Chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid, either alone or in combination, are effective therapy for diffuse melasma and localized hyperpigmentations (lentigo).
Grimes et al of the Division of Dermatology, University of California, Los Angeles, sought to determine the efficacy and safety of continuous therapy followed by a maintenance treatment regimen during a period of 24 weeks with a TC cream containing hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01%. The study concluded that TC cream is safe in the treatment of moderate to severe melasma for up to 24 weeks when used intermittently or continuously.
J Am Acad Dermatol. 2010 Jun;62(6):962-7. Epub 2010 Apr 15.
Continuous therapy followed by a maintenance therapy regimen with a triple combination cream for melasma.
Grimes PE et al.
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The purpose of this study was to evaluate the efficacy of trichloroacetic acid as well as glycolic acid associated with kojic acid in the treatment of cutaneous hyperpigmentations. This study concludes that both peelings can be considered effective.
Dermatol Surg. 1999 Jun;25(6):450-4.
The use of chemical peelings in the treatment of different cutaneous hyperpigmentations.
Cotellessa C et al.
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A cream containing 4% hydroquinone, 10% buffered glycolic acid, vitamins C and E, and sunscreen is safe and effective in the treatment of melasma.
Int J Dermatol. 2003 Dec;42(12):966-72.
Safety and efficacy of 4% hydroquinone combined with 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma.
Guevara IL, Pandya AG.
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Although hydroquinone showed a better response, ascorbic acid may play a role in the therapy of melasma as it is almost devoid of side-effects; it could be used alone or in combination therapy.
A double-blind randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma.
Espinal-Perez LE, Moncada B, Castanedo-Cazares JP.
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