Melasma is a common disorder of hyper-pigmentation, which has a severe impact on the quality of life. In spite of tremendous research, the treatment remains frustrating both to the patient and skin professional. Dark Skin types are especially difficult to treat owing to the increased risk of post-inflammatory hyper-pigmentation. Treatments varied from topical therapies to lasers and chemical peels. Peels have shown promising results in many clinical trials however in darker races the choice of the peeling agent becomes relatively limited: therefore the need for priming agents and maintenance peels.
Priming of skin, and post peels with the use of topical therapies is important to maintain the outcome and to prevent post-inflammatory hyper-pigmentation. Studies reflect that clearance of melasma is better and faster when one combined peels with topical therapy. Glycolic acid is the most widely used acid(AHA) for priming. Kojic acid is more effective in combination with other agents when used twice a day. Spot peeling of discrete areas of may also be useful since it would reduce the contrast between the normal skin and melanotic macules. It may also act as a test area when higher strength peels such as 15 -25% trichloroacetic acid (TCA) are used.
Although TCA is a commonly used peel in lighter skin TCA is less frequently preferred in darker skin types due to the risk o scarring and post peel dyschromias. This is probably because frosting, the end point for a TCA peel, is not well appreciated in darker skin, and hence can lead to over treatment. When use on darker skin a low concentration (15-25) is recommended but caution needs to be exercised while using them in dark skin owing to a higher frequency of adverse effects. Sunblock SPF30 must be used daily. —