Melasma salicylic acid

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...

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)... 

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). 

Fig. 14.5a, b. Mandibular melasma before and after superficial peeling with 25% salicylic acid... 

Fig. 14.7a, b. Malar melasma before and after combined peeling with 25% salicylic acid and 10% TCA gel... 

Kodali [11], in a prospective, randomized split-face study, assessed the efficacy of 20% and 30% salicylic acid peels in 20 Latin American women with melasma. Salicylic acid peels were applied to one side while both sides were treated with hydroquinone 4%. Although both sides of the face had significant reduction in pigment, there were no differences between the peeled and unpeeled side with all outcome measures suggesting that salicylic acid did not improve outcomes versus hydroquinone monotherapy in patients with melasma. 

Kodali S (2010) A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma... 

Ejaz A et al (2008) Comparison of 30% salicylic acid with Jessner s solution for superficial chemical peeling in epidermal melasma. J CoU Physicians Surg Pak 18 205-208... 

Fig. 11.1 Patient with Melasma before a series of 3 salicylic acid peels and 3 microdermabrasion treatments...

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