Combination peels darker skin types

This demarcation line (Figure 29.6) can be made less obvious both by a good peeling technique and by combination with other peels on the neck. Darker skin types are not such a good indication, because of the change in skin tone after the peel. Most patients with a lot of wrinkles, however, prefer to exchange their wrinkles for a difference in skin color that can easily be disguised with makeup. 

There is minimal published data on the use of combination peeling protocols in deeply pigmented skin (Fitzpatrick skin types IV-Vl). The author has reported the efficacy of combination peeling with salicylic acid 20 and 30% in combination with 10% TCA for recalcitrant melasma patients. This peeling regimen was well tolerated with minimal side effects in darker racial ethnic groups (see Salicylic acid/TCA peel section). 

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