Melasma post-peel care

If the melanin responsible for the melasma is too deep, TCA will only be effective after many repeated sessions. In any event, the TCA peel must be combined with effective sun protection and appropriate post-peel care in the long term. Simple aqueous solutions of TCA also require the skin to be prepared, in order to even out penetration and prevent common pigmentary changes. 

The histological features of melasma and chloasma are discussed elsewhere in this book. The standard recommendations for treatment often only mention topical applications of tretinoin, hydroquinone and other tyrosinase inhibitors corticosteroids and peels are considered as a last resort because of their potential to turn melasma into post-inflammatory hyperpigmentation (PIH). Conventional peels require conscientious pre-peel preparation to avoid this danger. Easy TCA (ETCA), in combination with appropriate post-peel care, can be used to treat melasma without the constraints of pre-peel preparation (Eigures 16.1-16.5). 

As a general rule, it is worthwhile preparing the skin carefully with tyrosinase inhibitors if there is any risk of post-peel pigmentary changes or to optimize results when treating melasma. Retinoic acid and sometimes glycolic acid are used to make transepidermal penetration more even or to deepen the action of the acid solution. 

Figure 6.11 Blistering. (A, B) A melasma patient with an excellent rosy red blanch after steps I, II, III and IV. (C, D) Note the blister on the upper lip on post peel day one. This was drained with a needle. (E, F) Excellent results. The patient can now return to her skin care program to prevent a recurrence...

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