Clinical and Instrumental Evaluation of Skin

Improvement after Treatment with a New 50%

Pyruvic Acid Peel
ENZO BERARDESCA, MD, NORMA CAMELI, MD, GRAZIA PRIMAVERA, MD,
AND MANUELA CARRERA, MD


BACKGROUND Pyruvic acid is an a-keto acid that presents keratolytic, antimicrobial, and
sebostatic properties as well as the ability to stimulate new collagen production and
elastic fibers formation. Because of its low pKa and its small dimension, it penetrates
rapidly and deeply through the skin, so far as to be considered a potent chemical peel
agent. It has proven its efficacy for the treatment of many dermatological conditions such
as acne, superficial scarring, photodamage, and pigmentary disorders. Pyruvic acid ap-
plication usually induces intense burning, and the postpeeling period is characterized by
erythema, desquamation, and, sometimes, crusting.
OBJECTIVE The aim of the study is to assess the efficacy and tolerability of 50% pyruvic
acid in a new non-erythematogenic formulation (pyruvic acid 50%, dimethyl isosorbide,
propylene glycol, ethyl alcohol, dimethyl sulfone, ethyl lactate, water) for the treatment of
photodamage, superficial scarring, and melasma.
MATERIALS AND METHODS Twenty subjects affected by photodamage, superficial scar-
ring, and melasma, but otherwise healthy, entered the study. Four peeling sessions were
performed once every 2 weeks. The patients were evaluated clinically and by means of
several noninvasive methods in order to monitor the following parameters: hydration,
color (erythema and pigmentation), elasticity, skin smoothness, skin roughness, scaliness,
and wrinkles.
RESULTS The patients did not report any discomfort either during the peeling session or
during the postpeeling period, without any impact on their social life. We did not observe
any case of persistent erythema as well as any case of postinflammatory hyperpigmen-
tation. Instrumental evaluations showed a significant reduction in the degree of pigmen-
tation in patients with melasma, a significant increase in skin elasticity, and an
improvement of the degree of wrinkling in all the patients.
CONCLUSION This innovative formulation of 50% pyruvic acid peel has been shown to be
safe and effective to treat photodamage, melasma, and superficial scarring, allowing the
patients to carry out regularly their working life as well as their social life. Furthermore, the
results have been evaluated by means of noninvasive devices, which have permitted one
to quantify the improvements.

The peeling solution used in this study was provided by General Topics, Salò, Italy.

T he history of chemical peel-

ing1 started from ancient
times with the Egyptians bathing
in sour milk to smooth their skin,
thus exploiting the properties of
an a-hydroxy acid contained
therein: lactic acid. Tilbury Fox
has to be considered the pioneer
dermatologist in the matter of
chemical peelings as he described
for the first time in 1871 the use
of 20% phenol to lighten the skin.
About 10 years later, P.G. Unna
reported the properties of salicylic
acid, resorcinol, phenol, and
trichloroacetic acid. In scientific
literature, some rare reports con-
cerning peeling were published in
the first half of the 20th century
but, until 1972 when Gordon and
Baker documented by photogra-

All authors are affiliated with Dermatological Institute S. Maria and S. Gallicano, IRCCS, Rome, Italy

& 2006 by the American Society for Dermatologic Surgery, Inc.  Published by Blackwell Publishing 
ISSN: 1076-0512  Dermatol Surg 2006;32:526–531  DOI: 10.1111/j.1524-4725.2006.32106.x

