|

Received: 13 November 2019    Accepted: 19 December 2019

DOI: 10.1111/jocd.13288

ORIGINAL CONTRIBUTION

A split-face comparative study to evaluate the efficacy of 50%

pyruvic acid against a mixture of glycolic and salicylic acids in
the treatment of acne vulgaris

Julita Zdrada MSc1  | Wiktoria Odrzywołek MSc1  | Anna Deda PhD2  |

Sławomir Wilczyński PhD, DSc1

1
Department of Basic Biomedical Science,
Faculty of Pharmaceutical Sciences in Abstract
Sosnowiec, Medical University of Silesia, Background: One of the ways to treat acne is by using chemical peels. Salicylic, gly-
Katowice, Poland
2 colic and pyruvic acids due to their keratolytic and antibacterial properties are often
Department of Cosmetology, Faculty of
Pharmaceutical Sciences in Sosnowiec, recommended for acne patients.
Medical University of Silesia, Katowice,
Aims: The aim of the study was to compare the effect of a preparation containing
Poland
glycolic and salicylic acids with pyruvic acid.
Correspondence
Patients/Methods: 14 women diagnosed with acne took part in the study. The facial
Julita Zdrada, Department of Basic
Biomedical Science, Faculty of treatment area was divided into two parts: right (a preparation containing 50% pyru-
Pharmaceutical Sciences in Sosnowiec,
vic acid) and left side ( a preparation containing glycolic and salicylic acids). A series of
Medical University of Silesia, Kasztanowa
Street 3, 41-200 Sosnowiec, Katowice, four treatments was performed at 2-week intervals. Skin parameters, namely hydra-
Poland.
tion, sebum secretion and skin colour were measured.
Email: julita.zdrada@med.sum.edu.pl
Results: As a result of using 50% pyruvic acid, the hydration of the right side of the
Funding information
face increased statistically and there was a decrease in the amount of melanin in the
Śląski Uniwersytet Medyczny, Grant/Award
Number: KNW-2-I16/N/9/K and KNW-1- epidermis. On the left side of the face, there was an increase in skin hydration after
065/K/9/O
using a mixture of glycolic and salicylic acids. The increase in skin hydration on the
left side of the chin and nose was not statistically significant. The use of the mixture
of glycolic and salicylic acids affected the skin colour on the left side of the face, on
the forehead, cheek and nose.
Conclusion: Chemical peels affect a wide range of pathological factors of acne. A
mixture of acids yields fewer side effects than a single acid used in high concentra-
tion, but the therapeutic effects are comparable.

KEYWORDS

acne vulgaris, aesthetic effects, alpha hydroxy acids, moisturizing, salicylic acid, sebum

1 |  I NTRO D U C TI O N
Acne is one of the most common dermatological diseases affect-
ing about 50% of adolescents. It arises as a result of several patho-
physiological mechanisms, including excessive sebum production,
abnormal proliferation of keratinocytes, and keratinization of the
pilo-sebaceous duct, which causes blockage of the sebaceous gland
and the formation of acne lesions.1 The accumulation of keratino-
cytes at the mouth of the hair follicle stimulates the formation of
blackheads, based on which acne lesions are formed. Finally, the
sebum is blocked and the follicle is filled with bacteria, lipids, and
cell fragments. There is also an increased proliferation of anaerobic

J Cosmet Dermatol. 2020;00:1–7. wileyonlinelibrary.com/journal/jocd© 2020 Wiley Periodicals, Inc.     1 |

