Melasma skin preparation

Resorcinol solutions have been used in combination with glycolic acid, trichloroacetic acid (TCA) and 5-fluorouracil (5-FU). Many modified versions of Jessner s solution have been presented, containing kojic acid, hydroquinone, etc. The effectiveness of these resorcinol solutions depends on skin preparation, skin sensitivity and thickness, the type of applicator and the force of application, the number of coats applied, the type of solution used, the quality of the solution s preparation, etc. Moreover, products with a tyrosinase-inhibiting action (kojic acid, hydroquinone, etc.) only produce their effect in the long term. Single application of these products cannot treat melasma in any way. Only repeated applications, allowing the gradual absorption of products that inhibit melanocyte metabolism, can be considered as an effective treatment. 

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. 

The results of a TCA-SAS peel also depend on the quality and consistent use of cosmeceuticals after the peel. It is clear that a melasma treatment will produce better results if the TCA-SAS peel is followed by the application of a retinol-anti-tyrosinase-anti-oxidant cream or a hydro-quinone-based preparation. For acne or aging or sagging skin, the same comments apply as for AHAs above. These creams can be applied as soon as flaking is finished, usually on the 7th day. 

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. 

It is not usually necessary to prepare the skin, but with long-standing or resistant melasma or with a skin phototype higher than Fitzpatrick IV, preparing the skin can be worthwhile and can improve results ... 

In contrast to photodamage, when treating conditions such as melasma and PIH, retinoids should either be discontinued 1 or 2 weeks before peeling or completely eliminated from the peeling preparation to avoid postpeel complications such as excessive erythema, desquamation, and PIH. These conditions are more common in darker racial/ethnic groups, populations at greater risk for postpeel complications. Similar precautions should be taken in acne patients with darker skin types (V and VI). 

---