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

2.3 | Statistical analysis analysis was reduced and amounted to 10 on the right side of the
nose and 8 on the left side of the nose.
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 3 | R E S U LT S
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 As a result of using 50% pyruvic acid during the procedure, the hydra-
statistically significant. Due to the anatomical structure of the nose tion of the right side of the forehead (P < .01), cheek (P < .05), and
and the related difficulties in measuring the hydration of its skin, chin (P < .05) increased in a statistically significant manner (Figure 1).
the number of triple measurements taken into account during the 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
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4       ZDRADA et al.

improve (P = .06). After 2 months, compared to the results obtained forehead (P  =  .07). However, the increase in skin hydration on the
before the therapy, the median skin hydration value on the right side left side of the chin and nose was not statistically significant. The
of the face increased by 11.3 on the forehead (P < .05), by 20.0 on the median hydration of the skin of the left cheek after 2 months com-
cheek (P < .05), by 9.6 on the chin (P < .05), and by 15, 4 on the nose. pared to the values obtained before the treatment increased by 28.1
After applying 50% pyruvic acid on the right side of the face, a (P < .05), whereas on the left side of the forehead by 6.1.
reduction in the amount of melanin in the epidermis was observed, The use of the mixture of glycolic and salicylic acids significantly
but it did not reach statistical significance (Figure 2). affected the skin color on the left side of the face, on the forehead
There was a significant increase in skin hydration on the left (P < .05), cheek (P < .05), and nose (P < .01) (Figure 4). The changes in
side of the face, on the cheek (P < .01), after using the mixture of the chin color were not statistically significant. The median color on
glycolic and salicylic acids peeling containing a mixture of glycolic the left side of the face decreased from 154 to 134 on the forehead,
and salicylic acids (Figure 3). A similar tendency was observed on the 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. |
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Peeling with the use of the mixture of glycolic and salicylic acids exfoliating agent, combining the keratolytic effect of the alpha-keto
and 50% pyruvic acid did not significantly affect sebum secretion acid and the water-retaining effect of the lactic acid. 22
(Table 1). A reduction in sebum and no significant differences in skin hy-
According to the survey, 100% of participants were satisfied dration were observed in subjects with high sebum production be-
with the results of both peels. 64% were satisfied at 8 points, 22% fore treatment with 40%-50% pyruvic acid. 23 Although our study did
at 9, and 7% at 7 and 10 points. 57% observed better effects on the not show a reduction in sebum production, there was an increase in
right side of the face where 50% pyruvic acid was applied. In con- skin hydration after using pyruvic acid.
trast, 43% did not notice any differences between both sides of the Barardesca et al conducted a study using 50% pyruvic acid. The
face (Figures 5 and 6). 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
4 | D I S CU S S I O N The study using a colorimeter also showed lightening of discolor-
ations after 4 sessions using 50% pyruvic acid. 25
Peeling with the use of 50% pyruvic acid has a statistically sig- After the third treatment with 50% pyruvic acid, statistically
nificant effect on epidermal hydration, reduction in the amount significant differences were observed in the amount of sebum se-
of melanin in the epidermis, and lightening of post-inflammatory creted on the chin. A similar trend was observed on the left cheek.
hyperpigmentation. Significant differences in the right cheek were detected after the
Pyruvic acid is transformed into lactic acid under physiological second procedure. There were also changes in sebum secretion
conditions and under the influence of water. 20 It is one of the most on the forehead. Moreover, pyruvic acid contributed to a signif-
effective natural humectants and is a component of NMF (Natural icant reduction in sebum secretion on the nose after the third
Moisturising Factor). 21 Pyruvic acid has the potential as a unique local 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
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6       ZDRADA et al.

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
(A) (B) caused burning and itching. However, no significant differences
in eliminating acne lesions were observed in clinical photos. Both
F I G U R E 5   Results of application the mixture of glycolic and preparations reduced acne lesions to a similar extent.
salicylic acids. a – before treatment, b – after treatment
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-

(A) (B) ing properties, but patients experience a burning sensation during
the procedure. Both pyruvic acid and a mixture of salicylic and gly-

F I G U R E 6   Results of application of 50% pyruvic acid. a – before colic acids can be successfully used to improve skin hydration as well
treatment, b – after treatment as reduce the number of blackheads, excessive activity of sebaceous
glands and hyperpigmentation.
Statistically significant differences in sebum secretion were ob-
served after the second treatment with 30% salicylic acid. The sec- ORCID
ond procedure also gave satisfactory results that were statistically Julita Zdrada  https://orcid.org/0000-0003-3255-457X
significant for the left and right cheeks. The largest differences in Wiktoria Odrzywołek  https://orcid.org/0000-0002-9371-0882
the measurement of sebum levels were found when using salicylic Anna Deda  https://orcid.org/0000-0002-1763-6676
acid on the forehead. As a result of this treatment, there was a sig- Sławomir Wilczyński  https://orcid.org/0000-0002-6066-3127
nificant decrease in sebum secretion on the nose. 26
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