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2       ZDRADA et al.
bacterium Propionibacterium acnes, which causes visible inflamma-
2
tory lesions. Acne treatment aims to modify the keratinization of
cells lining the sebaceous glands, reduce the activity of sebaceous
glands, and inhibit the growth of local bacterial flora.3,4
Chemical peels have proven effective in the treatment of acne
vulgaris. The mechanism of action is to induce exfoliation of corneo-
cytes and reduce the coherence between keratinocytes, increase
the activity of epidermal enzymes, remodel the epidermal structure,
and reduce sebum secretion.5,6 In the prevention and treatment of
acne, chemical exfoliation with alpha hydroxy, beta hydroxy, and al-
pha-keto acids is used.6
One of the most popular peeling substances is glycolic acid natu-
rally found in sugar cane. It is an acid with a very small molecule, hav-
ing only two carbon atoms in its structure, which ensures its good
penetration into the skin. Its action depends on the time it is left on
the skin and its concentration.7 During the procedure using glycolic
acid, so-called frosting may occur, manifested as whitening on the
epidermal surface. It indicates the acid penetration into the papil-
lary dermis. Glycolic acid has been used in the treatment of acne,
melasma, and skin photodamage. Its use has also been described in
the treatment of psoriasis and other dermatological diseases with
8-11
abnormal epidermal keratinization.
Salicylic acid is a lipophilic agent that causes peeling of the upper
layers of the stratum corneum and activation of the cells of the basal
layer and the underlying layer of fibroblasts.8 It is an inhibitor of
the arachidonic acid cascade, which makes it anti-inflammatory. It
solubilizes intercellular cement, which reduces the adhesion of cor-
neocytes and causes peeling of the stratum corneum. In addition,
its lipophilic nature means that salicylic acid has good comedolytic
12,13
properties and is able to shrink the outlets of sebaceous glands.
It has been used mainly in the treatment of acne and
hyperpigmentation.14,15
Pyruvic acid (CH3-CO-COOH) is an α-kato acid with keratolytic
and antibacterial properties. It also has a sebo-regulating effect and
stimulates neocollagenesis, which is particularly important in the
treatment of acne scars and wrinkles.16-18 During procedures with
pyruvic acid, patients often experience pain that disappears after
8
neutralization. Pyruvic acid in physiological conditions is trans-
formed into lactic acid, which is responsible for maintaining proper
epidermal moisture. Pyruvic acid is known for its effectiveness in
treating acne, surface scars, photoaging damage, and pigmenta-
tion disorders, the latter ones owing to the tyrosinase inhibition
properties.19
2 |  M ATE R I A L S A N D M E TH O DS
2.1 | Patients
The study was conducted in a group of 14 healthy women (average
age: 23 ± 1.6 years). It was approved by the Bioethics Committee. The
research obtained a positive opinion from the Bioethics Committee
of the Medical University of Silesia No. KNW/0022/KB1/27/16 on
the project entitled: "Observation and analysis of the effectiveness
of routine cosmetology, podology and esthetic medicine procedures".
Acne, abnormal keratinization, excessive seborrhea, hyperpigmen-
tation, and enlarged outlets of sebaceous glands within the nose,
forehead, chin, and cheeks were observed in the volunteers. They all
underwent a series of four treatments applied every 2 weeks.
2.2 | Procedure
Makeup was removed with micellar water, then Pre Peeling Cleanser
(Mene & Moy System) containing 20% glycolic acid was applied
with circular movements for 5 minutes, washed, and dried. The fa-
cial treatment area was divided into two parts: right and left side.
Alfa Beta Complex Gel (Mene & Moy System) containing glycolic
acid and salicylic acid was used on the left side, and on the right
side, a preparation containing 50% pyruvic acid (Perfarma Pyruvic
Peeling), after the previous degreasing with alcohol. The prepara-
tions were applied with a brush at the same time and washed with
water after the appearance of an erythematous reaction on the
skin. To wash the face at home, each volunteer used twice a day
Cetaphil MD Dermoprotector (aqua/water, glycerin, hydrogenated
polyisobutene, cetearyl alcohol, macadamia ternifolia seed oil/maca-
damia ternifolia nut oil, ceteareth-20, tocopheryl acetate, dimethi-
cone, acrylates/C10-30 alkyl acrylate crosspolymer, benzyl alcohol,
citric acid, farnesol, panthenol, phenoxyethanol, sodium hydrox-
ide, stearoxytrimethylsilane, stearyl alcohol), and then face cream
Alantan Plus (20 mg allantoin [Allantoinum] and 50 mg dexpanthe-
nol [Dexpanthenolum]) as a 50% solution of panthenol in propylene
glycol, lanolin, liquid paraffin, cetostearyl alcohol, ethyl parahy-
droxybenzoate, methyl parahydroxybenzoate, propyl parahydroxy-
benzoate, purified water, polawax NF), and they were instructed to
avoid sun exposure and use sunscreens daily.
Skin parameters were measured before the therapy (m0), after a
month (m1) and after 2 months (m2). Skin hydration (Corneometer®
CM 825) and sebum secretion (Sebumeter® SM 815) were measured.
Skin color (Mexameter® MX 18) (Courage + Khazaka Electronic GmbH,
Germany) was measured before the therapy (m0) and after 2 months
(m1). The measurements were performed on the face symmetrically
at four points: forehead, cheeks, chin, and nose. The measuring room
had constant humidity (40%-50%) and temperature (20-21°C). The
study was performed from February 2018 to May 2018.
Clinical photos of all the volunteers were taken using the
FotoMedicus system from Elfo® before, a month after and 2 months
after the therapy. The women were photographed from the front,
from the half right and half left profiles, and from the right and left
profiles. A series of photos was taken of each woman both in nonpo-
larized light and in cross-polarized light.
After a series of treatments, the volunteers completed a satis-
faction questionnaire that contained three questions: 1. Are you sat-
isfied with the effects of chemical peels? 2. How satisfied are you?
(linear scale from 1-10) 3. On which side of the face did you notice
better results?
ZDRADA et al. |
      3

