Chemical peels for melasma in dark-skinned patients

Rashmi Sarkar, Shuchi Bansal, Vijay K Garg, Rashmi Sarkar, Shuchi Bansal, Vijay K Garg

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.

Keywords: Chemical peels; dark skin; melasma.

Conflict of interest statement

Conflict of Interest: None declared.

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Appendix
Appendix
US preventive services task force levels of evidence for grading clinical trials[51]

References

    1. Sheth VM, Pandya AG. Melasma: A comprehensive update: Part I. J Am Acad Dermatol. 2011;65:689–97.
    1. Ball Arefiev KL, Hantash BM. Advances in the Treatment of Melasma: A Review of the Recent Literature. Dermatol Surg. 2012;38:971–84.
    1. Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, Gonzalez EA, Villemur JA, et al. Association of melasma with thyroid autoimmunity and other thyroidal abnormalities and their relationship to the origin of the melasma. J Clin Endocrinol Metab. 1985;61:28–31.
    1. Moin A, Jabery Z, Fallah N. Prevalence and awareness of melasma during pregnancy. Int J Dermatol. 2006;45:285–8.
    1. Grimes PE. Melasma. Etiologic and therapeutic considerations. Arch Dermatol. 1995;131:1453–7.
    1. Resnik S. Melasma induced by oral contraceptive drugs. JAMA. 1967;199:601–5.
    1. Kang WH, Yoon KH, Lee ES, Kim J, Lee KB, Yim H, et al. Melasma: Histopathological characteristics in 56 Korean patients. Br J Dermatol. 2002;146:228–37.
    1. Kim EH, Kim YC, Lee E-S, Kang HY. The vascular characteristics of melasma. J Dermatol Sci. 2007;46:111–6.
    1. Varma S, Roberts DL. Melasma of the arms associated with hormone replacement therapy. Br J Dermatol. 1999;141:592.
    1. O’Brien TJ, Dyall-Smith D, Hall AP. Melasma of the forearms. Australas J Dermatol. 1997;38:35–7.
    1. Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Mihm MC, Jr, et al. Melasma: A clinical, light microscopic, ultrastructural, and immunofluorescence study. J Am Acad Dermatol. 1981;4:698–710.
    1. Grimes PE, Yamada N, Bhawan J. Light microscopic, immunohistochemical, and ultrastructural alterations in patients with melasma. Am J Dermatopathol. 2005;27:96–101.
    1. Sheth VM, Pandya AG. Melasma: A comprehensive update: Part II. J Am Acad Dermatol. 2011;65:699–714.
    1. Azzam OA, Leheta TM, Nagui NA, Shaarawy E, Abdel Hay RM, Hilal RF. Different therapeutic modalities for treatment of melasma. J Cosmet Dermatol. 2009;8:275–81.
    1. Victor FC, Gelber J, Rao B. Melasma: A review. J Cutan Med Surg. 2004;8:97–102.
    1. Ho SG, Chan HH. The Asian dermatologic patient: Review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol. 2009;10:153–68.
    1. Khunger N. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol. 2008;74:5–12.
    1. Roberts WE. Chemical peeling in ethnic/dark skin. Dermatol Ther. 2004;17:196–205.
    1. Lim JT, Tham SN. Glycolic acid peels in the treatment of melasma among Asian women. Dermatol Surg. 1997;23:177–9.
    1. Javaheri SM, Handa S, Kaur I, Kumar B. Safety and efficacy of glycolic acid facial peel in Indian women with melasma. Int J Dermatol. 2001;40:354–7.
    1. Grover C, Reddu BS. The therapeutic value of glycolic acid peels in dermatology. Indian J Dermatol Venereol Leprol. 2003;69:148–50.
    1. Godse KV, Sakhia J. Triple combination and glycolic acid peels in melasma in Indian patients. J Cosmet Dermatol. 2011;10:68–9.
    1. Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatol Surg. 1999;25:18–22.
    1. Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid as a new therapeutic peeling agent in melasma. Dermatol Surg. 2005;31:149–54.
    1. Kalla G, Garg A, Kachhawa D. Chemical peeling-Glycolic acid versus trichloroacetic acid in melasma. Indian J Dermatol Venereol Leprol. 2001;67:82–4.
    1. Sarkar R, Kaur C, Bhalla M, Kanwar AJ. The combination of glycolic acid peels with a topical regimen in the treatment of melasma in dark-skinned patients: A comparative study. Dermatol Surg. 2002;28:828–32. discussion 832.
    1. Hurley ME, Guevara IL, Gonzales RM, Pandya AG. Efficacy of glycolic acid peels in the treatment of melasma. Arch Dermatol. 2002;138:1578–82.
