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A Treatment Combination of Peels, Oral Antioxidants, and Topical Therapy for Refractory Melasma: A Report of 4 Cases

Authors Piquero-Casals J, Granger C, Piquero-Casals V, Garre A, Mir-Bonafé JF

Received 13 December 2019

Accepted for publication 20 February 2020

Published 4 March 2020 Volume 2020:13 Pages 209—213


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Jeffrey Weinberg

Jaime Piquero-Casals,1 Corinne Granger,2 Vanesa Piquero-Casals,1 Aurora Garre,2 Juan Francisco Mir-Bonafé1

1Department of Aesthetic Dermatology and Laser, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain; 2Innovation and Development, ISDIN Pharmaceutical Laboratories, Barcelona, Spain

Correspondence: Jaime Piquero-Casals Carrer Escoles Pias 7. CP, Barcelona 08017, Spain

Background: Melasma is a difficult-to-treat, recurrent pigmentary disease. Combined therapy gives better, longer-lasting results.
Objective: To determine the clinical effects of a treatment protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with oral antioxidant supplement and topical treatment for refractory melasma.
Patients and Methods: We present four cases of patients with melasma, who, despite multiple treatments including hydroquinone, showed no improvement. We initiated a 16-week protocol involving 3 in-clinic peels (4 weeks apart) and a daily home treatment. The peels contained 30% trichloroacetic acid, 2% phytic acid, 8% L-ascorbic acid, Camellia sinensis leaf extract and Vitis vinifera seed extract. The home treatment was a depigmenting serum (4-butyl resorcinol, hydroxy-phenoxy propionic acid and niacinamide), a specific SPF50+ sunscreen, and an oral supplement (Polypodium leucotomos; green tea extract; Vitis vinifera; vitamins C, E, and D; and carotenoids), all in the morning, and, at night, a compounded gel-cream (4% hydroquinone, 0.025% tretinoin and 1% hydrocortisone). After 16 weeks, the gel-cream was stopped; the rest of the regimen (topical and oral) was continued for 12 further weeks. Melasma was assessed using the melasma severity scale (MSS) before starting the protocol, and at 4 and 12 weeks after the last peel. Photographs were taken before treatment and at the last evaluation. Patients indicated their satisfaction on a 5-point scale.
Results: All patients had good tolerance to the procedures. Three showed an excellent (> 75%) improvement and one showed a good (50– 75%) improvement. All four were very satisfied. At follow-up (12 weeks after last peel), no patients had recurrence.
Conclusion: This protocol of trichloroacetic acid, phytic acid and ascorbic acid peel combined with an oral supplement and topical daily treatment is a viable treatment option for refractory melasma.

Keywords: trichloroacetic acid, phytic acid, ascorbic acid, peel, peelings, oral supplement, Polypodium leucotomos, topical treatment, melasma

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