2.3 | Statistical analysis
Excel and Statistica 10 software were used in the statistical analysis
of results. The significance of the effects of treatments on skin hy-
dration and sebum secretion was assessed using Friedman's ANOVA
and Dunn's post-hoc test, whereas the Wilcoxon test was used for
the skin color. The results at the level of P < .05 were considered
statistically significant. Due to the anatomical structure of the nose
and the related difficulties in measuring the hydration of its skin,
the number of triple measurements taken into account during the
analysis was reduced and amounted to 10 on the right side of the
nose and 8 on the left side of the nose.
3 | R E S U LT S
As a result of using 50% pyruvic acid during the procedure, the hydra-
tion of the right side of the forehead (P < .01), cheek (P < .05), and
chin (P < .05) increased in a statistically significant manner (Figure 1).
In addition, the skin hydration on the right side of the nose tended to

F I G U R E 1   Hydration of the stratum

corneum at various facial areas before
(m0), a month after (m1), and 2 mo (m2)
after the treatment with 50% pyruvic acid.
##P < .01; #P < .05; *P < .05; +P = .06

F I G U R E 2   Melanin content in the

epidermis at various facial areas before
(m0) and 2 mo (m2) after the treatment
with 50% pyruvic acid
 |
4       ZDRADA et al.
improve (P = .06). After 2 months, compared to the results obtained
before the therapy, the median skin hydration value on the right side
of the face increased by 11.3 on the forehead (P < .05), by 20.0 on the
cheek (P < .05), by 9.6 on the chin (P < .05), and by 15, 4 on the nose.
After applying 50% pyruvic acid on the right side of the face, a
reduction in the amount of melanin in the epidermis was observed,
but it did not reach statistical significance (Figure 2).
There was a significant increase in skin hydration on the left
side of the face, on the cheek (P < .01), after using the mixture of
glycolic and salicylic acids peeling containing a mixture of glycolic
and salicylic acids (Figure 3). A similar tendency was observed on the
forehead (P  =  .07). However, the increase in skin hydration on the
left side of the chin and nose was not statistically significant. The
median hydration of the skin of the left cheek after 2 months com-
pared to the values obtained before the treatment increased by 28.1
(P < .05), whereas on the left side of the forehead by 6.1.
The use of the mixture of glycolic and salicylic acids significantly
affected the skin color on the left side of the face, on the forehead
(P < .05), cheek (P < .05), and nose (P < .01) (Figure 4). The changes in
the chin color were not statistically significant. The median color on
the left side of the face decreased from 154 to 134 on the forehead,
from 128 to 113 on the cheek, and from 157 to 135 on the nose.
F I G U R E 3   Hydration of the stratum
corneum at various facial areas before
(m0), a month after (m1), and 2 mo (m2)
after the mixture of glycolic and salicylic
acids treatment. ++P = .07; ##P < .01;
*P < .05
F I G U R E 4   Melanin content in the
epidermis at various facial areas before
(m0) and 2 mo (m1) after the mixture of
glycolic and salicylic acids treatment.
*P < .05; **P < .01
ZDRADA et al. |
      5

