Chemical Peels for Melasma: Evidence Update

Abstract

Introduction: Melasma is a challenging hyperpigmentation disorder. This review evaluates comparative efficacy of superficial and medium-depth chemical peels. Methods: Eleven RCTs (n=568) comparing glycolic acid (GA), trichloroacetic acid (TCA), and combination peels. Primary outcome: MASI score reduction at 12 weeks. Results: GA 30-50% reduced MASI by 38% (95% CI 30–46%). TCA 20% was more effective (52% reduction, p=0.02) but associated with higher post-inflammatory hyperpigmentation (PIH, 15% vs 6%). Combination GA+TCA showed no added benefit. Discussion: TCA penetrates deeper but risks PIH, especially in skin types IV-VI. Most studies excluded darker skin types, limiting generalizability. Conclusions: GA peels are safer first-line for melasma in darker phototypes; TCA should be reserved for refractory cases with strict sun protection.