Abstract
Abstract Background:Acne vulgaris is the most common skin condition affecting the pilosebaceoussystemin adolescents and young age and characterized bydifferentskinlesionsand might result in permanent scars. Chemical peeling is an effective option in the management of active acne. The mechanism of action lies in causing desquamation by targeting the corneosomes and keratinocytes, enhancing breakdown and decreasing cohesiveness. It also increases epidermal activity of enzymes, leading to epidermolysis and exfoliation and induces improvement of skin texture , pore size and reduces sebum production. Proper and successful treatment of acne involves choosing the right medication. Objectives:This study aims to evaluate the clinical efficacy and safety of using topical 25% Salicylic acid alone, in comparison with a combination of systemic Azithromycin and topical 25% salicylic acid, Zinc sulphate, and Benzoyl peroxide gel, in treatment of mild to moderate acne lesions. Subjects and methods:This study is a prospective, randomized clinical trial included a hundred patients diagnosed with mild-to-moderate facial acne vulgaris and randomly divided into two equal groups Group A, treated by25% Salicylic Acid peeling in combination with systemic Azithromycin in addition to Zinc sulphate and topical Benzoyl peroxide gel. Group B, treated by 25% salicylic peeling only.All patients received at least 6 peeling sessions performed 2 weeks apart in 12-weeks duration. Results:Number of peeling sessions was significantly lower in group A than group Bp= 0.03. Improvement rate (92%) 46 cases in group A vs. (20%) 10 cases in group B.Improvement score after 6th session was 4.71 in group A vs 2.67in group Bp<0.001.Also, there was a highly significant improvement after each session in group A as 15 cases (30%) needed only 4 sessions for complete improvement. group B showed only significant improvement after 2nd,3rd, and 4th sessions, while there was no improvement in score after 5th and 6thsessions.There were no statistically significant differences regarding risk factors of acne such as; psychological distress, family history, dairy product consumption, fast food, cosmetics, regular exercise and special diet habits p>0.05. Disease duration were matched in both groups as mean duration in group A was 26.8 versus 27.5 months in group B. Back & shoulder lesion were found in 34 cases in group A while they present in 31 cases in group B. There were no differences regarding lesions characteristics between both studied groups except for pustules that were predominant in group A in 34/50 cases (68%) whereas, they found in 24/50 cases (48%) in group Bp=0.04. Conclusion:Topical 25 % of salicylic acid is more efficient to treat mild to moderate acne vulgaris andincombinationwith systemic Azithromycin in addition to Zinc sulphate and topical Benzoyl peroxide gel is significant than alone and both protocols equal in safety and tolerability. Keywords:Acne Vulgaris, Salicylic Acid,Chemical Peeling, Benzoyl Peroxide.