Peeling with the use of the mixture of glycolic and salicylic acids
and 50% pyruvic acid did not significantly affect sebum secretion
(Table 1).
According to the survey, 100% of participants were satisfied
with the results of both peels. 64% were satisfied at 8 points, 22%
at 9, and 7% at 7 and 10 points. 57% observed better effects on the
right side of the face where 50% pyruvic acid was applied. In con-
trast, 43% did not notice any differences between both sides of the
face (Figures 5 and 6).
4 | D I S CU S S I O N
Peeling with the use of 50% pyruvic acid has a statistically sig-
nificant effect on epidermal hydration, reduction in the amount
of melanin in the epidermis, and lightening of post-inflammatory
hyperpigmentation.
Pyruvic acid is transformed into lactic acid under physiological
conditions and under the influence of water. 20 It is one of the most
effective natural humectants and is a component of NMF (Natural
Moisturising Factor). 21 Pyruvic acid has the potential as a unique local
exfoliating agent, combining the keratolytic effect of the alpha-keto
acid and the water-retaining effect of the lactic acid. 22
A reduction in sebum and no significant differences in skin hy-
dration were observed in subjects with high sebum production be-
fore treatment with 40%-50% pyruvic acid. 23 Although our study did
not show a reduction in sebum production, there was an increase in
skin hydration after using pyruvic acid.
Barardesca et al conducted a study using 50% pyruvic acid. The
results after four peeling sessions showed a significant reduction in
the degree of pigmentation in patients with melasma, and a statisti-
cally insignificant decrease in epidermal hydration. 24
The study using a colorimeter also showed lightening of discolor-
ations after 4 sessions using 50% pyruvic acid. 25
After the third treatment with 50% pyruvic acid, statistically
significant differences were observed in the amount of sebum se-
creted on the chin. A similar trend was observed on the left cheek.
Significant differences in the right cheek were detected after the
second procedure. There were also changes in sebum secretion
on the forehead. Moreover, pyruvic acid contributed to a signif-
icant reduction in sebum secretion on the nose after the third
treatment. 26

TA B L E 1   Sebum secretion at various facial areas before (m0), a month after (m1), and 2 mo (m2) after the treatment. Q1-first quartile,
Q3-third quartile, Min-minimum, Max-maximum

