included in this assessment, the evidence from this review is insufficient to provide clear guidelines for practice. Therefore, more high-quality RCTs are needed.

Topics: Glycolates; Humans; Keratolytic Agents; Laser Therapy; Ointments; Randomized Controlled Trials as Topic; Striae Distensae; Treatment Outcome; Tretinoin

Several methods of treatment are available to patients with melasma. First-line therapy usually consists of topical compounds that affect the pigment production pathway, broad-spectrum photoprotection, and camouflage. Second-line therapy often consists of the addition of chemical peels, although these must be used cautiously in patients with darker skin. Laser and light therapies represent potentially promising options for patients who are refractory to other modalities, but also carry a significant risk of worsening the disease. A thorough understanding of the risks and benefits of various therapeutic options is crucial in selecting the best treatment.

Topics: Administration, Topical; Asian People; Chemexfoliation; Dicarboxylic Acids; Drug Therapy, Combination; Glycolates; Glycyrrhiza; Humans; Hydroquinones; Low-Level Light Therapy; Melanins; Melanosis; Monophenol Monooxygenase; Phototherapy; Phytotherapy; Plant Extracts; Pyrones; Sunscreening Agents; Treatment Outcome; Tretinoin; Ultraviolet Rays

The periorbital region serves as a barometer of chronologic and environmental age and, as such, patients often seek its cosmetic rejuvenation.. The purpose of this article was to review the dermatologic treatments available for periorbital skin rejuvenation.. Topical retinoic and glycolic acid preparations, chemical peels, botulinum and collagen injections, dermabrasion, and laser resurfacing procedures for periorbital skin rejuvenation were reviewed. The relative benefits and risks of each treatment were detailed.. Minimal photodamage with mild rhytides should be responsible to topical acid therapy and superficial peels, whereas moderate wrinkling and photodamage generally require medium-depth peels, collagen injections, or erbium:YAG laser resurfacing. Deeper rhytides and more extensive cutaneous photo-damage usually necessitate CO2 laser resurfacing and botulinum injections.. Proper patient selection and assessment of aging severity are critical to determine the best therapeutic option.

Topics: Botulinum Toxins, Type A; Chemexfoliation; Collagen; Dermabrasion; Dermatologic Agents; Eyelids; Glycolates; Humans; Keratolytic Agents; Laser Therapy; Rhytidoplasty; Tretinoin

Topics: Chemexfoliation; Clinical Protocols; Dermatologic Surgical Procedures; Glycolates; Humans; Keratolytic Agents; Skin; Skin Aging; Sunlight; Treatment Outcome; Tretinoin

Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to moderate acne. However, irritant contact dermatitis is a common side effect of topical retinoids. A strategy to increase local tolerability is the "short contact therapy" (SCT) approach, consisting in the application of the product with the complete removal after 30 to 60 minutes using a non-aggressive cleanser. A gel containing tretinoin 0.02%, clindamycin 0.8%, and glycolic acid 4% in polyvinyl alcohol (MP-gel) has shown to be effective as monotherapy in mild to moderate acne with a tolerability profile similar to other topical retinoids. So far, no trials have been performed with this gel comparing the tolerability profile of SCT with standard application therapy (SAT). We conducted a 2-center randomized parallel groups, controlled, assessor-blinded study, comparing MP-gel applied as SCT in comparison with MP-gel used as SAT (The "MASCOTTE" trial). Forty-six subjects (nine men and 37 women, mean age 23 ± 4 years, range 18-31 years) with mild-to-moderate acne were enrolled, after their written informed consent in a randomized, parallel groups controlled, assessor-blinded 8-week trial. Twenty-three were assigned to MP-gel once daily (evening application) using the SCT approach (ie, complete removal of product after 1 hour using a gentle cleanser), and 23 were randomized to the SAT approach with the same gel. The primary endpoint was the evolution of the tolerability score (TS) assessed evaluating four items: erythema, dryness, stinging, and burning, using a 4-point score scale (from 0: no symptom to 3: severe symptom). Secondary endpoints were the evolution of global acne grading system (GAGS) score (range: from 0 to >39) and the investigator global assessment (IGA of acne severity) score (range from 0 to 4). TS was evaluated at 2, 4, and 8 weeks. GAGS and IGA scores were evaluated at baseline and at week eight. At week eight, an efficacy global score (EGS) (from 1: no efficacy to 4: very good efficacy) and a tolerability global score (TGS) (from 1: very low tolerability to 3: very good tolerability) evaluation were also done. All the evaluations were performed by an investigator unaware of treatment groups allocation (SCT or SAT). Thirty-eight subjects (83%) completed the 8-week treatment period. Eight subjects (two in the SCT group and six in the SAT group) dropped out prematurely due to low skin tolerability. In the SCT the TS at week two was 1.3 ± 1.7, in

