Melasma types

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

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). 

Melasma is an acquired hyperpigmentation disorder characterized by moth-eaten tan or brownish macules and patches that occur on the sun-exposed areas of the skin (Fig. 14.1) [1]. Melasma is most commonly observed in women, but also in 10% of men. It affects all racial groups but is more prevalent in skin types IV-Vl. When melasma is associated with pregnancy it is called chloasma or mask of pregnancy . 

Indeterminate melasma melasma in patients with skin type VI. 

Fig. 14.11a, b. Melasma of the face in a patient with skin type VI before and after combined peeling with 25% salicylic acid and 10% TCA gel. The improvement is mild... 

Melasma appears almost exclusively on areas of skin that have been exposed to the sun. It can be of the following types ... 

Purely epidermal there is a lot of melanin in the basal and suprabasal layers of the epidermis. It is occasionally found throughout the epidermis. A Wood s light increases the contrast between the melasma and normal skin. This is the most common type of melasma. 

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. 

Phenol is a good indication for all types of hyperpigmented lesions lentigines, pigmented keratoses, chloasma, melasma, freckles and post-inflammatory hyperpigmentation (PIH). All the same, phenol is not the first choice of... 

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