Chemical peels and Melasma treatment in dark-skinned patients

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Melasma, a common but puzzling case of hyperpigmentation disorder (blotchy skin, light to dark brown macules on sun beaten body parts) which continues to disrupt the quality of life despite intensive research does have some remedies especially chemical peels which have registered some positive results in clinical trials. Since Fitzpatrick ckin types IV to VI (darker tones) are harder to treat, it follows that its chemical treatment is also rarer but can be anything from glycolic and lactic acids that have proven to be safe and inexpensive to Phytic solution- a solution which unlike Alpha-Hydroxy peels doesn’t require neutralization. The peels to use are very important for maximum results but a specialized treatment is still quite far away but for now, we look at a few treatment options.

ETIOLOGY AND PATHOGENESIS

A case of excessive pigmentation that has risk factors like UV radiation and genetic predisposition and negative effects on pregnancy, thyroid disease, oral contraceptives and drugs such as antiepileptics. This condition is thought to be caused by melanocytosis and melanogenesis.

Melasma has three facial patterns: Mandibular, Centofacial and Malar. It also has three histological patterns- identified according to location of accumulation. Dermal, epidermal and mixed.

It has therapeutic options, from photoprotection through topical hypopigmenting agents to lasers and chemical peels to agents such as the Green Herb skin Peel, fish oil, deoxyarbutin and green tea. Most times, it requires a combination of agents for optimum results.

MELASMA TREATMENT IN DARK SKIN

Dark skin may offer better sun protection and photoprotection but its faulty response to cutaneous injuries due to increased melanocyte makes it a risky candidate for chemical peels or lasers. It has Post inflammatory Pigmentation (PIH) tendencies, whose management is important in treating melisma in dark skin.

Chemical peels are applied to the body to remove excess melanin from the body through controlled chemical burning to the skin. Peels can act as sole agents or with other therapies. Seek professional advice.

Peels for dark skin are much fewer due to the risk of prolonged hyperpigmentation. Below is a list of possible peels. Remember that chemical peels generally treat the mixed and epidermal melasma only.

Alpha hydroxy peels

  1. Glycolic acid is the most common alphahydroxy peel and is used mostly in strengths of 30-70% and applied at 2- 3 week intervals to the face for 3- 5 minutes each time.  A 1% bicarbonate solution or water is used to neutralize the peel. The peel is then neutralised using water or 1% bicarbonate solution. Glycolic Acid has always left moderate but efficient results on ethnic skin with the epidermis showing best results. This peel has also been compared to lasers and topical hypopigmenting agents.
  2. Lactic acid, is another alphahydroxy acid which despite being similar to Glycolic Acid in many ways and being inexpensive, is not used as extensively as its availability suggests it should.

Alpha keto peels

Pyruvic Acid, a dynamic keratolytic with sebostatic and antimicrobial properties is the best known of alpha keto peels. It’s good for acne, superficial scarring and photodamage. It also stimulates collagen plus elastic fibres. Its intense burning makes it unpopular though. Its efficacy on ethnic skin is however still subject to debate.

Beta hydroxy peels

Salicylic acid is the most famous of Beta hydroxyl peels, used traditionally against acne but also to decrease pigmentation disorders such as melasma. Ethanol solutions found in this acid are optimized for work on dark skin at a strength of 20-30%. Being anti-inflammatory, it decreases PIH and whitening effect on skin. A new salicylic acid with fatty chain called lipohydroxyacid has been introduced with a more targeted action mechanism and enhanced keratolytic effect. The stratum corneum is modified by it so that it becomes more flexible and resistant to such things as cracking and wrinkling.

Salicylic mandelic acid peels

One of the largest alpha hydroxyl acids, it is a combination of betahydroxy and alpha hydroxyl acids and penetrates the skin uniformly but slowly. This makes it good for sensitive skin and the combination of acids makes it ideal for dark skin. It also treats acne and post acne scarring with much less side effects.

Trichloroacetic acid peel

Only a low concentration of TCA (10-35%) must be used for dark skin owing to risk of scarring as well as post-peel dyschromias. Frosting, the after effect of TCA can cause the lead to overtreatment. At low concentration, this peel reaches the upper papillary dermis and is not recommended for treating mixed and dermal forms of melasma.

Jessner’s Solution

A combination of salicylic and lactic acids, resorcinol and ethanol, Jessner’s solution- combined with TCA makes for a very uniform penetration. The combination of jessner’s solution with 15% TCA has been found to better and more effective than an only 15% TCA solution.

Tretinoin peels

Research on this peel is still ongoing as regards its effects when used in combination in Kligman’s formula against the result if used alone and it is not yet determined without doubt if the combination is better than the single. What is known however is that their mechanism of action are similar to topical tretinoin especially as regards changes in the epidermis plus melanin dispersion. Multiple lab tests in dark skinned patients found 1% Tretinoin to be equal to 70% glycolic acid peel and with minimal side effects.

Newer peels

While traditional peels continue to rule the roost, newer peels are being explored to cater for increasing complexities as well as the complicated issue that is melasma. Peels like the aforementioned phytic acid peel come to mind. Having a low PH, it doesn’t need neutralization and all the application complexities that come with the process such as side effects or no shows for results. Phytic peels are to be applied once a week although two times in a week is also possible if faster effects are needed. It is very good on dark skin although evaluation is ongoing.

The Obagi blue peel, also a new peel comes with a composition of TCA together with blue peel base which contains saponins, glycerine and non-ionic blue base. Significant improvements will be found in melasma lesions within four weeks- usually after.

Another newer peel is the Green herb skin peel, Used to fight hyperpigmentation, acne, fine lines and wrinkles. This peel is applicable to dark skin, using salicylic acid, this peel leaves a lasting impression on skin inside five days with improving radiance by the day. It sheds of the hard outer layer of skin and allows a fresh one to grow, revealing a wonderful skin glow.

Antioxidants in the form of Amino fruit acid peels have also been recently added. They are anti-aging cosmetics that fight photopigmentation. There have been studies on light-skinned people but not yet on dark skin.

USE OF PRIMING

Priming is important to prepare the skin for peels to avoid side effects such as PIH. Priming agents help to ensure uniform penetration of the peel used and speeds up the healing process of the skin as well as maintaining the effects of the skin after it peels. Priming involves applying topical depigment agents like tretinoin and Glycolic acid about two weeks before the planned peel.

PREVENTING RELAPSE

Chemical peels temporarily remove cutaneous melanin without using the either of the processes melanocytes or melanogenesis. This system helps to avoid relapse or recurrence after treatment of melasma especially on dark-skinned patients. Its therapeautic approach is appropriate in multiple chemical peels sessions such as 5-6 times at intervals of two to four weeks. This is best if supported by additional maintenance using bleaching agents such as kojic acid and tretinoin.

CONCLUSION

Chemical peeling is advancing greatly towards providing more varied solutions to dark skinned patients where they previously had a very small pool to choose from. It is good to note that there are very many peels that come up daily, but then not all of them have been thoroughly researched on especially in relation to their efficiency on dark skin. Glycolic peels have proved to be the best in safety, efficacy and availability. Lactic acids are inexpensive and available while also showing tremendous results although further experiments are needed. Phytic solutions might eventually replace hydroxyl acids owing to the unique properties it has. TCA peels will, as always continue to be used cautiously for the time being especially on dark skin but either way, in the end, the choice of peel to use will depend on efficiency, availability, downtime, and use.

 

Chemical peels for dark skin

Use a Green Herb skin peel to treat melasma

Skin peels for darker skin Melasma and at home chemical peels www.homepeel.com.au