526

phy the excellent results obtained
using a mysterious formula for the
treatment of wrinkles, physicians
were doubtful about the real effi-
cacy of chemical peeling. In
the 1980s, Van Scott and Yu
performed the first peelings with
a-hydroxy acids, which attracted
the media’s attention in the 1990s.
Since then and because of the
media’s promotion, chemical
peeling has become popular as a
way to improve skin appearance,
minimizing wrinkles, irregular
pigmentation, melasma,
lentigines, actinic keratoses,
wrinkling, roughness, and
superficial scars.
Chemoexfoliation dermal peeling
consists of the application of one
or more chemical agents to the
skin, resulting in skin resurfacing
with the formation of new colla-
gen and reorganization of the
elastic fibers in the skin. Chemical
peeling is classsified on the basis
of the depth of skin injury as su-
perficial, medium, and deep peels.
The intensity of the peel is not
only due to the chemical agent but
it results from several parameters:
the concentration of the acid, the
pH of the solution, the vehicle in
which the acid is contained, the
amount of acid applied on the
skin, and the method of delivering
the acid. Superficial peels are the
most widely used because of the
necessity of minimal recovery
time whereas medium-depth peels
usually require a longer post-
peeling period. Actually, a wide
range of peeling agents are avail-
able. The choice of the chemical
agent is based on Fitzpatrick skin
type and on the Glogau classifi-
cation.2
Pyruvic acid is an a-keto acid
whose use has first been described
in the scientific literature in 1996
by Moy and colleagues,3 who
pointed out its keratolytic, anti-
microbial, sebostatic properties as
well as its capability to stimulate
the formation of collagen and
elastic fibers. Pyruvic acid has
always been considered a very
potent acid, and it has been
included in the group of medium-
depth peeling agents.4
The aim of this study was to
evaluate the efficacy and tolera-
bility of peeling with 50% pyruvic
acid in a new preparation, for the
treatment of photodamage, pig-
mentary dischromias, superficial
scarring, and melasma of
facial skin.
This new 50% pyruvic acid is
formulated with a technology that
results in epidermal increased skin
absorption of the acid, homoge-
neous absorption of the acid, and
reduced skin irritation due to the
addition of dimethyl sulfone,
which acts as an inflammatory
ingredient.5 The balance between
efficacy and side effects is the art
in peeling.
The permeation of different com-
pounds onto the skin is directly
correlated to the polar and lipid
routes, and polar and lipid pene-
trants are characterized by differ-
BERARDESCA ET AL
ent kinetics of absorption. The
middle-strong organic acid (AHA,
a-keto acids, etc.) are typically
dissociated in water. This dissoci-
ation defines the strength of the
acid. The activity of the acid in
the superficial layer of the skin,
the horny layer, is limited by the
lipid structure, because the release
of the proton depends on the
aqueous medium. This new tech-
nology can incorporate the hy-
drophilic acid and carrier the
same towards the lipidic struc-
tures to the proteic components of
the skin (keratin, desmosomes,
etc.) where the smoothing and
keratolytic effect can take place.
This technology can increase the
release of the proton (the pH is
lower if compared with a normal
water solution of the same acid at
the same concentration), and it
seems to diminish the mobility of
the same proton. Once the acid is
carried into a hydrophilic struc-
ture, the mobility of the proton
increases, and the chemo exfolia-
ting effect can effectively take
place. The result of such a condi-
tion is that the epidermal turnover
is accelerated, and desquamation
is less marked if compared with
an aqueous solution of the same
acid at the same concentration.
Materials and Methods
Twenty subjects affected by pho-
todamage, superficial scarring, or
melasma, but otherwise healthy,
entered the study. Patients were
evaluated carefully before starting
treatment. Our patients presented
Fitzpatrick skin types II to III and
32:4:APRIL 2006 527
 S K I N I M P R O V E M E N T A F T E R T R E AT M E N T W I T H A N E W 5 0 % P Y R U V I C A C I D P E E L
Glogau photoaging scale types I,
II, and III (mild to advanced).
Further factors were considered
and exclusion criteria were as
follows:
 Pregnant or nursing subjects.
 Previous recent (2–6 months)
aesthetic surgery (blepharopla-
sty, rhytidectomy, brow lift) in
the treatment area.
 Active herpes simplex in the
treatment area.
 Immunocompromising diseases
(possibility of delayed healing,
increased susceptibility to infec-
tion or excessive pigmentation
after peeling).
 Previous facial radiation ther-
apy that might impair the ability
of the skin to regenerate.
 Recent isotretinoin treatment.
 Hypertrophic scarring.
 Keloids.
 Allergies.
 Subjects with significant history
or current evidence of any psy-
chological disorder that, in the
investigator’s opinion, would pre-
clude enrolment into the study.
After degreasing the skin with a
defatting solution, the timer was
set up according to the applica-
tion time based on the skin type
and the Glogau-Fitzpatrick index
(GF index). The time of applica-
tion ranged between 3 and 5
minutes. The 50% pyruvic acid
was applied using the special ap-
528 D E R M AT O L O G I C S U R G E RY
plicator. The peel was then neu-
tralized with a 10% sodium
bicarbonate in water solution
when the time warning signal
started ringing. Immediately after
the procedure, an emollient facial
cream was applied to the treated
areas, and patients were instruct-
ed to apply a moisturizing cream
twice daily for a week, to avoid
sun exposure, and to use sun-
screens daily.
Four peeling sessions were per-
formed once every 2 weeks.
Patients were evaluated with non-
 Elasticity: The elasticity of the
invasive methods at baseline, every
2 weeks before performing the
peeling, and 90 days after the first
peeling because it is the necessary
time for collagen remodelling.
Several parameters were moni-
tored as follows:
 Hydration: Skin surface hydra-
tion was determined with the
Corneometers CM 825 (Cour-
age & Khazaka, Koln,
Germany). The measuring prin-
ciple of this instrument is based
on capacitance measurement of
 Skin smoothness, skin rough-
a dielectric medium. Any
change in the dielectric constant
because of skin surface
hydration variation alters the
capacitance of a precision
measuring capacitor.
 Color: The color of the skin is
mainly due to two components:
melanin and hemoglobin (ery-
thema). Mexameters MX 18
(Courage & Khazaka) was used
to assess melanin content and
erythema level. The measure-
ment is based on absorption/re-
flection. The probe emits three
specific light wavelengths, and a
receiver measures the light re-
flected by the skin. The melanin
content and the erythema level
are measured by specific wave-
lengths corresponding to the
spectral absorption peak of each
pigment. The results for both
parameters are immediately
shown as index numbers. The
values range from 0 (white) to
1,000 (black). The mexameter
has an accuracy of 7 5%.
skin is evaluated by the Cuto-
meters MPA 580 (Courage &
Khazaka). The measuring prin-
ciple is based on the suction
method. Negative pressure is
created in the device, and the
skin is drawn into the aperture
of the probe. The resistance of
the skin to be sucked up by the
negative pressure (firmness) and
its ability to return to its origi-
nal position (elasticity) are dis-
played as curves at the end of
each measurement.
ness, scaliness, wrinkles: These
four clinical parameters describe
quantitatively and qualitatively
the skin surface; they are meas-
ured by a special UV-light video
camera (Visioscans VC, Cour-
age & Khazaka). The images of
the skin surface are elaborated
by a particular software that
permits the calculation of the
parameters. Thus, before and
after treatment comparisons of
 BERARDESCA ET AL

