Preparation melasma treatment

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. 

Preparing a patient who has acne is not the same as preparing a patient with photoaging or melasma. Hyperpigmentation of all sorts responds extremely well to pre-peel treatments. 

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). 

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. 

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