Topics: Acne Vulgaris; Adolescent; Adult; Clindamycin; Dermatologic Agents; Female; Gels; Glycolates; Humans; Male; Treatment Outcome; Tretinoin; Young Adult

Facial postinflammatory hyperpigmentation (PIH) is challenging to manage in patients with skin of color because of the risk of subsequent treatment-related hyperpigmentation.. To evaluate the safety and efficacy of combining glycolic acid (GA) peels with a modified Kligman formula (MKF) containing hydroquinone 2%, tretinoin 0.05%, and hydrocortisone 1% for the treatment of facial PIH in Indian patients.. Thirty Indian patients (Fitzpatrick skin Types III-V) with facial PIH were randomly assigned to 2 groups of 15 each. One group received serial GA peels combined with an intervening topical regimen containing MKF. The other group received MKF alone. Results were evaluated by a clinical investigator at baseline and at the end of 21 weeks (3 weeks after treatment completion) using an objective scoring system, the Hyperpigmentation Area and Severity Index (HASI) score, and clinical photography.. The baseline mean HASI scores of the 2 groups were comparable. There was a statistically significant difference in the mean HASI score of the peels group compared with the MKF alone group at 12 weeks (p = .004) and 21 weeks (p < .001). Side effects were observed in both groups and were managed with liberal application of emollients. No patient dropped out of the study as a result of the side effects.. This study demonstrates that serial GA peels in combination with a MKF are efficacious and safe in the treatment of facial PIH in dark-skinned patients.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Chemexfoliation; Drug Combinations; Facial Dermatoses; Female; Glycolates; Humans; Hydrocortisone; Hydroquinones; Hyperpigmentation; India; Inflammation; Keratolytic Agents; Male; Severity of Illness Index; Tretinoin; Young Adult

Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. Chemical peels have become a popular modality in the treatment of melasma.. To compare the therapeutic efficacy and tolerability of glycolic acid (35%) versus salicylic-mandelic (SM) acid (20% salicylic/10% mandelic acid) versus phytic combination peels in Indian patients with melasma.. Ninety patients diagnosed with melasma were randomly assigned into 3 groups of 30 patients each. Group A received glycolic acid (GA-35%) peel, Group B received SM acid, and Group C received phytic combination peels. Each group was primed with 4% hydroquinone and 0.05% tretinoin cream for 4 weeks before treatment. Chemical peeling was done after every 14 days in all groups until 12 weeks. Clinical evaluation using melasma area and severity index (MASI) score and photography was recorded at every visit and follow-up was done until 20 weeks.. There was a decrease in MASI score in all 3 groups but it was statistically significantly lower in Group A than Group C (p = .00), and it was also statistically significantly lower in Group B than Group C (p = .00) but there was no statistically significant difference between Groups A and B (p = .876). Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was 62.36% reduction in GA group, 60.98% reduction in SM group, and 44.71% in phytic acid group.. It is concluded that GA (35%) and SM acid peels are both equally efficacious and a safe treatment modality for melasma in Indian skin, and are more effective than phytic acid peels. Salicylic-mandelic peels are better tolerated and more suitable for Indian skin.

Topics: Adult; Antioxidants; Chemexfoliation; Drug Combinations; Female; Follow-Up Studies; Glycolates; Humans; Hydroquinones; India; Keratolytic Agents; Male; Mandelic Acids; Melanosis; Middle Aged; Phytic Acid; Prospective Studies; Salicylic Acid; Severity of Illness Index; Treatment Outcome; Tretinoin; Young Adult

Various treatment modalities are available for management of melasma, ranging from topical and oral to chemical peeling, but none is promising alone. Very few studies are available regarding efficacy of combination of topical treatment with chemical peeling. Combination of chemical peeling and topical regimen can be a good treatment modality in the management of this recalcitrant disorder.. To assess the efficacy of combination of topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling in the treatment of melasma in Indian patients.. Forty Indian patients of moderate to severe epidermal variety melasma were divided into two groups of 20 each. One Group i.e. peel group received topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling and other group i.e. control group received topical regimen (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin).. There was an overall decrease in MASI from baseline in 24 weeks of therapy in both the groups (P value < 0.05). The group receiving the glycolic acid peel with topical regimen showed early and greater improvement than the group which was receiving topical regimen only.. This study concluded that combining topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling significantly enhances the therapeutic efficacy of glycolic acid peeling. The combination of glycolic acid peeling with the topical regimen is a highly effective, safe and promising therapeutic option in treatment of melasma.