the same skin site enable a
comparison of trends in skin
condition.
Until now, profilometry has been
the only method to determine the
condition of skin surface, other
than subjective evaluation. By
means of a Visioscans VC, skin
can be monitored optically, using a
new method called surface evalu-
ation of the living skin (SELS). The
parameters evaluated have been
developed in various clinical stud-
ies in order to be perfectly suitable
to characterize the skin surface.
Skin smoothness (SEsm) is the
calculation from the average width
and depth of wrinkles. Skin
roughness (SEr) is the opposite
parameter. The scaliness (SEsc)
measures the level of dryness of the
stratum corneum. The wrinkles
(SEw) derive from the proportion
of horizontal and vertical wrinkles.
Measurements have been per-
formed at 7 201C of environ-
mental temperature with a
relative humidity of 45 7 5% ac-
cording to guidelines published
for these techniques.
 Burning during the peeling pro-
cedure.
 Discomfort (erythema, desqua-
mation, irritation, crusting) in
the post-peeling period.
 Hydration.
 Elasticity.
 Color.
Statistical analysis was performed
using the t test. Values of po.05
were considered statistically sig-
nificant.
Results
After four peeling sessions, we ap-
preciate a global improvement in
skin aspect which appears lighter,
especially in patients affected by
melasma, more tense, and less fur-
rowed (Figures 1–3). We did not
observe any case of persistent ery-
thema as well as any case of post-
inflammatory hyperpigmentation.
The patients reported lightening
of the skin, improvement of the
skin’s elasticity, reduction of
wrinkling, and dryness of the
skin. Whereas the application of
pyruvic acid usually causes a
very intense burning sensation,
with this new formulation the
patients referred to moderate
stinging and burning sensations
that faded in a few minutes after
the neutralization of the acid.
Furthermore, most of the patients
presented only a mild erythema
immediately after the peeling and
did not report any discomfort
during the postpeeling period,
such as desquamation, irritation,
erythema or crusting, without any
impact on their social life. All the
patients were satisfied with the
treatment.
The evaluation performed by
means of non-invasive devices
confirmed the clinical data.

At baseline and during each peeling

session, a clinical evaluation of the
patients was performed by the
investigator using digital photog-
raphy documentation and a visual
numerical scale (0–10) to assess the
patients’ view of skin appearance.

The evaluated parameters were as

follows:

 Redness during the peeling pro- Figure 1. Marked clinical improvement after four peelings of superficial scarring
cedure. in a patient affected by acne.

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 S K I N I M P R O V E M E N T A F T E R T R E AT M E N T W I T H A N E W 5 0 % P Y R U V I C A C I D P E E L

The results after four peeling ses-

sions (the last evaluation was
performed 1 month after the
fourth peeling) show a significant
increase of skin elasticity (Figure
4, po.05) in all the patients, and
a significant reduction in the de-
gree of pigmentation (Figure 5, p
o.05) in patients with melasma.
The evaluation of erythema is
slightly higher compared with the
baseline and the skin hydration
results decreased, but these changes
are not statistically significant. With
regard to the parameters evaluated
with the Visioscans VC, there is a
Figure 2. Improvement of skin photoaging with reduction of periocular lines,
pigmentation, and improvement of skin texture. significant (Figure 6, po.05) im-
provement in the degree of wrinkl-
ing (number and width of wrinkles)
as shown by the decreased values of
the SEw parameter.

