Safety and Efficacy of Trichloroacetic Acid Peels in the Treatment of Melasma: A Split-face, Randomized, Prospective Trial in Latin American Women.

Background: There is controversy on the efficacy and safety of chemical peels used to treat Hispanic women with melasma. Studies evaluating superficial peels for melasma are limited due to lack of controls, blinding or objective assessment tools, poor inclusion of darker phototypes, and small sample number.

Objectives: We sought to evaluate the safety and efficacy of trichloroacetic acid (TCA) peels when added to hydroquinone and tretinoin in the treatment of melasma in Hispanic women.

Methods: A single blinded, prospective, split-face trial of superficial TCA peels was performed on Hispanic women with melasma. Topical hydroquinone and tretinoin were used on both sides. A total of four monthly peels were performed on one side. The relative reduction of melasma severity was evaluated using narrowband reflectance spectrophotometry (NRS), Modified Melasma Area and Severity Index (mMASI), and Global Melasma Severity Assessment (GMSA). Adverse events were monitored.

Results: Thirty-three patients completed the study. Pigment intensity was reduced on both sides based on all measures. A greater improvement of mMASI and GMSA was achieved on the peeled side.

Limitations: Limitations include the single-center study design with one blinded investigator.

Conclusion: Based on our results, TCA peels appear to be safe and effective in augmenting treatment response on melasma patients with phototypes III and IV treated with hydroquinone and tretinoin.