Abstract

Background: Mostly impacting women with darker Fitzpatrick skin types, especially in sun-exposed regions of the face, melasma is a chronic acquired hyperpigmentation condition. Because of their relapsing character and tolerance to treatment, chemical peels have become complementary or replacement therapies to topical depigmenting agents. The goal of this systematic review was to assess the effectiveness and safety of several chemical peels in melasma therapy.
Methodology: Randomized control trials (RCTs), split-face trials, and future comparative investigations examining chemical peels for melasma treatment were found by means of a systematic literature search. Studies were considered if they evaluated clinical results like pigment reduction and treatment tolerance in patients with varied Fitzpatrick skin types. Study design, patient demographics, type and intensity of chemical peel, comparator treatments, and key outcomes were all extracted.
Results: Eleven studies met the inclusion criteria, with sample sizes ranging from 10 to 45 participants. Glycolic acid (GA) and trichloroacetic acid (TCA) were the most often investigated and demonstrated uniform effectiveness across skin types III-VI. Although many studies showed equal results with peels, some found better clinical results with TCA or GA. Promising new substances include nanosome vitamin C and azelaic acid lotion. Used properly, most chemical peels were well-tolerated and had little negative effects. Differences in side effect profiles and onset of improvement were found among treatments.
Conclusion: GA and TCA peels have shown both efficacy and safety in the management of melasma, even among darker skin types. As no peel consistently outperforms others, treatment should be individualized, taking into account skin characteristics, peel strength, and patient tolerance. Combining chemical peels with other modalities may offer added benefit in recalcitrant cases.

Key words: Melasma, Chemical Peels, Treatment Efficacy, Systematic Review