Journal of the European Academy of Dermatology and Venereology

JEADV
ELSEVIER 5 (1995) 21.5-217

Review
Glycolic acid and its use in dermatology
C. Cotellessa, K. Peris, S. Chimenti *
Clinica Dermatologica, Uniuersitci de& Studi de L ‘Aquila, L ‘Aquila, Italy

Abstract

Glycolic acid has distinctive pharmacologic properties that recommend it for topical use in a range of
skin disorders: acne, aging and photoaging, keratoses, age spots. Future studies and more extensive and
varied clinical trials would surely point out its therapeutic potential and extend its range of clinical
applications.

Keywords: Giycolic acid, use in dermatology; Aging; Photoaging; Acne; Chemical peeling

a-hydroxy acids (AHAs) are a group of organic
acids found in natural foods, such as sugarcane
(glycolic acid), milk, (lactic acid), apples (malic
acid), citric fruits (citric and ascorbic acid), and
grapes (tartaric acid) [l]. Among AHA family, the
different acids differ in the length of molecules:
glycolic acid is the smallest one, because it con-
tains only two carbons: this structure makes giy-
colic acid particularly easy to handle for dermato-
logical applications since it can seep through the
skin layers [2].
Glycolic acid has been shown to diminish cor-
neocyte adhesion at the lower levels of the stra-
tum corneum and to cause epidermolysis, further
supporting its therapeutic use in some dermato-
logical conditions such as acne, actinic keratoses,
age spots, warts, wrinkles and for superficial and
* Corresponding author. Fax: + 39-862-433433
deep peeling 131.Its effects on peeling depend on
the time the agent is left on the skin and on its
concentration. The common available concentra-
tions of glycolic acid vary from 2% to 70% in
lotions, creams and gels. Glycolic acid, when ap-
plied topically, has shown its effects both at epi-
dermal and dermal level. At concentrations of
S-20%, it appears to exert corneocyte detection
among cells at the lower levels of stratum corneum
and to stimulate cellular mitosis. In fact, glycolic
acid does not cause disaggregation of corneocytes
of the mature upper levels of the stratum
corneum, as keratolytic agents do, but it exerts its
influence at the lower, newly forming levels of
stratum corneum [4].
At 70% it creates rapid epidermolysis [2]. Al-
though the exact mechanism of these effects is
still not clear, it has been speculated that glycolic
acid diminishes corneocyte cohesion interacting
with ionic bonds on the cellular surface; this
action could be mediated by interference with the

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216 C. Cotellessa et al. /J. Eur. Acad. Dermatol. Venereol. 5 (1995) 215-217
functions of enzymes that form O-S and O-P
linkages of sulphate and phosphate bonds. Re-
cently, it has also been supposed that it might act
also at the dermal level, turning on biosynthesis
of glycosaminoglycans and leading the synthesis
of new collagen in the papillary dermis [2,41.
Furthermore, the epidermolytic effects of gly-
colic acid had supported its use as a vehicle to
improve the penetration of different therapeutic
agents through the skin.
Pratical uses of glycolic acid during the past
few years have been expanding to cover a range
of different conditions. Below are briefly indi-
cated some dermatological diseases in which we
have employed glycolic acid with good results.
Acne. Lower concentrations of glycolic acid
cause a reduction of cohesion of follicular cor-
neocytes, while higher concentrations result in
epidermolysis. The use of glycolic acid 50% or
70% solutions, repeated weekly or every two
weeks has demonstrated a substantial improve-
ment in patients affected by comedonic and
papulo-pustolar forms of acne. Nowdays it is par-
ticularly used also as an adjunct to conventional
antibiotic therapies and as a vehicle to improve
cutaneous penetration of topical therapeutic
agents. During the interval periods, the daily use
of low concentrations can help to prevent the
re-occluding of follicles [3,5,6].
Aging and photoaging. Low concentrations of
glycolic acid produce diminished corneocyte co-
hesion and subsequent prevention of stratum
corneum thickening. Clinical manifestation of
these pharmacologic actions is an improvement
of fine wrinkles. 70% glycolic acid applied on
facial skin weekly for several months has revealed
to be effective in reducing wrinkles. This action is
probably due to the increased biosynthesis of
dermal glycosaminoglycans and to the formation
of new collagen in the papillary dermis [2,7,8].
Kerutoses. Simple keratoses; seborrheic ker-
atoses and actinic keratoses can be removed with
the use of concentrated solutions of glycolic acid.
The treatment of these lesions depends upon
epidemolysis, which is achieved by the use of high
doses of glycolic acid. To obtain the complete
eradication of larger actinic keratoses has been
recently proposed the use of glycolic acid in asso-
ciation with 5-fluorouracil in order to shorten the
treatment time [3].
Age spots. The removal of age spots can be
obtained with the repeated use of high concentra-
tions of glycolic acid or with lower formulations
applied daily for long periods. Glycolic acid mixed
with 2% hydroquinone can provide additional
benefits for patients because it seemsmore effec-
tive and less irritating than hydroquinone alone
L&91.
Additional uses. Glycolic acid is especially
helpful in the treatment of a variety of different
hyperproliferative diseases. Recently, several pa-
tients with plaque psoriasis have been treated
with 70% solutions with excellent results [lo].
Icthyosis and hyperkeratosis palmaris and
plantaris can receive beneficial effects from treat-
ment with glycolic acid, as alternative or adjuvant
therapy. Keratosis pilaris and warts can also be
treated with glycolic acid with good results [2,3].
However, several contraindications to peeling
with glycolic acid have been identified. In fact,
patients with recurrent facial herpetic lesions may
need to avoid peeling or require preprocedural
oral antiviral therapy. Oral retinoids can alter
postpeeling healing, so that it is recommended to
delay chemical peeling by at least 6 months after
cessation of the therapy. Patients with extreme
skin sensivity can show low tolerance to chemical
peeling and need careful observation.
With respect to side effects, the most common
problem with high concentrations of glycolic acid
is persistent erythema, that can last 2-3 weeks.
Postpeel hyperpigmentation seems a very rare
event, less frequent than using other peeling
agents [ill.
References
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[3] Van Scott EJ, Yu RJ. Alpha hydroxy acids: procedures
for use in clinical practise. Cutis 1989; 43:222-228.
[4] Van Scott EJ, Yu RJ. Hyperkeratinization, corneocyte
 C. Cotellessa et al. /J. Eur. Acad. Dermatol. Venereal. 5 (1995) 215-217 217

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