Topics: Adult; Anti-Inflammatory Agents; Antioxidants; Chemexfoliation; Female; Glycolates; Humans; Hydrocortisone; Hydroquinones; Hyperpigmentation; Hypertrichosis; Irritants; Keratolytic Agents; Male; Melanosis; Treatment Outcome; Tretinoin; Young Adult

Melasma is an irregular brownish pigmentation observed on the faces of young to middle-aged women, especially of Asian races, which may contribute to various emotional disturbances. Although not any favorable treatment being approved yet, one appropriate approach is peeling by glycolic acid 70% (GA 70%). Considering the efficiency of Tretinoin in lower concentrations as over-the-counter lightening agents, peelings with higher strength Tretinoin may effectively relieve the pigmentation (melasma) sooner than other topical therapies.. The main purpose was to compare the efficiency and complications of GA 70% with Tretinoin 1% peeling.. A randomized, double-blinded clinical trial performed on 63 female patients with bilateral melasma. One facial side was treated by drug A (GA 70%) and the opposite side by agent B (Tretinoin 1%) peeling for four sessions with 2-week intervals. Descending changes in Melasma Area and Severity Index (MASI) scores, patients' discomfort and untoward complications following peeling all were evaluated and compared during the research period.. The efficiency of Tretinoin 1% peelings in declining the MASI score (treatment of melasma) was similar to GA 70%, as well as the rare unwanted complications of them. However, the patients' discomfort following procedures as expressed by their own, was significantly lower with Tretinoin 1% compared to GA 70% peeling. The cases' satisfaction with the intervention was statistically similar to each other. Furthermore, we experienced almost the equal times of beginning the therapeutic responses in both groups.

Topics: Adult; Double-Blind Method; Facial Dermatoses; Female; Glycolates; Humans; Keratolytic Agents; Melanosis; Middle Aged; Patient Satisfaction; Treatment Outcome; Tretinoin; Young Adult

Triple-combination (TC) cream is a stable combination of fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%, and currently is the only US Food and Drug Administration-approved drug for the topical treatment of melasma. Furthermore, it is the only US Food and Drug Administration-approved product containing hydroquinone. Anecdotal evidence suggests that improvements in melasma can be achieved with a multifactor approach involving TC cream with a variety of procedures. A pilot study was designed to evaluate the efficacy and safety of sequential treatment with TC cream and a series of glycolic acid (GA) peels in participants with moderate to severe melasma. Participants were treated with TC cream for 2 weeks before the alternating sequential treatment cycles with TC cream and GA peels began. A total of six 2-week cycles of TC cream and 5 GA peels were used. Efficacy and safety evaluations were conducted at weeks 6 and 12. Investigator global assessment (IGA) ratings indicated that 1 of 20 participants (5%) had achieved treatment success (clear/almost clear) as early as week 6 and most participants had achieved treatment success by week 12 (65% [13/20]; P < .001 vs baseline). Objective absorption spectrometry measurements of the difference in melanin for involved versus uninvolved skin confirmed that hyperpigmentation was significantly reduced in participants at weeks 6 and 12 compared with baseline (P < .001 for both). Investigator and participant evaluations revealed that most participants (> or = 90%) showed improvement (excellent improvement, much improved, improved) by week 12 with alternating sequential treatment with TC cream and GA peels. Furthermore, the results of this study indicated that sequential treatment with TC cream and GA peels was well-tolerated.

Topics: Administration, Cutaneous; Adult; Chemexfoliation; Dermatologic Agents; Drug Combinations; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Follow-Up Studies; Glycolates; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Ointments; Pilot Projects; Severity of Illness Index; Treatment Outcome; Tretinoin

Chemical peels have become a popular modality in the treatment of melasma. The most disturbing side effect of this procedure is postinflammatory hyperpigmentation. This may be minimized with the help of priming agents. Because there is a paucity of such studies, this study was taken up to evaluate the beneficial effects of hydroquinone versus tretinoin as priming agents in treatment of melasma with glycolic acid peels.. Sixty patients of melasma were randomly assigned in three groups of 20 patients each in a single-blind study. Group I received only glycolic acid peels while Groups II and III were primed with 0.025% tretinoin and 2% hydroquinone, respectively, for 2 weeks before peeling. The patients received serial glycolic acid peels fortnightly for the first 3 months and then monthly for the next 3 months and were then followed up for the next 3 months when peeling was stopped. Clinical and photographic evaluation was done at 3, 6, and 9 months, and subjective improvement was noted.. There was an overall decrease in MASI from baseline to 6 months in all three groups but it was highly significant between Groups I and III (p<.001) at 6 and 9 months and significant between Groups II and III (p<.01) at 9 months.. Results are better with hydroquinone as priming agent compared to tretinoin in enhancing the results with glycolic acid peels in melasma and in decreasing postpeel postinflammatory hyperpigmentation.

