Physician perspectives on the use of glycolic acid, salicylic acid, and urea combination in dermatology practice in Indian settings

• Author Details:   
• S Manjula ^*
• Krishna Kumar M

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Background: Keratolytic substances including alpha-hydroxy acids (AHAs), salicylic acid, and urea have long been employed in treating hyperkeratosis and related disorders. Although there were clinical studies available, there was a dearth of studies regarding their clinical practice among clinicians. This study aimed to gather expert opinion regarding the physician's perspective and preference on the use of a combination of glycolic acid, salicylic acid, and urea in managing hyperkeratosis in Indian settings.
Materials and Methods: The cross-sectional study used a multiple-response questionnaire comprising 29 questions designed to collect feedback, clinical observations, and experiences from specialists regarding the management of hyperkeratosis by using a combination of glycolic acid, salicylic acid, and urea in routine settings. The questionnaire was structured to capture insights on the frequency of use, perceived efficacy, adverse effects, and preferences for this combination. Data analysis was conducted using descriptive statistics.
Results: The survey involved 559 dermatology specialists, and more than half of them (54.03%) reported 10% as the most commonly prescribed strength of urea for the treatment of hyperkeratosis of the palms and soles. Approximately 63.5% of the participants preferred both glycolic and salicylic acid as keratolytic agents. Majority (74.6%) favored the combination of glycolic acid, salicylic acid, and urea for treating hyperkeratosis on their palms and soles. Almost 51% of the clinicians opined that the glycolic acid (1%), salicylic acid (1%), and urea (5%) combination showed good results, while 47% of them reported it as an excellent monotherapy for the treatment of hyperkeratosis of the palms and soles.  Approximately 63% of the participants recommended the use of glycolic acid (1%), salicylic acid (1%), and urea (5%) in combination with topical steroids for the effective management of plaque psoriasis.
Conclusion: The study highlighted a strong preference for treating hyperkeratosis with a combination of glycolic acid (1%), salicylic acid (1%), and urea (5%). Clinicians favored a 10% urea strength and preferred glycolic and salicylic acids as keratolytic agents.  The combination of these 3 ingredients emerged as the preferred choice. The combination received positive ratings for hyperkeratosis and was recommended with topical steroids for plaque psoriasis, indicating a consensus on its efficacy.

Keywords: Hyperkeratosis, Glycolic acid, Salicylic acid, Urea, Plague psoriasis