Citric acid formulations enhance glycolic acid peels

New Orleans - Peel formulationscontaining citric acid appear to be a safe and effective adjuvant for enhancing outcomes of glycolic acid peels, reported Elizabeth Briden, M.D., adjunct associate professor of dermatology, University of Minnesota, Minn., and a private practitioner in Edina, Minn., at the 63^rd Annual Meeting of the American Academy of Dermatology, here.

The citric acid "booster peels" are available from NeoStrata Company in three versions that are formulated with different ingredients to address specific skin problems. There is an antioxidant product targeting environmental damage (photoaging), a brightening peel formulated for skin with uneven pigmentation and a clarifying peel for acne-prone skin.

Application The booster peel solution is rubbed onto the face using a pre-saturated pad. After two minutes, if the patient is tolerating the peel, the glycolic acid solution is applied directly on top. The theory underlying this dual regimen is that each peel will complement and enhance overall activity and improve outcomes without compromising the safety of the superficial peels.

Non-irritating, safe Dr. Briden's experience indicated the citric acid booster peel was non-irritating and safe. Based on clinical impressions, it also appeared to enhance the outcomes of the glycolic peel by hastening the time to onset of improvement and increasing its extent relative to treatment with glycolic acid peels alone. Overall, outcomes were rated as good to excellent by both the patients and physician, and all patients elected to continue with the peeling regimen after the study was completed.

"Based on this initial study, the citric acid peel booster pads appear to be an easy way to take the results of glycolic acid peeling a step further without increasing downtime or the risk of complications," Dr. Briden tells Dermatology Times. However, controlled clinical trials will be needed to conclusively demonstrate the benefit of the booster peels for enhancing outcomes."

Spectrum of activities Citric acid is an alpha- and beta hydroxy acid and has the skin benefits associated with those compounds as well as antioxidant activity due to free radical scavenging effects.

In clinical studies using concentrations of citric acid ranging from 10 percent to 25 percent, it has been shown to cause visible improvement in skin quality consistent with histological changes in the epidermis and dermis that included smoothing of the stratum corneum, increases in viable epidermal thickness, collagen synthesis and density of water-binding glycosoaminoglycans, as well as improvement in the quality of elastic fibers.

"Citric acid is an attractive agent for anti-aging skincare because of its combined antioxidant and rejuvenating effects," Dr. Briden says.

In the booster peel designed to treat environmentally damaged skin, 30 percent citric acid is the sole beneficial ingredient. Two bleaching agents, kojic acid 3 percent and arbutin 2 percent, are added to the formulation for the brightening peel targeting uneven pigmentation. The clarifying peel for acne-prone skin contains 10 percent citric acid with 20 percent mandelic acid, a lipophilic alpha-hydroxy acid that targets the sebaceous gland and also has antibacterial properties.

Start slow When using the citric acid booster peel as an adjuvant to glycolic acid in patients who have had glycolic acid peels in the past, the glycolic acid peel should be performed at first using a concentration that is a step lower than that used previously.

In patients naive to glycolic acid peeling, a glycolic acid concentration of 20 percent should be used, or treatment can be performed with the citric acid peel booster alone for the first one or two sessions in patients with highly sensitive skin, Dr. Briden recommends.