Topics: Adolescent; Adult; Chemexfoliation; Female; Glycolates; Humans; Hydroquinones; Male; Melanosis; Middle Aged; Treatment Outcome; Tretinoin

Melasma continues to be a difficult condition to treat, especially in dark-skinned patients, although various topical modalities including hydroquinone, tretinoin, and/or topical steroids have been used singly or in combination with variable results.. To determine if serial glycolic acid peels provide additional improvement when combined with a time-tested topical regimen, a modification of Kligman's formula (hydroquinone 5%, tretinoin 0.05%, hydrocortisone acetate 1% in a cream base). All cases had epidermal melasma as detected by Wood's light examination.. Forty Indian melasma patients were divided into two groups of 20 each. One group received serial glycolic acid peel combined with a topical regimen, modified Kligman's formula. The other, a control group, received only modified Kligman's formula. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 (before the fourth peel), and 21 (3 weeks after the sixth peel) weeks. For clinical evaluation, the Melasma Area and Severity Index (MASI) was used.. A significant decrease in the MASI score from baseline to 21 weeks was observed in both groups (P <.001). The group receiving the glycolic acid peels showed a trend toward more rapid and greater improvement, with statistically significant results (P <.001). Only a few side effects were observed in the peel group.. This study demonstrates that serial glycolic acid peels provide an additional effect to a topical regimen which is a modification of the time-tested Kligman's regimen for treating melasma in dark-complexioned individuals if used judiciously and under supervision. It demonstrates that superficial chemical peels are beneficial in the treatment of melasma.

Topics: Administration, Topical; Adult; Chemexfoliation; Drug Combinations; Female; Glycolates; Humans; Hydroquinones; Keratolytic Agents; Male; Melanosis; Middle Aged; Severity of Illness Index; Treatment Outcome; Tretinoin

Transient hyperpigmentation is the most common complication seen following cutaneous carbon dioxide (CO2) laser resurfacing.. The purpose of this study was to determine whether the use of a topical skin lightening regimen prior to cutaneous laser resurfacing reduces the incidence of post-laser resurfacing hyperpigmentation.. One hundred consecutive CO2 laser resurfacing patients (skin types I-III) were randomized to receive preoperative treatment with 10% glycolic acid cream twice daily (n=25), hydroquinone 4% cream qHS and tretinoin 0.025% cream twice daily (n=25) or no pretreatment (n=50, control) for at least 2 weeks. Clinical and photographic assessments were performed prior to laser resurfacing and at 4 and 12 weeks following treatment.. There was no significant difference in the incidence of post-CO2 laser resurfacing hyperpigmentation between subjects who received pretreatment with either topical glycolic acid cream or combination tretinoin/hydroquinone creams and those who received no pretreatment regimen.. It is postulated that reepithelialization after cutaneous laser resurfacing includes follicular melanocytes that have not been affected by topical pretreatment. When instituted as a component of the skin care regimen postoperatively, topical hydroquinone, tretinoin and/or glycolic acid preparations may be helpful in reducing post-laser resurfacing hyperpigmentation.

Topics: Administration, Cutaneous; Adult; Carbon Dioxide; Dermatologic Surgical Procedures; Facial Dermatoses; Female; Glycolates; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Laser Therapy; Male; Middle Aged; Premedication; Radiation-Protective Agents; Tretinoin

Studies comparing purported antiaging compounds are rare.. To compare in a randomized, placebo-controlled double-blind study 10% glycolic acid (GA), 2% 2-hydroxy-5-octanoyl benzoic acid (beta-lipohydroxy acid, LSA) and 0.05% all-trans-retinoic acid (RA).. Women volunteers treated one forearm twice daily with one of the active products and the other one with the vehicle. Comparative evaluations of efficacy were made using histochemistry and quantitative immunohistochemistry.. Improvement in the various epidermal compartments was the most prominent finding at the RA-treated site. The LSA-treated site also exhibited similar positive changes, although to a lesser degree. GA showed no significant effect.. In the presently tested concentrations and formulations, RA had a beneficial impact upon the aging epidermis. LSA mimicked RA but with somewhat lesser efficacy. By contrast, GA appeared almost inactive.