Preparation Face side Area Measurement Median Q1 Q3 Min Max

50% pyruvic acid Right side Forehead m0 81.5 16.0 223.0 40.0 123.0
m1 76.5 32.0 175.0 48.0 93.0
m2 71.5 15.0 234.0 43.0 110.0
Cheek m0 47.5 7.0 213.0 17.0 65.0
m1 41.5 6.0 91.0 23.0 78.0
m2 54.0 2.0 202.0 35.0 85.0
Chin m0 84.0 15.0 239.0 62.0 138.0
m1 96.5 18.0 239.0 53.0 149.0
m2 92.5 42.0 234.0 76.0 157.0
Nose m0 147.5 68.0 237.0 99.0 204.0
m1 114.0 25.0 227.0 78.0 166.0
m2 131.0 25.0 211.0 72.0 176.0
Glycilic and salicylic Left side Forehead m0 80.5 16.0 183.0 35.0 114.0
acids mixture m1 74.0 19.0 195.0 46.0 93.0
m2 58.5 24.0 228.0 52.0 116.0
Cheek m0 33.5 5.0 173.0 10.0 84.0
m1 36.0 8.0 121.0 21.0 78.0
m2 50.5 2.0 173.0 26.0 62.0
Chin m0 94.5 12.0 211.0 59.0 149.0
m1 98.5 35.0 235.0 73.0 131.0
m2 106.5 29.0 234.0 68.0 133.0
Nose m0 118.5 7.0 223.0 64.0 211.0
m1 116.0 41.0 185.0 49.0 171.0
m2 126.0 28.0 223.0 68.0 159.0
 |
6       ZDRADA et al.
(A) (B)
F I G U R E 5   Results of application the mixture of glycolic and
salicylic acids. a – before treatment, b – after treatment
(A) (B)
F I G U R E 6   Results of application of 50% pyruvic acid. a – before
treatment, b – after treatment
Statistically significant differences in sebum secretion were ob-
served after the second treatment with 30% salicylic acid. The sec-
ond procedure also gave satisfactory results that were statistically
significant for the left and right cheeks. The largest differences in
the measurement of sebum levels were found when using salicylic
acid on the forehead. As a result of this treatment, there was a sig-
nificant decrease in sebum secretion on the nose. 26
Kaminaka et al performed a split-face study with 40% glycolic acid
and a placebo. Hydration and sebum secretion measurements were
made on the cheeks. There were no significant differences in skin hy-
dration before and 10 weeks after the treatment. The level of sebum
secretion was statistically significantly reduced at weeks 8 and 10.27
A study by Lee et al using 30% salicylic acid did not show signif-
icant changes in hydration and sebum secretion on the cheeks. 28 In
the study by Marczyk et al, there was a slight dryness and exfoliation
after applying 30% salicylic acid. 26 In contrast, our study showed a
significant increase in skin hydration on the cheeks after using the
mixture of glycolic and salicylic acids.
Rodriguez-Cerdeira et al performed a study on the effective-
ness of gel with 15% glycolic acid and 2% salicylic acid on flat warts,
which lasted 2 months. The preparation was well tolerated and no
side effects were observed despite daily application. 29 This proves
that combining the action of different acids has greater therapeutic
potential than monotherapy, which can be translated into various
therapeutic aspects.
Jaffary et al showed similar acid activity—both 50% pyruvic acid
and 30% salicylic acid are effective in reducing mild to moderate
acne without significant differences in efficacy and side effects.30
During the study, patients reported that they believed the prepa-
ration on the left side (50% pyruvic acid) worked better because it
caused burning and itching. However, no significant differences
in eliminating acne lesions were observed in clinical photos. Both
preparations reduced acne lesions to a similar extent.
In a histological study on long-term use of glycolic acid, it was
found that melanin deposits in the stratum corneum were the same
in all treated skin specimens, but the squamous layers were clearly
different. In skins treated with glycolic and lactic acids, the melanin
deposits were less visible.31
5 | CO N C LU S I O N S
Chemical peels are a very useful tool in the treatment of acne be-
cause they affect a wide range of pathological factors of this disease.
A mixture of acids yields fewer side effects than a single acid used
in high concentration, but the therapeutic effects are comparable.
Patients' sensations after the applied procedures do not coincide
with the test results. Pyruvic acid has skin lightening and moisturiz-
ing properties, but patients experience a burning sensation during
the procedure. Both pyruvic acid and a mixture of salicylic and gly-
colic acids can be successfully used to improve skin hydration as well
as reduce the number of blackheads, excessive activity of sebaceous
glands and hyperpigmentation.
ORCID
Julita Zdrada  https://orcid.org/0000-0003-3255-457X
Wiktoria Odrzywołek  https://orcid.org/0000-0002-9371-0882
Anna Deda  https://orcid.org/0000-0002-1763-6676
Sławomir Wilczyński  https://orcid.org/0000-0002-6066-3127
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How to cite this article: Zdrada J, Odrzywołek W, Deda A,
Wilczyński S. A split-face comparative study to evaluate the
efficacy of 50% pyruvic acid against a mixture of glycolic and
salicylic acids in the treatment of acne vulgaris. J Cosmet
Dermatol. 2020;00:1–7. https​://doi.org/10.1111/jocd.13288​