A new study published in Clinical, Cosmetic and Investigational Dermatology aimed to determine the clinical effects of a treatment protocol with trichloroacetic acid, phytic acid and ascorbic acid peel combined with oral antioxidant supplement and topical treatment, for refractory melasma.

The present study selected four patients with melasma, who showed no improvement despite multiple treatments including hydroquinone. A 16-week protocol was initiated—involving three in-clinic peels (each, 4 weeks apart) and a daily home treatment. The peels contained 30% trichloroacetic acid, 2% phytic acid, 8% L-ascorbic acid, Camellia sinensis leaf extract and Vitis vinifera seed extract. Meanwhile, home treatment was done using a depigmenting serum, comprising 4-butyl resorcinol, hydroxy-phenoxy propionic acid and niacinamide; a specific SPF50+ sunscreen; and an oral supplement – Polypodium leucotomos, green tea extract, Vitis vinifera, vitamins C, E, and D; and carotenoids.

All of these, were administered in the mornings and at night; in addition, a compounded gel-cream – 4% hydroquinone, 0.025% tretinoin and 1% hydrocortisone, was also used. After 16 weeks, the gel-cream was stopped; the rest of the regimen (topical and oral) was continued for 12 more weeks. Melasma was assessed using the melasma severity scale (MSS) before starting the protocol, and at 4 and 12 weeks after the last peel.

All patients reported good tolerance to the procedures and were very satisfied. While three of the patients showed an excellent (>75%) improvement, one showed good (50-75%) improvement. On follow-up, at 12 weeks after last peel, no patients had recurrence.

From the findings, it was concluded that this protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with an oral supplement and topical daily treatment is a viable treatment option for managing refractory melasma.

Source: Clinical, Cosmetic and Investigational Dermatology. 2020 Mar 4;13:209-213. doi: 10.2147/CCID.S242180.