Discussion

In recent years, patients seeking

medical procedures that improve
their skin appearance have greatly
increased; furthermore, they ask
for soft therapeutic options that
provide benefits without compli-
cations and without a long re-
covery time. Pyruvic acid is an a-
keto acid, which is a carboxylic
acid having a keto group at the a
Figure 3. Marked reduction of acne scarring and pigmentation.
position of the aliphatic carbon
ELASTICITY atom. Pyruvic acid is physiologi-
1.5000 cally in equilibrium with lactic
acid as lactate dehydrogenase
1.0000 converts each acid into the other.
R6
It is considered a potent acid be-
0.5000
cause its small molecule allows
0.0000 deep penetration and its pKa is
T0 T1 T2 T3 T4 low (about 2.4). It presents
Figure 4. Significant increase in skin elasticity after four peelings (po.05). keratolytic, antimicrobial,
T = time; T1 = after the first peeling, etc. sebostatic effects, and stimulates

530 D E R M AT O L O G I C S U R G E RY
 BERARDESCA ET AL

PIGMENTATION their working life as well as their

250
200
150
100
50
0 not only subjectively but also by
T0 T1 T2
Figure 5. Significant decrease of pigmentation as measured by a mexameter
(po.05). T = time; T1 = after the first peeling, etc.
collagen and elastic fiber forma-
tion.4 Pyruvic acid has been
employed as a medium chemical
peeling agent, in concentrations
ranging from 40 to 70% and
has only recently attracted atten-
tion on the basis of the clinical
evidence of its capability to
treat several skin conditions such
as wrinkles, pigmentary
disorders, acne, and superficial
scarring.6,7 It has proven to be
effective and safe and to combine
better results and fewer side
effects compared with the most
commonly used peeling agents.
MELANIN
T3 T4
study we have employed an inno-
vative formulation of 50%
pyruvic acid containing special
ingredients, which associates good
efficacy and less discomfort in the
postpeeling period. Compared
with the pH value of a non-
buffered aqueous solution of
50% pyruvic acid (pH = 0.1050),
the pH value of this new formu-
lation is significantly lower
(pH = 0.5086), resulting in an
increased absorption.
With this innovative formulation
of 50% pyruvic acid, we have
social life.
In this report, the results obtained
by peelings with this new 50%
pyruvic acid have been evaluated
means of several non-invasive de-
vices that have permitted us to
quantify improvement in terms of
degree of pigmentation, erythema,
and especially elasticity and de-
gree of wrinkling.
References
1. Brody HJ, Monheit GD, Resnik SS, Alt
TH. A history of chemical peeling. Der-
matol Surg 2000;26:405–9.
2. Glogau RG. Chemical peeling and aging
skin. I Geriatr Dermatol 1994;2:30–5.
3. Moy LS, Peace S, Moy RL. Comparison of
the effects of various chemical peeling
agents in a mini-pig model. Dermatol Surg
1996;22:429–32.
4. Monheit GD. Medium-depth combination
peels. Dermatol Ther 2000;13:183–91.
5. Data on file, General Topics srl, Salò,
Italy.

successfully treated 20 subjects 6. Griffin TD, Van Scott EJ, Maddin S. The
use of pyruvic acid as a chemical peeling
Acidity is very important for affected by photodamage, super- agent. J Dermatol Surg Oncol 1989;
efficacy and absorption of the ficial scarring, or melasma with- 15:1316–20.

chemical agent, but it is also re-
sponsible for side effects. In this
out any unwanted effect, allowing
the patients to carry out regularly
7. Cotelessa C, Manunta T, Ghersetich I,
Brazzini B, Peris K. The use of pyruvic acid
in the treatment of acne. J Eur Acad
Dermatol Venereol 2004;18:275–8.

DEGREE OF WRINKLING 8. Ghersetich I, Brazzini B, Peris K, Cotel-

lessa C, Manunta T, Lotti T. Pyruvic acid
38 peels for the treatment of photoaging.
37 Dermatol Surg 2004;30:32–36.
36
35
Sew
34
33
Address correspondence and reprint
requests to: Enzo Berardesca, MD,
32
T0 T1 T2 T3 T4 San Gallicano Dermatological
Institute, Via Chianesi 53, 00144
Figure 6. Significant decrease of wrinkles (Sew parameter, po.05). Rome, Italy, or e-mail: berardesca@
T = time; T1 = after the first peeling, etc. berardesca.it

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