Topics: Double-Blind Method; Epidermis; Female; Filaggrin Proteins; Glycolates; Humans; Immunohistochemistry; Intermediate Filament Proteins; Keratins; Keratolytic Agents; Ki-67 Antigen; Lectins; Middle Aged; Plant Lectins; Salicylates; Skin; Skin Diseases; Transglutaminases; Treatment Outcome; Tretinoin

Melasma can be resistant to topical therapy.. Our purpose was to evaluate the efficacy of superficial peels in conjunction with topical tretinoin and hydroquinone in patients with melasma and to evaluate the ability of Wood's light examination to predict response to treatment.. We measured increased light reflectance in melasma areas with a colorimeter. Clinical observations were scored through an index designed to weigh numerically homogeneity, intensity of color, and area of melasma.. Colorimetric analysis showed an average lightening of 3.14 +/- 3.1 on the glycolic acid-treated side and 2.96 +/- 4.84 on the Jessner's solution-treated side. There was no statistically significant difference between the right and left. There was an overall decrease in melasma area and severity of 63%.. Superficial peels hasten the effects of topical therapy in melasma. Wood's light examination did not help predict response to treatment.

Topics: Chemexfoliation; Colorimetry; Drug Combinations; Ethanol; Facial Dermatoses; Female; Glycolates; Humans; Keratolytic Agents; Lactic Acid; Melanosis; Resorcinols; Salicylates; Tretinoin

Treatment of postinflammatory hyperpigmentation in patients of Fitzpatrick skin types IV, V, and VI is difficult. Glycolic acid peels are useful for pigment dyschromias in caucasians; however, there are no controlled studies examining their safety and efficacy in dark-complexioned individuals.. To determine if serial glycolic acid peels provide additional improvement when compared with a topical regimen of hydroquinone and tretinoin.. Nineteen patients with Fitzpatrick skin type IV, V, or VI were randomized to a control or peel group. The control group applied 2% hydroquinone/10% glycolic acid gel twice daily and 0.05% tretinoin cream at night. The peel patients used the same topical regimen and, in addition, received six serial glycolic acid peels (68% maximum concentration). Patients were evaluated with photography, colorimetry, and subjectively.. Sixteen patients completed the study. Both treatment groups demonstrated improvement, but the patients receiving the glycolic acid peels showed a trend toward more rapid and greater improvement. The peel group also experienced increased lightening of the normal skin.. This pilot study demonstrates that serial glycolic acid peels provide an additional benefit, with minimal adverse effects, for the treatment of postinflammatory hyperpigmentation in dark-complexioned individuals.

Topics: Administration, Topical; Adult; Black People; Chemexfoliation; Dermatitis; Drug Combinations; Female; Glycolates; Humans; Hydroquinones; Hyperpigmentation; Keratolytic Agents; Middle Aged; Pilot Projects; Tretinoin

Cutaneous intrinsic ageing has been shown to be improved by hormone replacement therapy (HRT). Photoageing is, however, unresponsive to such treatment. The present double-blind study was undertaken to compare the beneficial effect of a 1-month topical treatment with 0.05% all-trans-retinoic acid or 6% glycolic acid.. Biomechanical properties were measured on facial skin of HRT-treated menopausal women using both topical products on the hemifaces for 1 month.. Skin elasticity proved to be significantly higher at the tretinoin-treated site than at the glycolic acid-treated site.. Objective non-invasive measurements of the biomechanical properties of facial skin show the superiority of retinoic acid over glycolic acid in improving a deleterious effect of ageing.

Topics: Administration, Topical; Double-Blind Method; Estrogen Replacement Therapy; Estrogens, Conjugated (USP); Female; Glycolates; Humans; Keratolytic Agents; Medrogestone; Middle Aged; Postmenopause; Skin Aging; Time Factors; Tretinoin

Topics: Animals; Ascorbic Acid; Cosmeceuticals; Estrogens; Female; Glycine max; Glycolates; Mice; Mice, Hairless; Plant Preparations; Skin Aging; Tretinoin

Retinoids and hydroxy acids have been widely used due to their effects in the regulation of growth and in the differentiation of epithelial cells. However, besides their similar indication, they have different mechanisms of action and thus they may have different effects on the skin; in addition, since the topical formulation efficiency depends on vehicle characteristics, the ingredients of the formulation could alter their effects. Thus the objective of this study was to compare the effects of retinoic acid (RA) and glycolic acid (GA) treatment on the hairless mouse epidermis thickness and horny layer renewal when added in gel, gel cream, or cream formulations. For this, gel, gel cream, and cream formulations (with or without 6% GA or 0.05% RA) were applied in the dorsum of hairless mice, once a day for seven days. After that, the skin was analyzed by histopathologic, morphometric, and stereologic techniques. It was observed that the effects of RA occurred independently from the vehicle, while GA had better results when added in the gel cream and cream. Retinoic acid was more effective when compared to glycolic acid, mainly in the cell renewal and the exfoliation process because it decreased the horny layer thickness.

