Treating melasma with chemical peels and skin priming with hydroquinone or retinoic acid

Melasma is a common condition that affects mostly women and is characterised by excess skin pigmentation, usually located over the cheeks, between the brows, and on the upper lip. Melasma is triggered by oestrogen, and therefore is very sensitive to medications such as the oral contraceptive pill, HRT, and is usually worsened by pregnancy. UV radiation/sun exposure also worsen melasma, so sun protection/sun avoidance is paramount in the treatment of melasma.

Generally, melasma is a difficult condition to treat, and usually there is no ‘cure’ for the problem. However, with appropriate treatments, it can be kept to a minimum, but usually maintenance treatments are required to keep it diminished.

One method of treating melasma is with chemical peels. Chemical peels can help to exfoliate and turn over the skin to help ‘flush’ out the excessive pigmentation. Used carefully, chemical peels can help with melasma. To enhance the effect of chemical peels in the treatment of melasma, priming agents are often used on the skin to help prepare the skin for the peel and to also help in removing the excess pigmentation.

A recent study published in Dermatologic Surgery August 2008 compared the effectiveness of two priming agents , namely 2% hydroquinone, and 0.025% retinoic acid on the effect of enhancing the results of glycolic acid peels in the treatment of melasma.

60 patients were randomly assigned into three groups of 20 patients. Group 1 only received glycolic peels, whilst group 2 and 3 were primed with 0.025% retinoic acid and 2% hydroquinone respectively. The results were found to be more effective with hydroquinone – there was a greater decrease in the melasma, as well as a decrease in post-inflammatory hyperpigmentation after the peel (ie. worsening of the pigmentation after the glycolic peel).