Published: 2017-01-02

Assessment of response of microdermabrasion with 2% kojic acid in melasma

Kalpana Gupta, Nidheesh Agarwal


Background: Melasma is an acquired disorder of hypermelanosis and several therapeutic modalities is in use to treat melasma. Kojic acid is a popular depigmenting agent, but its hydrophilic nature limits its transepidermal penetration. Microdermabrasion has been reported to increase the penetration of topical preparations. The objective of the study was to compare the efficacy of daily kojic acid (2%) gel along with biweekly microdermabrasion versus daily kojic acid (2%) gel alone in Indian patients.

Methods: This study was carried out in 60 patients with melasma which were randomised into 2 groups of 30 patients each. The group I patients were treated with kojic acid 2% gel along with biweekly microdermabrasion, and group II patients were treated with kojic acid 2% gel alone. The results were assessed and compared after 12 weeks.

Results: Both objective assessment and subjective assessment did not reveal a statistically significant difference in the treatment efficacy of two groups. However, the patients who received biweekly microdermabrasion were significantly more satisfied than those who did not.

Conclusions: Microdermabrasion does not appear to have any synergistic effect with kojic acid in decreasing pigmentation in melasma. However, it does have a placebo effect on the patient.



Melasma, Microdermabrasion, Kojic acid

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Sheth VM, Pandya AG. Melasma: a comprehensive update (Part I). J Am Acad Dermatol. 2011;65:689-97.

Curto EV, Kwong C, Hermersdörfer H, Glatt H, Santis C, Virador V, et al. Inhibitors of mammalian melanocyte tyrosinase: in-vitro comparisons of alkyl esters of gentisic acid with other putative inhibitors. Biochem Pharmacol. 1999;57:663-72.

Bentley R. From miso, saké and shoyu to cosmetics: a century of science for kojic acid. Nat Prod Rep. 2006;23:46-62.

Brtko J, Rondahl L, Fickova M, Hudecova D, Eybl V, Uher M. Kojic acid and its derivatives: History and present state of art. Cent Eur J Publ Health. 2004;12:16-18.

Burdock GA, Soni MG, Carabin IG. Evaluation of health aspects of kojic acid in food. Regul Toxicol Pharmacol. 2001;33:80-101.

Cabanes J, Chazarra S, Garcia-Carmona F. Kojic acid, a cosmetic skin whitening agent, is a slow-binding inhibitor of catecholase activity of Tyrosinase. J Pharm Pharmacol, 1994;46:982-5.

Choi H, Kim K, Han J, Choi H, Jin SH, Lee EK, et al. Kojic acid induced IL-6 production in human keratinocytes plays a role in its anti-melanogenic activity in skin. J Dermatol Sci. 2012;66(3):207-15.

Gill HS, Andrews SN, Sakthivel SK, Fedanov A, Williams IR, Garber DA, Priddy FH, Yellin S, Feinberg MB, Staprans SI, Prausnitz MR. Selective removal of stratum corneum by microdermabrasion to increase skin permeability. Eur J Pharm Sci. 2009;38(2):95-103.

Kauvar AN. Successful treatment of melasma using a combination of microdermabrasion and Q-switched Nd:YAG lasers. Lasers Surg Med. 2012;44(2):117-24.

Briden E, Jacobsen E, Johnson C. Combining superficial glycolic acid (alpha-hydroxy acid) peels with microdermabrasion to maximize treatment results and patient satisfaction. Cutis. 2007;79(1):13-6.

Hexsel D, Mazzuco R, Dal'Forno T, Zechmeister D. Microdermabrasion followed by a 5% retinoid acid chemical peel vs. a 5% retinoid acid chemical peel for the treatment of photoaging - a pilot study. J Cosmet Dermatol. 2005;4(2):111-6.

Trommer H, Neubert RH. Overcoming the stratum corneum: the modulation of skin penetration. a review. Skin Pharmacol Physiol. 2006;19:106-21.

Walker RB, Smith EW. The role of percutaneous penetration enhancer. Adv Drug Del Rev. 1996; 18:295-301.

Lee WR, Tsai RY, Fang CL, Liu CJ, Hu CH, Fang JY. Microdermabrasion as a novel tool to enhance drug delivery via the skin: an animal study. Dermatol Surg. 2006;32(8):1013-22.

Cornwell PA, Barry BW. Sesquiterpene components of volatile oils as skin penetration enhancers for the hydrophilic permeant 5-fluorouracil. J Pharm Pharmacol. 1994;46:261-9.

Phillips CA, Michniak BB. Transdermal delivery of drugs with differing lipophilicities using azoneanalogs as dermal penetration enhancers. J Pharm Sci. 1995;84:1427-33.

Sinha VR, Kaur MP. Permeation enhancers for transdermal drug delivery. Drug Dev Ind Pharm. 2000;26:1131-40.

Trommer H, Neubert RH. Overcoming the stratum corneum: the modulation of skin penetration. A review. Skin Pharmacol Physiol. 2006;19:106-21.

Walker RB, Smith EW. The role of percutaneous penetration enhancer. Adv Drug Del Rev. 1996;18:295-301.

El Maghraby GM. Microemulsions as transdermal drug delivery systems. Current Nanoscience. 2012;8:504-11.

Ntimenou V, Fahr A, Antimisiaris SG. Elastic vesicles for transdermal drug delivery of hydrophilic drugs: a comparison of important physicochemical characteristics of different vesicle types. J Biomed Nanotechnol. 2012;8:613-23.

Gómez C, Costela A, García-Moreno I, Llanes F, Teijón JM, Blanco D. Laser treatments on skin enhancing and controlling transdermal delivery of 5-flurouracil. Lasers Surg Med. 2008;40:6-12.

Lee WR, Shen SC, Lai HH, Hu CH, Fang JY. Transdermal drug delivery enhanced and controlled by erbium:YAG laser: a comparative study of lipophilic and hydrophilic drugs. J Control Release. 2001;75:155-66.

Freedman BM, Rueda-Pedraza E, Earley RV. Clinical and histologic changes determine optimal treatment regimens for microdermabrasion. J Dermatolog Treat. 2002;13(4):193-200.

Fujimoto T, Shirakami K, Tojo K. Effect of microdermabrasion on barrier capacity of stratum corneum. Chem Pharm Bull. 2005;53:1014-6.

Lee WR, Shen SC, Wang KH, Hu CH, Fang JY. Lasers and microdermabrasion enhance and control topical delivery of vitamin C. J. Invest. Dermatol. 2003;121:1118-25.

Fang JY, Lee WR, Shen SC, Fang YP, Hu CH. Enhancement of topical 5-aminolaevulinic acid delivery by erbium:YAG laser and microdermabrasion: a comparison with iontophoresis and electroporation. Br J Dermatol. 2004;151:132-40.

Lim JT. Treatment of melasma using KA in a gel containing HQ and glycolic acid. Dermatol Surg. 1999;25:282-417.

Garcia A, Fulton JE Jr. The combination of glycolic acid and HQ or KA for the treatment of melasma and related conditions. Dermatol Surg. 1996;22:443-7.