Melasma is a condition characterized by patches of hyperpigmentation usually located on the face. It is believed to be caused by an interplay of hormones or medications and sun exposure. Melasma is more common in women and may be associated with oral contraceptive use and can occur in pregnancy. Although less common, melasma can also be seen in men.
Melasma can be a challenging condition to treat. Some forms of melasma are superficial and responsive to treatment while other forms demonstrate pigment deeper in the skin and can be quite recalcitrant. The mainstay of therapy consists of strict sun avoidance and sun protection in combination with skin lightening creams. If a medication is implicated in producing the melasma, then discontinuation of that medication may help reverse the hyperpigmentation.
Chemical peels are an excellent adjunctive treatment option that can be used to maximize results. However, great care must be exercised when performing chemical peels on ethnic skin to avoid complications that can include scarring and potential worsening of the skin discoloration. In some cases, hypopigmentation may even result from overaggressive peels.
Three types of chemical peels that are safe and effective for ethnic skin when performed by experienced hands are:
1. Salicylic acid peels: These peels known as beta peels are one of my favorite treatments for hyperpigmentation from acne and melasma. They have an excellent safety profile and are gentle and safe for ethnic skin. There is minimal downtime (with only a couple days of minor redness and flaking) and although improvement may be slow and gradual, salicylic acid is definitely a preferred type of peel for evening out melasma.
2. Glyocolic acid/ AHA peels: Derived from sugar or fruit acids, alpha hydroxy acid (AHA) peels are effective agents for exfoliation and skin lightening. As with salicylic acid peels, there is minimal downtime with only a couple days of redness.
3. Retinoic Acid based peels: These peels often come in kits that incorporate a potent combination of peeling agents. One type of peel that is particularly effective and safe for melasma is the Vitalize Peel (by Skinmedica). This peel includes salicylic acid, AHA’s, and retinoic acid to maximize effectiveness. These peels are superficial but actually can produce visible peeling and shedding of the skin for 3-5 days after the treatment so this must be accounted for when a patient schedules for these procedures.
In addition to the peels listed above, there are certain mask type treatments that contain potent combinations of skin lightening agents such as hydroquinone and kojic acid. Such systems include Melanage or Cosmelan. These are less of a peel and more of a potent mask that is administered in the doctor’s office with follow up products for home use.
In general, more aggressive and deeper chemical peels should be avoided in ethnic skin. The approach to treating melasma with chemical peels should be slow and steady to minimize skin inflammation that can actually worsen the hyperpigmentation. Keeping up with light chemical peels performed monthly in combination with skin lightening creams and sun protection is the best way to manage melasma over time.