Abstract

Chemical peeling is among the top five non-surgical dermatology procedures in the USA (1). Trichloroacetic acid (TCA) is the most commonly used agent in chemical peeling, while hydroquinone (HQ) and kojic acid (KA) are popular topicals to reduce hyperpigmentation. However, due to potential safety concerns, all three aforementioned ingredients are under strict regulations (2-4). Therefore, the objective of our research was to identify and develop a novel peel technology free from ingredients of concerns with superior efficacy and minimum downtime. Through in-silico and in-vitro screening of the tyrosinase enzyme, a synergistic mixture of alpha-hydroxy (lactic and mandelic acids), alpha-keto (pyruvic acid) and tranexamic acid (TXA) at a proprietary ratio was identified. After a single application on ex-vivo skin explants, the peel was found to be more effective than a commercial HQ peel in inhibiting melanin by gene expression and histochemical staining. In two IRB-approved case studies, the peel showed good tolerance, and improvements in hyperpigmentation (melasma, photodamage, and acne-induced post-inflammatory hyperpigmentation), skin texture, erythema, and fine lines/wrinkles. The visible improvement in hyperpigmented and dull facial skin after peeling could be correlated to subsurface reduction in melanin and increase in NADH (energy marker in mitochondria of the keratinocytes), as visualized real-time by reflectance confocal microscopy (RCM) and multiphoton tomography (MPT). Subsequent swabbing of the cheek skin found no microbiota dysbiosis resulting from the peel. The strong efficacy with minimum downtime and no adverse events could be linked to the synergistic action of the multi-acid blend.