The relative efficacies of certain chemical peels for the treatment of melasma in patients of color were outlined in study data published in Dermatologic Therapy. Compared with lactic acid peels, glycolic acid and trichloroacetic acid (TCA) peels were associated with greater reduction in melasma severity. However, lactic acid peels had fewer side effects.
Although chemical peels are common treatment options for the treatment of melasma, few studies have directly compared their efficacy and safety profiles. Two practicing dermatologists at the University of Health Sciences in Haryana, India, conducted a 12-week, open-label, prospective randomized study of 3 chemical peel modalities for the treatment of melasma.
Patients who sought treatment for melasma from October 2018 to September 2020 were eligible for inclusion. Participants were randomly assigned 1:1:1 to the following chemical peel conditions: 30% glycolic acid, 92% lactic acid, and 15% TCA. Chemical peels were administered every 2 weeks for a total of 12 weeks.
Primary study outcomes were improvement from baseline on the Melasma Area Severity Index (MASI) and the Health-Related Quality of Life scale (HRQOL). Patients’ global tolerance of peeling treatments was graded on an ordinal scale. Safety signals were monitored throughout the trial.
The total study cohort comprised 90 patients with epidermal melasma, 74 women and 16 men. Each study group had 30 patients. Treatment groups were similar with respect to age, gender, disease duration, skin type, and family history.
The distribution of patients by Fitzpatrick skin phototype was as follows: 16.7% type III, 48.9% type IV, and 34.4% type V. Overall, patients in all 3 study groups experienced significant improvements in MASI score.
Significant changes were observed at week 4 and continued through week 12 for each group. Mean MASI score at 8 weeks was lower in the glycolic acid and TCA peel groups compared with the lactic acid group, suggesting greater improvement. However, MASI scores were comparable in all 3 groups by 12 weeks.
HRQOL score at 12 weeks was greatest in the glycolic peel group (33.10±3.661), followed by the TCA (31.50±4.524) and lactic acid (30.13±3.411) peel groups. The difference between the glycolic acid and lactic acid peel groups was significant (P =.003).
The most common adverse events were postinflammatory hyperpigmentation, pruritus, burning sensation, erythema, and scaling. The incidence of adverse events was greatest in the TCA group. Patients who received lactic acid peels reported the fewest side effects. However, all symptoms resolved with time and did not require treatment cessation.
According to these data, glycolic acid and TCA chemical peels were associated with the greatest improvement in melasma, the researchers believe. Lactic peel, although less efficacious as a melasma treatment, had fewer side effects.
Study limitations include the short follow-up period, which prevented monitoring for melasma recurrence.
“Our study concluded that 15% TCA and 30% [glycolic acid] peel are equally effective and superior [to] 92% lactic peel in treatment of epidermal melasma in skin of color. However [a] dermatologist can use any of these peels judiciously considering patient profile and its safety,” investigators wrote.
Sahu P, Dayal S. Most worthwhile superficial chemical peel for melasma of skin of color: authors’ experience of glycolic, trichloroacetic acid, and lactic peel. Published online December 28, 2020. Dermatol Ther. doi:10.1111/dth.14693