A Randomised Open Label Trial to Evaluate the Efficacy of TCA Peel with Oral Metformin vs TCA Peel with Oral Alpha Lipoic Acid in Acanthosis Nigricans

Background: Acanthosis Nigricans (AN) is a condition acquired by keratinization.It presents as velvety skin and hyperpigmentation and can affect any area of the body, including the face.Several topical, systemic, and physical therapies, including laser therapy have been studied.For the most part, randomised controlled trials are lacking for therapy choices other than weight loss and lifestyle adjustments.Therefore, the present study was designed to compare the efficacy of 15% trichloroacetic acid (TCA) peel with oral metformin against 15% TCA peel with alpha lipoic acid in cases of AN with metabolic syndrome.Methods: Fifty patients were included & divided into two groups.Each patient in Group A was given oral alpha lipoic acid 200 mg BID along with monthly 15% TCA for 03 months, while in Group B, patients were given monthly oral metformin 500 mg BID for three months along with monthly 15% TCA.The effectiveness of each peel was assessed by looking into the severity of neck lesions & texture.Results: The generalized estimating equations method was used to compare the total change over time in the two groups.Over time, there was a substantial difference between the two groups (p<0.001).When compared to a TCA peel with an oral lipoic acid group, the skin thickness and texture changed more in the metformin group. Conclusion:In both groups, oral metformin with TCA peel was more effective than oral alpha lipoic acid in our study.As a safe and efficient treatment for AN, we advise using metformin in conjunction with a 15% TCA peel.For supporting data, however, more thorough randomized control studies are needed.