Chemical peels as treatment of melasma

In a recently published study, the use of certain chemical peels for the treatment of melasma in patients of colour has been outlined – compared with lactic acid peels, glycolic acid and trichloroacetic acid (TCA) peels have been associated with greater reduction in melasma severity. However, lactic acid peels had fewer side-effects. Even though chemical peels are a common treatment option for the treatment of melasma, there have been few studies that have directly compared their effectiveness and safety profiles. Reportedly, two practicing dermatologists at the University of Health Sciences in Haryana, India, conducted a 12-week, open-label, prospective randomised study of three chemical peel modalities for the treatment of melasma.

As reported, the study was conducted on patients who sought melasma treatment from October 2018-September 2020. Participants were randomly assigned 1:1:1 to the following chemical peel conditions: 30 per cent glycolic acid, 92 per cent lactic acid, and 15 per cent TCA. Chemical peels were administered every two weeks for a total of 12 weeks. Primary study outcomes were improvement from baseline on the Melasma Area Severity Index (MASI) and the Health-Related Quality of Life scale (HRQOL). Patients’ global tolerance of peeling treatments was graded on an ordinal scale. Safety signals were monitored throughout the trial.

The most common negative effects were post inflammatory hyperpigmentation, pruritus, burning sensation, erythema, and scaling. The adverse effects were greatest in the TCA group. Patients who received lactic acid peels reported the fewest side-effects. However, all symptoms resolved with time and did not require the treatment to be stopped.

According to the data generated by the research, glycolic acid and TCA chemical peels were associated with the greatest improvement in melasma. Lactic peel, although less efficacious as a melasma treatment, had fewer side-effects. Study limitations include the short follow-up period, which prevented monitoring for melasma recurrence.
The study, as reported, concluded that 15 per cent TCA and 30 per sent (glycolic acid) peel is equally effective and superior (to) 92 per cent lactic peel in treatment of epidermal melasma in skin of colour. However a dermatologist can use any of these peels judiciously considering patient profile and its safety.