The effects and safety of sequential high concentration glycolic acid and trichloroacetic acid chemical peels in skin photo-type IV-VI, a retrospective cross-sectional monocentric review

Abstract

BACKGROUND : Melasma is a common chronic form of cutaneous hyperpigmentation, particularly prevalent in individuals with Fitzpatrick skin phototypes IV-VI, and it predominantly affects the facial areas of women. The patients with melasma often experience a significant reduction in quality of life. Treating melasma is challenging, as no single gold-standard therapy exists, and higher concentrations (>30%) of trichloroacetic acid peels have been inadequately studied in darker skin phototypes due to the potential complications. PURPOSE : To evaluate the effectiveness and safety of a sequential chemical peel protocol for treating melasma in African patients. OBJECTIVE : To describe the clinical effects and safety parameters of African patients treated sequentially with glycolic acid and trichoroacetic acid chemical peels. METHODS : This retrospective, cross-sectional, single-center review analyzed medical records of patients with melasma who received a sequential peeling protocol. Data collected included patient demographics, adverse effects, visual analogue scale (VAS) pain scores, and modified melasma area and severity index scores at baseline, 12 weeks, and 24 weeks. Descriptive statistics, including interquartile range, analysis of variance, Pearson's correlation, and logistic regression, were applied to analyze treatment outcomes and tolerability. RESULTS : Records of patients with melasma were reviewed, with the majority being female (n = 37; 92.5%) and of skin phototype V (n = 31; 77.5%). At 12 weeks, modified melasma area and severity index scores showed statistically significant improvement (F[4.7235] = 4.72, P = .032). The most common adverse effects were irritation (77.5%), postpeel cracking (62.5%), and transient hyperpigmentation (12.5%), with no cases of scarring observed. However, the recurrence rate of melasma reached 70% by week 12 after treatment cessation. LIMITATIONS : Owing to the single-center setting as well as the retrospective nature of the study, the results of this study necessitate further prospective randomized controlled studies to validate these findings. CONCLUSION : Despite recurrences, this study found that a sequential chemical peel protocol using glycolic acid and trichloroacetic acid was effective in reducing melasma severity without causing scarring.