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10% thioglycolic acid gel peels: a safe and efficient option for pigmented purpuric dermatosis

Presented by
Dr Arunima Ray, IMS and SUM Hospital, India
Conference
ICD 2021
Pigmented purpuric dermatosis (PPD) is a dyspigmentation skin disorder. A treatment option for PPD that has been considered is 10% thioglycolic acid (TGA), which has shown efficacy and safety in a pilot study.

PPD is a chronic condition characterised by reddish-brown skin lesions caused by capillaritis. Although it can arise on any part of the body, lesions are usually found on the legs. While benign, PPD can cause considerable cosmetic concern. There is no effective treatment available for PPD, which calls for new therapies to be explored. The use of 10% TGA gel was found to be effective for pigmentary dermatoses in general. Thus, Dr Arunima Ray (IMS and SUM Hospital, India) and her team conducted a pilot study to assess the efficacy and safety of 10% TGA in the clearance of PPD [1].

A prospective, right-left leg comparative pilot study was conducted in patients with bilateral PPD over the legs. Peeling sessions were done in a tertiary hospital in Eastern India. The peel was applied weekly on the left leg for 6 weeks, while the right leg remained untreated. Photographs and dermoscopic images were evaluated at baseline and weeks 3 and 6. Patient self-assessment and dermatologists’ assessment were compared. Side effects were monitored during the peel application and afterwards.

Of 10 patients included, 4 observed mild improvement, 5 moderate improvement, and 1 marked improvement. According to the physician’s assessment, 2 patients had >60% improvement, 5 patients had 30–60% improvement, and 3 patients had <30% improvement. Dermoscopic assessment showed a decrease in red dots and intensity of brownish pigment at 6 weeks in all patients. An increase in scaling was seen in the post-peel period in all patients. Side effects were mild, including burning sensation, foul smell, and persistent smell during peel application. One patient had post-procedural erythema, pain, and swelling of the peeling site for 5 days, which was resolved with topical mometasone.

In conclusion, 10% TGA was effective in the partial clearance of PPD dyspigmentation with weekly sessions for 6 weeks without any serious side effects. While TGA peel is commercially unavailable in India, topical TGA can be safely used at less than 15% concentration.


    1. Ray A, et al. Use of 10% thioglycolic acid peel in treatment of pigmented purpuric dermatoses – a pilot study. Abstract 220, ICD 2021, 10–13 November.

 

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