1% RETINOIC ACID PEEL IN TREATMENT OF MELASMA: PEEL FOR THE DARK SKINED? An Interventional Study.
Abstract
Melasma is a common disorder of hyperpigmentation, which has a severe impact on the quality of life. Inspite of tremendous research, the treatment remains frustrating both to the patient and the treating physician. Peels are a well-known modality of treatment for melasma, having shown promising results in many clinical trials. Dark skin types (Fitzpatrick types IV to VI) are especially difficult to treat owing to the increased risk of post-inflammatory hyperpigmentation (PIH). Although a number of new agents have come up, there is little published evidence supporting their use in day-to -day practice.
AIMS: To determine the efficacy of 1% Retinoic acid peeling in the treatment of melasma. To assess the degree of improvement in pigmentation objectively using Melasma Area and Severity Index at baseline and after 12 weeks of treatment with 1% retinoic acid peel and to compare the side effects associated with the modality.
Objective: Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent in the treatment of melasma patients.
Methods: Thirty patients of melasma, after written consent, were taken up for an open pilot study of 12 weeks. One percent tretinoin peel was applied on full face at three weekly intervals. The results were evaluated by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks
Results: A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed (p<0.001). Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients.
Conclusion: It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel.