Topics: Administration, Topical; Animals; Cell Size; Chemistry, Pharmaceutical; Epithelium; Glycolates; Male; Mice, Hairless; Skin; Tretinoin

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Antioxidants; Chemexfoliation; Drug Combinations; Face; Female; Fluocinolone Acetonide; Glycolates; Humans; Hydroquinones; India; Keratolytic Agents; Male; Melanosis; Middle Aged; Treatment Outcome; Tretinoin; Young Adult

Retinoids and alpha-hydroxy acids (AHAs) are major compounds in topical therapy. They exert distinct but potentially complementary activities. However, their association is limited by their respective irritating potential. Recently, the first association between a retinoid and an AHA has been achieved; this formulation (RALGA) associates retinaldehyde (RAL)--a precursor of retinoic acid (RA)--and glycolic acid (GA)--an AHA.. To study the pharmacological properties of RALGA.. The bioavailability of RAL into the skin after topical RALGA was studied by HPLC, and its bioconversion to RA was analysed by measuring the enzyme activity of retinaldehyde dehydrogenase and the RA content in the epidermis and dermis. The retinoid activity of RALGA was studied on the modulation of Hhb4 keratin mRNA on the tail of C57BL/6 mice, and its comedolytic properties on the size and density of dermal cysts and the morphology of sebaceous glands in hairless mice.. Epidermal and dermal concentrations of RAL and RA were higher after RALGA treatment, as compared to both RAL 0.1% alone and RA 0.05% alone; this indicates that the presence of GA favours the bioavailability and biotransformation of RAL into RA. The retinoid activity of RALGA (suppression of Hhb4 mRNA keratin) was similar to that of RAL alone, indicating that the presence of GA does not interfere with specific retinoid activity; GA alone had no effect in this test, which confirms the specificity of Hhb4 mRNA keratin modulation for retinoid activity. The diameter and the density of dermal cysts as well as the size of sebaceous glands were significantly decreased by RALGA.. These observations indicate that the addition of an AHA such as GA to a retinoid such as RAL results in a better bioavailability of the retinoid, thus a higher delivery of RA, which potentiates the biological activities of the retinoid. This combination allows a delivery of high amounts of RA in the skin while preventing the side-effects usually observed with high concentrations of topical RA.

Topics: Aldehyde Oxidoreductases; Animals; Biological Availability; Biotransformation; Chromatography, High Pressure Liquid; Cysts; Dermatologic Agents; Dermis; Drug Combinations; Epidermis; Female; Glycolates; Keratins; Keratolytic Agents; Mice; Mice, Hairless; Mice, Inbred C57BL; Mice, Inbred Strains; Retinal Dehydrogenase; Retinaldehyde; Sebaceous Glands; Tretinoin

Chemical peels have become a popular method for treating melasma. Although daily topical 0.05 and 0.1% tretinoin have been used for melasma, the therapy takes at least 4 to 6 months to produce clinically significant lightening. In a recent trial, 1% tretinoin peel has shown good clinical and histologic results after biweekly applications in 2.5 weeks only in the treatment of melasma.. Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent versus a standard peeling agent, 70% glycolic acid, in the treatment of melasma in Indian women.. Ten female patients of melasma, after written consent, were taken up for an open left-right comparison pilot study of 12 weeks. One percent tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other at weekly intervals. The results were evaluated by a clinical investigator by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks.. A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed on both facial sides (p<0.001). Nevertheless, there was no statistically significant difference between the right and the left sides. Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients.. It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel, 70% glycolic acid, although larger trials over longer periods may be necessary to substantiate such findings.

Topics: Administration, Topical; Adult; Asian People; Chemexfoliation; Face; Female; Glycolates; Humans; India; Keratolytic Agents; Melanosis; Pilot Projects; Prospective Studies; Treatment Outcome; Tretinoin

To study the potential anti-androgenic activity of roxithromycin (RXM), we previously used human dermal fibroblasts transiently transfected with the expression vector of androgen receptor (AR) coactivator ARA55 as the in vitro model reflecting the end-organ hypersensitivity.. To examine the potential anti-androgenic activity of anti-acne therapeutic agents, nadifloxacin (NDFX), RXM, all-trans retinoic acid (atRA), and glycolic acid (GA), we carried out the transient transfection assays using the CV-1 cells as a more sensitive assay system.. The result showed that 5 microg/ml of RXM suppress 10(-9)M R1881-induced AR transcriptional activity by 21.2%. 50 microg/ml of NDFX can suppress AR transcriptional activity to 29.8%. Furthermore, the assays with treatment of 1, 5, 10, or 50 microg/ml NDFX in the presence of 1 microg/ml RXM showed that 5, 10, or 50 microg/ml NDFX inhibits the AR transactivity by 32.7, 31.1 or 61.0%, respectively, indicating the synergistic effect of NDFX and RXM. Besides 10(-5)M atRA suppressed the R1881-induced luciferase activity by 50%, but GA did not alter AR transactivity.. We demonstrated that anti-acne agents available in the clinical practice can exert anti-androgenic effects in the treatment of acne.

