A Comparative Study of Topical 4% Kojic Acid Versus 25% Glycolic Acid Peel in Patients With Melasma at a Tertiary Care Centre

Background: Melasma is a common facial hyperpigmentary disorder with frequent recurrence and variable treatment response. The objective is to compare the efficacy and safety of topical 4% kojic acid with 25% glycolic acid peels in moderate-to-severe melasma. Material and Methods: In this prospective comparative study, 60 adults were allocated to topical 4% kojic acid once nightly or 25% glycolic acid peel every 3 weeks for six sessions. Participants were followed for 18 weeks. The primary outcome was change in Melasma Area and Severity Index (MASI). Patient-reported severity and adverse effects were also assessed. Results: Both treatments significantly reduced MASI scores. At week 18, mean MASI was 10.45 ± 2.24 with kojic acid and 7.33 ± 1.87 with glycolic acid. Mean percentage MASI reduction was 48.47 ± 5.24% and 62.78 ± 6.30%, respectively (p<0.001). All participants in the glycolic acid group achieved a good response compared with 53.3% in the kojic acid group. Patient-reported severity was also lower with glycolic acid. Adverse effects were more frequent with glycolic acid, particularly desquamation, burning, dryness, and erythema. Conclusion: Glycolic acid peels produced greater improvement than topical kojic acid but were less well tolerated.

Keywords: Melasma, Kojic Acid, Glycolic Acid Peel, MASI, Chemical Peeling.