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Abstract
Treatment of melasma remains an enigma due to prolonged time to respond as well as the substantial relapse rate. Chemical peels have become a popular modality in the treatment of melasma. Also topical depigmenting agents used for treatment of melasne are widely available.
Objective: To compare the clinical efficiency of chemical peeling using trichloroacetic acid 20% versus Jessner’s solution versus the topical use of a mixture of hydroquinone 2% and kojic acid.
Patients and methods: Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner’s solution peels (4 coats), group B received TCA 20% peels and group C received topical hydroquinone 2% and kojic acid to be used at night for 2 months. Groups A and B were primed with tretinion 0.05% for 2 weeks and peeling sessions were done on weekly basis for 6 weeks. All patients were seen in follow-up period after 16 weeks clinical evaluation using MASI score and photography were recorded before after treatment and also after 16 weeks (follow-up period). Side effects and subjective improvement were noted.
Results: There was an overall decrease in MASI score in all three groups after treatment and after follow-up period but after treatment it was highly significant between groups A and C (P=0.01) and groups B and C (P=0) but not between groups A and B. After the follow-up period, MASI score was highly significant between groups B and C (P=0) and significant between groups A and B and A and C (P<0.05).
Conclusion: Chemical peeling using TCA 20% showed better results than Jessner’s solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma.