Glycolic acid peel for acne: is it still relevant?
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AHA peels are considered inferior to BHA for acne treatment. What is the available evidence for the use of AHA peels in acne?
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Glycolic acid peel for acne: is it still relevant?
- 1. Glycolic Acid Peel for Acne: Is it relevant? Peter Nugraha Soekmadji Department of Dermatovenereology Faculty of Medicine Maranatha Christian University Bandung
- 2. Conflict of Interest Statement • NO support or commercial funding for this presentation or for any products mentioned here
- 4. Acne Vulgaris Fitzpatrick's Dermatology in General Medicine, 8th Ed
- 5. Acne Variants Fitzpatrick's Dermatology in General Medicine, 8th Ed • Acne conglobata • Acne fulminans • Acne mechanica • Drug-induced acne • Occupational acne • Gram negative folliculitis • Tropical acne
- 7. Chemical Peels • α-Hydroxy acids: glycolic acid, lactic acid, mandelic acid, citric acid • β-hydroxy acid: salicylic acid • Jessner solution • Trichloroacetic acid • Phenol peel • Various cocktail peels Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed Fitzpatrick's Dermatology in General Medicine, 8th Ed
- 8. Fitzpatrick's Dermatology in General Medicine, 8th Ed
- 9. Possible Depths of Peels Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 10. Glycolic Acid • Fruit acids • α-Hydoxy-acid • pKa: 3.83
- 11. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 12. Mechanism of Action of Glycolic Acid
- 13. Glycolic Acid for Acne • Disrupts corneocyte cohesion → works well on comedonal acne
- 14. A 10% GA containing oil-in-water emulsion improves mild acne - a double-blind placebo-RCT
- 15. Glycolic Acid for Acne • Disrupts corneocyte cohesion → works well on comedonal acne • What is the efficacy on inflammatory acne?
- 16. GA has bactericidal effects on P. Acnes Takenaka Y, Hayashi N, Takeda M, Ashikaga S, Kawashima M. Glycolic acid chemical peeling improves inflammatory acne eruptions through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol. 2012 Apr;39(4):350-4. doi: 10.1111/j.1346- 8138.2011.01321.x. Epub 2011 Sep 28.
- 17. Takenaka Y, Hayashi N, Takeda M, Ashikaga S, Kawashima M. Glycolic acid chemical peeling improves inflammatory acne eruptions through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol. 2012 Apr;39(4):350-4. doi: 10.1111/j.1346- 8138.2011.01321.x. Epub 2011 Sep 28. pH 1.5 pH 3.5 pH 5.5
- 18. P. acnes colonies decrease after GA peels Takenaka Y, Hayashi N, Takeda M, Ashikaga S, Kawashima M. Glycolic acid chemical peeling improves inflammatory acne eruptions through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol. 2012 Apr;39(4):350-4. doi: 10.1111/j.1346- 8138.2011.01321.x. Epub 2011 Sep 28.
- 19. Glycolic Acid Peel vs Placebo
- 20. Quality of Evidence on GA Efficacy de Vries FMC, Meulendijks AM, Driessen RJB, van Dooren AA, Tjin EPM, van de Kerkhof PCM. The efficacy and safety of non- pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis. J Eur Acad Dermatol Venereol. 2018 Jul;32(7):1195-1203. doi: 10.1111/jdv.14881.
- 21. GA vs Placebo Kaminaka C, Uede M, Matsunaka H, Furukawa F, Yamomoto Y. Clinical evaluation of glycolic acid chemical peeling in patients with acne vulgaris: a randomized, double-blind, placebo-controlled, split-face comparative study. Dermatol Surg. 2014 Mar;40(3):314- 22. doi: 10.1111/dsu.12417. Epub 2014 Jan 21. GA Placebo
- 22. • 25 patients • Split-face comparison RCT • 40% GA vs placebo, every 2 weeks, 5x • GA significantly superior than placebo • Flare-up of GA 12% (not statistically significant) GA vs Placebo: Comments Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607. Kaminaka C, Uede M, Matsunaka H, Furukawa F, Yamomoto Y. Clinical evaluation of glycolic acid chemical peeling in patients with acne vulgaris: a
- 23. Glycolic Acid Peel vs Other Peels
- 24. GA vs Salicylic Acid Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris. Dermatol Surg. 2008 Jan;34(1):45-50; discussion 51. Epub 2007 Dec 5.
- 25. GA vs Salicylic Acid Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris. Dermatol Surg. 2008 Jan;34(1):45-50; discussion 51. Epub 2007 Dec 5.
- 26. GA vs Salicylic Acid: Comments Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607. Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to • 20 patients • Split-face comparison RCT • 30% GA vs 30% SA, every 2 weeks, 6x • Total number of lesions & patients’ preference was comparable • After 2-month follow-up, mean number of lesions was higher on GA-treated side
- 27. Comparison of AHA vs BHA AHA BHA Lipophilic - + Inhibits arachidonic acid - + Anesthetic properties - + Antiinflammatory properties ± + Increase collagen + - Ease of use (neutralization, time dependent) + +++ Use in pregnancy + - Cosmetic Dermatology - Principles & Practice, 2nd Ed
- 28. AG vs SA+Mandelic Acid El Refaei, Asmaa M.; Abdel Salam, Hany A.; Sorour, Neveen E. Salicylic–mandelic acid versus glycolic acid peels in Egyptian patients with acne vulgaris. Journal of the Egyptian Women's Dermatologic Society, Volume 12, Number 3, September 2015, pp. 196- 202(7). DOI: 10.1097/01.EWX.0000464740.18592.42 GA SA+MA
- 29. AG vs SA+Mandelic Acid El Refaei, Asmaa M.; Abdel Salam, Hany A.; Sorour, Neveen E. Salicylic–mandelic acid versus glycolic acid peels in Egyptian patients with acne vulgaris. Journal of the Egyptian Women's Dermatologic Society, Volume 12, Number 3, September 2015, pp. 196- 202(7). DOI: 10.1097/01.EWX.0000464740.18592.42
- 30. AG vs SA+MA: Comments Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607. El Refaei, Asmaa M.; Abdel Salam, Hany A.; Sorour, Neveen E. Salicylic–mandelic acid versus glycolic acid peels in Egyptian patients with acne • 40 patients • RCT • 35% GA vs 20% SA + 10% MA, every 2 weeks, 6x • SA+MA was superior in all aspects, except in improvement on scars • Side effects was comparable
- 31. GA vs Jessner Kim SW, Moon SE, Kim JA, Eun HC. Glycolic acid versus Jessner's solution: which is better for facial acne patients? A randomized prospective clinical trial of split-face model therapy. Dermatol Surg. 1999 Apr;25(4):270-3.
- 32. GA vs Jessner: Comments Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607. • 25 patients • Split-face comparison RCT • 70% GA vs JS, every 2 weeks, 3x • Efficacy & patient’s preference was comparable • JS-induced scaling negatively affect patient’s daily activities (0 vs 36%)
- 33. GA vs Amino Acid Ilknur T, Demirtaşoğlu M, Biçak MU, Ozkan S.. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther. 2010 Oct;12(5):242-5. doi: 10.3109/14764172.2010.514919. baseline 3 month 6 month AA GA
- 34. GA vs Amino Acid: Comments Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. doi: 10.1136/bmjopen-2017-019607. Ilknur T, Demirtaşoğlu M, Biçak MU, Ozkan S.. Glycolic acid peels versus amino fruit acid peels for acne. J Cosmet Laser Ther. 2010 Oct;12(5):242- • 30 patients • Split-face comparison RCT • 20-70% GA vs 20-60% AA, every 2 weeks, 12x • Efficacy & patient’s preference was comparable • Discomfort was more common on GA
- 35. Glycolic Acid Peel: Clinical Pearls
- 36. Kontochristopoulos G, Platsidaki E. Chemical peels in active acne and acne scars. Clin Dermatol. 2017 Mar - Apr;35(2):179-182. doi: 10.1016/j.clindermatol.2016.10.011. Epub 2016 Oct 27.
- 37. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 38. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 39. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 40. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 41. Textbook of Chemical Peels - Superficial, Medium & Deep Peels In Cosmetic Practice, 2nd Ed
- 43. GA Peel For Acne • Good treatment modalities for comedonal acne • Inferior to salicylic acid for inflammatory acne • Great options if patients can not tolerate side effects of other peels (desquamation, etc) • Useful if patients are able to adhere to long- term and 2x/month treatment plan
Editor's Notes
- Glycolic acid (GA) side: clinical appearance (A) before treatment and (B) at week 10. Placebo side: clinical appearance (C) before treatment and (D) at week 10. These photographs show improvement on both treated sides at week 10. There was a larger decline in the number of inflammatory and noninflammatory lesions on the GA side than on the placebo side between baseline and week 10 (GA side: inflammatory lesion count dropped from 15 to 4; noninflammatory lesion count dropped from 15 to 4. Placebo: inflammatory lesion counted dropped from 13 to 17; noninflammatory lesion counted dropped from 14 to 10).
- Glycolic acid (GA) side: clinical appearance (A) before treatment and (B) at week 10. Placebo side: clinical appearance (C) before treatment and (D) at week 10. These photographs show improvement on both treated sides at week 10. There was a larger decline in the number of inflammatory and noninflammatory lesions on the GA side than on the placebo side between baseline and week 10 (GA side: inflammatory lesion count dropped from 15 to 4; noninflammatory lesion count dropped from 15 to 4. Placebo: inflammatory lesion counted dropped from 13 to 17; noninflammatory lesion counted dropped from 14 to 10).
- Typical patient course shown. (A) Patient at baseline; (B) patient after third treatment; (C) Patient after fifth treatment; (D) patient at 2-month follow-up. Similar degrees of improvement in acne lesions were noted with both the glycolic and the salicylic acid peels. No significant difference in texture, color, or pigmentation is seen between either treatment side.
- Typical patient course shown. (A) Patient at baseline; (B) patient after third treatment; (C) Patient after fifth treatment; (D) patient at 2-month follow-up. Similar degrees of improvement in acne lesions were noted with both the glycolic and the salicylic acid peels. No significant difference in texture, color, or pigmentation is seen between either treatment side.
- Typical patient course shown. (A) Patient at baseline; (B) patient after third treatment; (C) Patient after fifth treatment; (D) patient at 2-month follow-up. Similar degrees of improvement in acne lesions were noted with both the glycolic and the salicylic acid peels. No significant difference in texture, color, or pigmentation is seen between either treatment side.
- Participant’s photographs at baseline (A) and at month 3 (B) and 6 (C) of the treatment. Amino fruit acid peels were applied to the right side and glycolic acid peels were applied to the left side.