May 1, 2020 Chemical Peels For Melasma
A variety of treatment options exist for people who have melasma, such as the chemical peel. A chemical peel is a procedure that removes the epidermis, the outermost layer of skin, through controlled destruction of the skin. This process leads to the formation of a new epidermis without the excess pigmentation from melasma.
What’s In A Chemical Peel?
Chemical peels come in many different forms, and they will usually vary in their strength and application according to the skin type of the patient. Variables to consider will be one’s shade of skin color, the skin layer in which the hyperpigmentation is present, and more. The different chemicals which comprise the peel include:
- Trichloroacetic acid (TCA)
- Glycolic acid
- Salicylic acid
- Jessner’s solution
Beyond these, there exist some proprietary blends like the popular VI peel for melasma. They will usually consist of nearly the same chemicals.
Trichloroacetic acid (TCA)
The TCA peel for melasma is another common facial peel for melasma. It can constitute a superficial or moderate peel depending on the strength of the solution used and the number of layers of the peel that is applied to the patient. TCA is a known efficacious melasma treatment option and has been used in this way for years (Dayal).
Because TCA can be used to penetrate deeply into the skin, it does carry the risk of side effects more serious than those associated with other commonly used chemical peels for melasma, such as glycolic acid. Treated areas can become swollen and crusted for upwards of a week after treatment. Considering the added risk for injury, TCA peels are best performed by a skincare professional.
The glycolic peel for melasma is the most common chemical peel treatment option. Derived from sugar cane and cousin to citric and lactic alpha hydroxy acids, glycolic acid is an organic compound with a proven application for treating melasma.
As the skin ages, it accumulates dead skin cells that make for the appearance of old and unattractive skin. Glycolic acid works to loosen the bindings that hold those cells together to promote cell turnover, resulting in a new epidermis. That new layer of skin can be one without the irregular melanocytes that contribute to the appearance of melasma.
This turnover has the effect of allowing other topical medication, often bleaching agents like hydroquinone, to penetrate more deeply into the epidermis and increase their efficacy. Thus, glycolic acid chemical peels for melasma will often be found as adjunct therapies to more standard melasma treatment. The treatment will usually consist of four to six sessions over two to three weeks.
The efficacy of glycolic acid for melasma has been substantiated across multiple studies (Sarkar). Glycolic acid is sometimes called a “lunchtime” chemical peel because it is a superficial one with mild side effects that are largely limited to some redness (Sarkar).
While not traditionally used as monotherapy for melasma, salicylic acid has application for its treatment. Salicylic acid is a beta-hydroxy acid that is well known among dermatologists for its ability to treat other skin maladies such as acne.
Salicylic acid can aid in the breakdown of the epidermis and therefore has application for melasma. It is often used alongside other topical agents that can take advantage of the deep penetration into the skin which medications such as salicylic acid allow. It has the added benefit of acting as an anti-inflammatory.
The Jessner peel for melasma is similar to glycolic acid peels in that it uses other alpha hydroxy acids in its solution. It also uses salicylic acid, a common skincare medication which helps to break up an unwanted, sun-damaged epidermis.
Combination therapy is a popular route among skincare professionals by which to treat melasma as it often has a complicated etiology that warrants a “kitchen sink” approach. Therefore, peels that use multiple medications at once can be a preferred treatment method. There is no singular, definitive treatment option for melasma; one’s particular complexion is generally the variable that decides the best chemical peel to use.
Topical tretinoin is used for the treatment of various skin ailments such as acne, scars, skin aging, and melasma. Tretinoin peels have a mechanism of action similar to their use as a regular topical treatment for melasma. Tretinoin does not directly bleach skin. It helps to promote cell turnover, which can help the efficacy of other medications and allow them greater access to the skin.
While its use in the form of a peel is not as popular nor as well studied as other chemical peel treatments for melasma, it has some advantages. Namely, it tends to be better tolerated and produce fewer side effects when compared with other peels which more aggressively break up the epidermis (Sumita).
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What To Expect During A Chemical Peel Treatment For Melasma
The chemical peel procedure itself is a simple one. There is a gradation of chemical strength used in the peel. Superficial peels that use chemicals like glycolic acid require little preparation and run little risk of side effects. More serious peels that penetrate deeply into the skin might require local anesthetics.
During your treatment:
- The skin will be cleansed ahead of time, removing excess oil and dead skin cells.
- The agent responsible for the peel is then applied, and it will remain there for several minutes depending on which medication comprises the peel.
- While the chemical is on the skin, some slight pain and burning is natural and is a sign that the medication is working.
- After several minutes have elapsed, the chemical is then neutralized.
For several days after treatment, those who have undergone a superficial peel can expect symptoms akin to a sunburn: the skin will be red and slightly inflamed, indicating that the epidermis has been removed successfully. Signs of the peel can be disguised with makeup several hours after the procedure.
More substantial peels which penetrate into layers of the skin deeper than the epidermis can expect relatively strong swelling and inflammation. These symptoms will persist for about a week while new layers of skin are formed.
Chemical peels can be met with some skepticism, but this concern is best reserved for chemical peels used to treat more severe skin conditions that require access to much deeper layers of skin.
Ultimately, the chemical peel is usually sought after only after melasma has proved resistant to topical treatment (Sarkar).
- Dayal S, Sahu P, Yadav M, Jain VK. Clinical Efficacy and Safety on Combining 20% Trichloroacetic Acid Peel with Topical 5% Ascorbic Acid for Melasma. J Clin Diagn Res. 2017;11(9):WC08–WC11. doi:10.7860/JCDR/2017/26078.10685. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5713840/.
- Sarkar R, Bansal S, Garg VK. Chemical peels for melasma in dark-skinned patients. J Cutan Aesthet Surg. 2012;5(4):247–253. doi:10.4103/0974-2077.104912. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560164/.
- Sarkar R, Arsiwala S, Dubey N, et al. Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. Indian J Dermatol. 2017;62(6):578–584. doi:10.4103/ijd.IJD_490_17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724304/
- Sarma N, Chakraborty S, Poojary SA, et al. Evidence-based Review, Grade of Recommendation, and Suggested Treatment Recommendations for Melasma. Indian Dermatol Online J. 2017;8(6):406–442. doi:10.4103/idoj.IDOJ_187_17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707834/.
- Sumita JM, Leonardi GR, Bagatin E. Tretinoin peel: a critical view. An Bras Dermatol. 2017;92(3):363‐366. doi:10.1590/abd1806-4841.201755325. https://www.ncbi.nlm.nih.gov/pubmed/29186249.
About the author
Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the ...