We thank Drs Coleman and Brody for their letter regarding our study. Since glycolic acid peeling solutions are used in a variety of strengths, the term "low-strength" might have been a useful addition to our title. It is true that we purposely chose lower concentrations of glycolic acid to peel our patients, in order to avoid visible frosting or epidermolysis. This latter reaction frequently leads to postinflammatory hyperpigmentation in our experience, which then requires weeks or months of depigmenting agents afterwards. Previous studies have reported that 50% to 70% glycolic acid peels can cause depths of injury equal to 30% to 50% trichloracetic acid peels,1 a response we were trying to avoid in these patients with skin types IV and V. The erythema produced in our patients indicated a biologic effect, but fortunately was not severe enough to cause postinflammatory hyperpigmentation. Use of glycolic acid has been shown to decrease keratinocyte cohesion down to the granular cell layer,2 which we hoped would enhance the penetration of hydroquinone. Unfortunately, we did not even detect a trend in improvement of melasma after 4 peels. Dermatologists taking care of brown-skinned patients worldwide face a daily dilemma in which they are asked to remove pigmentation without going too far. This balancing act will continue until we have more effective therapies as a result of additional, controlled, prospective studies.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early
dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Dermatology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.