J Cosmet Dermatol 2007 Jun;6(2):89-94
The Department of Dermatology, Kasr El-Aini University Hospital, Cairo University, Cairo, Egypt.
Background: Melasma is a common acquired hypermelanosis that is difficult to treat. Several chemical peeling agents were used in treatment of melasma. Topical vitamin C was also used with minimal side effects.
Aim: To compare the effect of 20% trichloroacetic acid (TCA) peel alone vs. 20% TCA peel combined with topical 5% ascorbic acid in cases of epidermal melasma.
Patients And Methods: Thirty women with bilateral epidermal melasma (Fitzpatrick skin types III and IV) were divided into two groups (A and B, 15 patients each). Before therapy, digital photography and a melasma area and severity index (MASI) score were done for each patient. Groups A and B were primed for 2 weeks before TCA peel. Group B also applied 5% ascorbic acid topically once daily; 20% TCA peel was done for all patients weekly until clearance of melasma or for a maximum of six peels. Group B continued to use 5% ascorbic acid topically in between peels and during the 16-week follow-up period. Patients were assessed at the end of peeling sessions and at the end of follow-up by photography, MASI score, and a global evaluation by the patient.
Results: Group B compared with group A showed a significant decrease in MASI score at the end of TCA peels (P < 0.001) and at the end of the 16-week follow-up period (P < 0.003). Global evaluation showed that 13 patients (87%) in group B improved or maintained their improvement compared with only 10 patients (67%) in group A.
Conclusion: Topical ascorbic acid combined with 20% TCA peel in melasma improves the results and helps in maintaining the response to therapy.