Efficacy and tolerability of chemical peeling as a single agent for melasma in dark-skinned patients: A systematic review and meta-analysis of comparative trials.

Background: Chemical peelings are used on a wide scale in cosmetic field including melasma treatment. They often provide clinicians with flexibility in tailoring treatments according to patient needs and satisfaction.

Objective: To evaluate safety and efficacy of chemical peeling as single agents in melasma management in patients with darker skin types.

Methods: We included randomized controlled trials (RCTs) and prospective studies that assessed efficacy and safety of chemical peeling as single agents for facial melasma. An online bibliographic search was conducted, and data were extracted from the included studies.

Results: Ten RCTs and three prospective comparative studies (No. of patients = 478) were included. The overall effect estimate favored Glycolic acid (GA) over trichloroacetic acid peel in terms of melasma activity and severity index (MASI) (mean difference [MD] -1.89, 95% CI [-3.26, -0.52], P = .007). On the other hand, the overall effect estimates did not favor GA over tretinoin (MD 0.53, 95% CI [-0.46, 1.52], P = .3), vitamin C iontophoresis (MD 1.50, 95% CI [-0.50, 3.50], P = .14), and amino fruit acid (MD 0.39, 95% CI [-0.64, 1.42], P = .46) in terms of MASI. The overall effect estimates favored trichloroacetic acid peel (MD -5.30, 95% CI [-6.41, -4.19], P < .001) and Jessner's solution (MD -3.20, 95% CI [-5.35, -1.05], P = .004) over topical hydroquinone in terms of MASI.

Conclusion: In conclusion, chemical peelings are effective as single agents for management of melasma in patients with darker skin types, with the use of topicals as maintenance treatment.