Topics: Acne Vulgaris; Androgen Antagonists; Animals; Cell Line; Dermatologic Agents; Fluoroquinolones; Glycolates; Haplorhini; Metribolone; Quinolizines; Receptors, Androgen; Roxithromycin; Transcription, Genetic; Transfection; Tretinoin

Topics: Clinical Trials as Topic; Confounding Factors, Epidemiologic; Drug Administration Schedule; Glycolates; Humans; Keratolytic Agents; Melanosis; Tretinoin

Topics: Erythema; Glycolates; Humans; Hydroquinones; Keratolytic Agents; Laser Therapy; Lasers; Pigmentation Disorders; Radiation-Protective Agents; Randomized Controlled Trials as Topic; Time Factors; Tretinoin

Topical treatment of striae rubra with 0.1% tretinoin and laser treatment of striae rubra and alba with the 585-nm pulsed dye laser are proven therapeutic options. However, little efficacy has been shown for treatment of striae alba topically, and the laser is currently not a suitable treatment option for darker ethnic skin types.. The purpose of this study was to demonstrate that selected commercial topical agents can improve the appearance of striae alba.. Ten patients of varying skin types (I-V) having straie distensae alba on the abdomen or thighs were selected to evaluate the effectiveness of two topical treatment regimens. Patients were placed on daily topical application of 20% glycolic acid (MD Forte) to the entire treatment area. In addition, the patients applied 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine to half to the treatment area and 0.05% tretinoin emollient cream (Renova) to the other half of the treatment area. The creams were applied on a daily basis for 12 weeks. Improvement was evaluated at 4 and 12 weeks in an objective unblinded fashion at the follow-up visits, a objective blinded fashion by visual grading at the conclusion of the study, and in an objective blinded fashion with profilometry. Additionally, histopathologic analysis was performed.. Analysis of these data reveals: 1) both regimens can improve the appearance of stretch marks; 2) these topical therapy regimens are safe and effective in study patients with minimal irritation; 3) elastin content within the reticular and papillary dermis can increase with topical 20% glycolic acid combined with 0.05% tretinoin emollient cream therapy; 4) both regimens increased epidermal thickness and decreased papillary dermal thickness in treated stretch marks when compared with untreated stretch marks; 5) combined epidermal and papillary dermal thickness in stretch marks treated with either topical regimen approaches that of normal skin; and 6) profilometry can objectively measure differences in skin texture associated with striae treatments when compared to controls, however, it is not sensitive enough to justify comparison or quantitative improvements between similarly effective treatments.

Topics: Abdomen; Administration, Cutaneous; Adult; Ascorbic Acid; Astringents; Atrophy; Connective Tissue Diseases; Dermatologic Agents; Drug Combinations; Elastic Tissue; Elastin; Emollients; Female; Follow-Up Studies; Glycolates; Humans; Keratolytic Agents; Middle Aged; Safety; Single-Blind Method; Skin; Thigh; Tretinoin; Tyrosine; Zinc Sulfate

Eleven female patients are reported who underwent full-face resurfacing. Three patients were treated for cosmetic rhytids, five for residual acne scarring, and three for photoaging. There were no complications or side effects in this group of patients. Reepithelialization was achieved in an average of 9.3 days, and erythema disappeared in an average of 8.9 weeks. The UltraPulse carbon dioxide laser with computerized pattern generator (CPG) scanner allows a rapid, uniform laserbrasion. The sequence of the procedure involves close application of adjacent squares at 60 W, 200 to 300 ml, at moderate density. Skin preparation with Retin-A and bleaching agents is important for best wound healing. Postoperative wound care includes maintenance of a moist environment and Zovirax for herpes prophylaxis.

