Chemical peels for melasma in dark-skinned patients

Abstract

Melasma is a common disorder of hyperpigmentation, which has a severe impact on the quality of life. Inspite of tremendous research, the treatment remains frustrating both to the patient and the treating physician. Dark skin types (Fitzpatrick types IV to VI) are especially difficult to treat owing to the increased risk of post-inflammatory hyperpigmentation (PIH). The treatment ranges from a variety of easily applied topical therapies to agents like lasers and chemical peels. Peels are a well-known modality of treatment for melasma, having shown promising results in many clinical trials. However, in darker races, the choice of the peeling agent becomes relatively limited; so, there is the need for priming agents and additional maintenance peels. Although a number of new agents have come up, there is little published evidence supporting their use in day-to -day practice. The traditional glycolic peels prove to be the best both in terms of safety as well as efficacy. Lactic acid peels being relatively inexpensive and having shown equally good results in a few studies, definitely need further experimentation. We also recommend the use of a new peeling agent, the easy phytic solution, which does not require neutralisation unlike the traditional alpha-hydroxy peels. The choice of peeling agent, the peel concentration as well as the frequency and duration of peels are all important to achieve optimum results.

Phytic Acid and Sodium Chloride Show Marked Synergistic Bactericidal Effects against Nonadapted and Acid-Adapted Escherichia coli O157:H7 Strains

“…In addition, exposing the skin to PA may have more advantages than disadvantages. Some commercially available cosmetics contain PA, and several studies report that PA has the following positive effects on human skin: moisturization, lightening, increased elasticity, peeling, and improved acne vulgaris and melasma symptoms (62)(63)(64).…”

Chemical peeling in ethnic skin: an update

“…It is effective for treating acne, photodamage, superficial scarring and pigmentary disorders in light-skinned patients. 23 Further testing in darker skin types is required, but it shows promise.…”

Melasma, Novel Treatment Modalities

“…The more recently introduced phytic acid peels [62] and amino fruit peels [63] are better tolerated with less side effects than the classical peels [61].…”

“…The value of priming the skin before treatment with bleaching creams, tretinoin (0.025-0.1%), glycolic acid (<15%) creams individually or as TCC and the use of TCC together with sunscreens during and after treatment sessions would add to the efficacy and decrease melasma relapse [61]. The more recently introduced phytic acid peels [62] and amino fruit peels [63] are better tolerated with less side effects than the classical peels [61].…”

“…Different topical therapy combinations have been studied and combining topical, oral therapies with each other and/or with peeling and light therapies add to the efficacy of treatment especially in recalcitrant cases. Starting by TCC before other treatment modalities decrease the incidence of PIH and may decrease melasma relapse [54,61,72,74,75,79,83,89,99].…”