    1. Khunger N, Sarkar R, Jain RK. Tretinoin peels versus glycolic acid peels in the treatment of Melasma in dark-skinned patients. Dermatol Surg. 2004;30:756–60. discussion 760.
    1. Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid chemical peels as a new therapeutic modality in melasma in comparison to Jessner's solution chemical peels. Dermatol Surg. 2006;32:1429–36.
    1. Safoury OS, Zaki NM, El Nabarawy EA, Farag EA. A study comparing chemicalpeeling using modified Jessner's solution and 15% trichloroacetic Acid versus 15% trichloroacetic acid in the treatment of melasma. Indian J Dermatol. 2009;54:41–5.
    1. Kumari R, Thappa DM. Comparative study of trichloroacetic acid versus glycolic acid chemical peels in the treatment of melasma. Indian J Dermatol Venereol Leprol. 2010;76:447.
    1. Sobhi RM, Sobhi AM. A single-blinded comparative study between the use of glycolic acid 70% peel and the use of topical nanosome vitamin C iontophoresis in the treatment of melasma. J Cosmet Dermatol. 2012;11:65–71.
    1. Hong SP, Han SS, Choi SJ, Kim MS, Won CH, Lee MW, et al. Split-face comparative study of 1550 nm fractional photothermolysis and trichloroacetic acid 15% chemical peeling for facial melasma in Asian skin. J Cosmet Laser Ther. 2012;14:81–6.
    1. Griffin TD, Van Scott EJ, Maddin S. The use of pyruvic acid as a chemical peeling agent. J Dermatol Surg Oncol. 1989;15:13.
    1. Berardesca E, Cameli N, Primavera G, Carrera M. Clinicaland Instrumental Evaluation of Skin Improvement after Treatment with a New 50% Pyruvic Acid Peel. Dermatol Surg. 2006;32:526–31.
    1. Ahn HH, Kim IH. Whitening effect of salicylic acid peels in Asian patients. Dermatol Surg. 2006;32:372–5.
    1. Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B. Evidence and Considerations in the Application of Chemical Peels in Skin Disorders and Aesthetic Resurfacing. J Clin Aesthet Dermatol. 2010;3:32–43.
    1. Uhoda E, Pierard-Franchimont C, Pierard GE. Comedolysis by a lipohydroxyacid formulation in acne-prone subjects. Eur J Dermatol. 2003;13:65–8.
    1. Taylor MB. Summary of mandelic acid for the improvement of skin conditions. Cosmet Dermatol. 1999;12:26–8.
    1. Garg VK, Sinha S, Sarkar R. Glycolic acidpeels versus salicylic-mandelicacid peels in active acne vulgaris and post-acne scarring and hyperpigmentation: A comparative study. Dermatol Surg. 2009;35:59–65.
    1. Zakopoulou N, Kontochristopoulos G. Superficial chemical peels. J Cosmet Dermatol. 2006;5:246–53.
    1. Monheit GD. The Jessner's + TCA peel: A medium-depth chemical peel. J Dermatol Surg Oncol. 1989;15:945–50.
    1. Cuce LC, Bertino MC, Scattone L, Birkenhauer MC. Tretinoin peeling. Dermatol Surg. 2001;25:12–4.
    1. Deprez P. Easy Phytic Solution: A New Alpha Hydroxy Acid Peel with Slow Release and without Neutralization. Int J Cosm Surg Aesth Derm. 2003;5:45–51.
    1. Obagi ZE, Obagi S, Alaiti S, Stevens MB. TCA-based bluepeel: A standardized procedure with depth control. Dermatol Surg. 1999;25:773–80.
    1. Klein M. Amino fruit acids: The new cosmeceutical. Cosmet Dermatol. 2000;13:25–8.
    1. Ilknur T, Bicak MU, Demirtaroglu M, Ozkan S. Glycolic Acid Peels Versus Amino Fruit Acid Peels in the Treatment of Melasma. Dermatol Surg. 2010;36:490–5.
    1. Rubin ME. Superficial and medium depth. Philadelphia: Lippincott; 1995. Manual of chemical peels; pp. 17–25.
    1. Garg VK, Sarkar R, Agarwal R. Comparative Evaluation of Beneficiary Effects of Priming Agents (2% Hydroquinone and 0.025% Retinoic Acid) in the Treatment of Melasma with Glycolic Acid Peels. Dermatol Surg. 2008;34:1032–40.
    1. Nanda S, Grover C, Reddy BS. Efficacy of hydroquinone (2%) versus tretinoin (0.025%) as adjunct topical agents for chemical peeling in patients of melasma. Dermatol Surg. 2004;30:385–8.
    1. Morton CA, McKenna KE, Rhodes LE British Association of Dermatologists Therapy Guidelines and Audit Subcommittee and the British Photodermatology Group. Guidelines for topical photodynamic therapy: Update. Br J Dermatol. 2008;159:1245–66.

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