Topics: Acne Vulgaris; Acyclovir; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antiviral Agents; Carbon Dioxide; Cicatrix; Dexamethasone; Epithelium; Erythema; Facial Dermatoses; Female; Follow-Up Studies; Glycolates; Herpesviridae Infections; Humans; Hydroquinones; Keratolytic Agents; Laser Therapy; Middle Aged; Radiation-Protective Agents; Rhytidoplasty; Skin Aging; Skin Care; Therapy, Computer-Assisted; Tretinoin; Wound Healing

Recently, there has been an exponential increase in the use of alpha-hydroxy acids in dermatologic practice. Their inclusion in a myriad of cosmetic preparations underscores their popularity. Among the clinical effects of alpha-hydroxy acids are their ability to prevent the atropy resulting from potent topical corticosteroids, improve the appearance of photoaged skin, and correct disorders of keratinization. Despite this range of desirable effects, very little is known about the specific changes produced by various alpha-hydroxy acid preparations in the epidermis and dermal extracellular matrix. Previous work by others has demonstrated the ability of another alpha-hydroxy acid to increase viable epidermal thickness, and dermal glycosaminoglycans.. In this study, we examined the effect of 20% citric acid lotion, as compared with vehicle alone, on skin thickness, viable epidermal thickness, and dermal glycosaminoglycan content. Biopsy samples were harvested after 3 months of treatment.. Image analysis of biopsy sections revealed increases in viable epidermal thickness and dermal glycosaminoglycans in treated skin.. Topical citric acid produces changes similar to those observed in response to glycolic acid, ammonium lactate, and retinoic acid including increases in epidermal and dermal glycosaminoglycans and viable epidermal thickness. Further studies of citric acid and other alpha-hydroxy acids are warranted to clarify their clinical effects and mechanisms of action.

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Atrophy; Biopsy; Chondroitin Sulfates; Citric Acid; Dermatologic Agents; Epidermis; Extracellular Matrix; Female; Follow-Up Studies; Glucocorticoids; Glycolates; Glycosaminoglycans; Humans; Hyaluronic Acid; Hydroxy Acids; Image Processing, Computer-Assisted; Keratins; Keratolytic Agents; Lactates; Pharmaceutical Vehicles; Quaternary Ammonium Compounds; Skin; Skin Aging; Tissue Survival; Tretinoin

Topics: Administration, Topical; Antioxidants; Ascorbic Acid; Controlled Clinical Trials as Topic; Double-Blind Method; Glycolates; Humans; Lactic Acid; Radiation-Protective Agents; Skin; Skin Aging; Skin Physiological Phenomena; Tretinoin; Ultraviolet Rays; Vitamin E

The effects of topical glycolic acid and all-trans retinoic acid on stratum corneum barrier function and hydration of human skin were investigated in 6 healthy volunteers utilizing non-invasive techniques. In addition, changes in stratum corneum turnover time induced by the substances were examined using the dansyl chloride fluorescence test. Twelve percent glycolic acid in water and 0.1% retinoic acid in ethanol, respectively, were applied for 60 min once daily, over a period of 2 weeks (5 consecutive days weekly) on dansyl chloride-labelled skin and on untreated skin. During a 10-day application period, both glycolic acid and retinoic acid similarly induced a significant increase in TEWL. However, after discontinuing treatment, TEWL in retinoic acid-exposed skin remained increased. Glycolic acid significantly reduced stratum corneum hydration from day 11 to day 18 (p < 0.05), while retinoic acid induced skin dryness after 9 days of treatment, which persisted until day 18 (p < 0.005). Whereas glycolic acid rapidly induced an intense erythema implying a direct non-specific inflammatory response, the retinoic acid-exposed skin gradually developed erythema. Retinoic acid caused scaling to a greater extent than did glycolic acid, even after treatment cessation. Both glycolic acid and retinoic acid significantly decreased stratum corneum turnover time and stratum corneum turnover time50 (the time in days from labelling until approximately 50% of fluorescence disappeared), compared with the vehicle controls. However, glycolic acid shortened stratum corneum turnover time (12.8 +/- 0.9 days) as well as stratum corneum turnover time50 (7.3 +/- 0.7 d) significantly more than did retinoic acid (15.8 +/- 0.7 d and 9 +/- 0.8 d, respectively). While ethanol (vehicle of retinoic acid) slightly but significantly decreased stratum corneum turnover time (p < 0.05), water (vehicle of glycolic acid) did not. This study showed that both glycolic acid and retinoic acid induced certain functional changes in stratum corneum, mirroring their irritation potential. However, changes at retinoic acid-exposed sites appeared longer-lasting, implying a distinct mode of action. An increase in stratum corneum turnover induced by the substances may be, in part, linked with their irritation properties.

Topics: Adult; Body Water; Epidermis; Female; Glycolates; Humans; Irritants; Keratolytic Agents; Male; Tretinoin; Water Loss, Insensible