Melasma

Salicylic acid 20-30% Jessner s solution Glycolic acid 20,35,50,70% Trichloracetic acid 10-30% 

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Dermatologic—chloasma (pigmentation of the skin) or melasma (discoloration of the skin), which may continue when use of the drug is discontinued... 

Useful in acne, post-inflammatory hyperpigmentation and melasma... 

Actinic keratoses Dark skin Melasma Photoaging... 

Most beneficial in treating recalcitrant melasma and post-inflammatory hyperpigmentation... 

Patients with melasma (Eig. 2.3) applied topical sunscreens (sun protection factor 15) and 10% glycolic acid lotion at night for 2 weeks. They were then treated with 50% glycolic acid facial peels once a month for 3 consecutive months. At regular intervals and at the end of the follow-up period (3 months) after the last peel, the degree of improvement in pigmentation was assessed by measuring MASl (Melasma Area and Severity Index) [11]. 

Javaheri SM, Handa S, Kaur I, Kumar B (2001) Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol 40(5) 354-357... 

Jessner s peels have been used to treat acne, melasma, post-inflammatory hyperpigmentation, lentigines, freckles, and photodamage (Figs. 3.2a,b, 3.3a, b and 3.4a, b). 

Fig. 3.4. a Patient with melasma, b Patient after treatment with Jessner s peeling... 

Fig. 5.4a. Patient with melasma before treatment Fig. 5.4b. Patient with melasma after treatment...

Grimes et al. [8] reported substantial efficacy and minimal side effects in 25 patients treated with 20 and 30% salicylic acid peels in darker racial-ethnic groups. Conditions treated included acne vulgaris, melasma and post-inflammatory hyperpigmentation. 

Given these findings, indications for salicylic acid peels include acne vulgaris (inflammatory and non-inflammatory lesions), acne rosacea, melasma, post-inflammatory hyperpigmentation, freckles, lentigines, mild to moderate photodamage, and texturally rough skin. 

Fig. 6.4a. Melasma before and after a series of five salicylic acid peels and 4% hydroquinone...

Fig. 7.2a, b. Medium depth chemical peel for melasma, (a) Pre-operative, (b) intraoperative - Level III frosting... 

Excellent to Good Response Actinic keratoses Superficial melasma Superficial hyperpigmentation Ephelides Lentigines... 

Seborrheic keratoses Hypertrophic keratoses Mixed melasma Mixed hyperpigmentation... 

In 2002, Grimes reported the efficacy of combination salicylic acid/TCA 10% peeling [1]. She treated patients with moderate to severe melasma with this combination regimen. In the series, nine patients were classified as Fitzpatrick skin type IV, eleven were skin type V, and seven were skin type VI. Many of the subjects included in the study had not responded to salicylic acid or glycolic acid peels. The concentration of salicylic acid was 20 and 30%, and the TCA concentration was 10%. A series of four peels was performed at 2-week intervals. Thirty percent of the patients experienced moderate improve-... 

The combination of salicylic acid and TCA 15% is also an effective treatment for mild to moderate photodamage, acne and melasma in types 1-111. Moderate to excellent improvement has been observed (Figs. 10.3a, b, 10.4a, b and 10.5a, b). Hence, the combination salicylic acid/TCA peeling protocol can be used in all skin types. 

Fig. 10.2. a Patient with recalcitrant melasma unresponsive to glycolic acid or salicylic acid peels, b Responded to combination salicylic acid/TCA peeling... 

Fig. 10.4. a Facial melasma in skin type 111. b Note significant improvement after combination salicylic acid/TCA peel... 

Grimes PE (2005) The use of a combination salicylic acid/ trichloroacetic acid 10% chemical peel for treatment of melasma in darker racial ethnic groups. Dermatol Surg (in press)... 

The safety and efficacy of a series of glycolic acid facial peels were investigated in 25 Indian women with melasma [16]. Patients were treated with 50% glycolic acid peels monthly for 3 months. Improvement was noted in 91% of patients with maximal clearing occurring in patients classified with epidermal melasma. Side effects were observed in one patient who developed brow hyperpigmentation. 

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