Melasma is a difficult-to-treat, recurrent pigmentary disease. Combined therapy gives better, longer-lasting results.

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

This was a review of four cases of patients with melasma, who, despite multiple treatments including hydroquinone, showed no improvement. Here, a 16-week protocol was initiated involving 3 in-clinic peels (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 Vitisvinifera seed extract. Meanwhile, the home treatment was a depigmenting serum (4-butyl resorcinol, hydroxy-phenoxy propionic acid and niacinamide), a specific SPF50+ sunscreenand an oral supplement – containing Polypodiumleucotomos; green tea extract; Vitis vinifera; vitamins C, E and D; and carotenoids—all in the morningand at night, a compounded – gel-cream 4% hydroquinone, 0.025% tretinoin and 1% hydrocortisone.

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. Photographs were taken before treatment and at the last evaluation. Patients indicated their satisfaction on a 5-point scale.

The results showed that all patients had good tolerance to the procedures. Three showed an excellent (>75%) improvement and one showed a good (50-75%) improvement. All four were very satisfied. At follow-up – 12 weeks after last peel, no patients had recurrence.

It was inferred 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 refractory melasma.

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