- Best Results1-5
- Treatment Recovery0-10 days
- Procedure Time5 to15 minutes
- Skin SpecialistNurse, dermal therapist
- Duration of ResultsVariable
- AnaestheticNot required
- Back to Work0-6 days
Chemical peels are useful adjunctive treatments for melasma. Peels can be tailored according to skin type, downtime & budget. Much like lasers, they are most useful for epidermal & mixed melasma. My favorite peeling agents for melasma include Dermamelan, lactic acid, retinoic acid & modified Jessner peels.
FactsFact on Chemical Peels for Melasma
- Chemical peels are useful as adjunctive therapy for melasma.
- Peels have limited value in deep or dermal melasma
- Jessner peels in low concentrations can be effective
- Dermamelan & Cosmelan are useful adjunctive peels
- TCA peels should not exceed 8-10%
- Peels are adjunctive to pigment inhibitors & vascular modifiers
- Pico lasers are more effective than chemical peels for the treatment of melasma
What peels are used for melasma?
Lots, but the safest peels are low strength glycolic, lactic, retinoic acid, modified Jessner & low concentration TCA. Novel peels including Dermamelan & Cosmelan can be useful.
Do BHA or salicylic acid peels work?
Salicylic acid is a BHA peel. This peel is anti-inflammatory & lipophilic, meaning it works better for acne. If you combine it with lactic acid, & add resorcinol, it becomes a Jessner. This can be more effective for melasma.
Which AHA peel is the best for treating melasma?
According to the papers, lactic acid. I use both lactic & glycolic acids, ranging from 20-30%. I do go up to 50-70% short contact in some. These peels require neutralisation.
What is a Jessner peel, & is it any good?
Jessner peel contains both AHA & BHA elements, namely lactic & salicylic acid, along with resorcinol. This peel is good for pigmentation, acne, & sun damage. It can be used for melasma (especially in lower concentrations).
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What is Dermamelan Peel?
Dermamelan is an effective treatment that is used to treat skin blemishes that are caused by melanin including melasma/Chloasma. Its aim is to improve the overall texture & luminosity of skin. It involves a combination of professional treatment conducted in the clinic followed by a home maintenance cream. The home kit contains pigment correctors, washes, moisturiser & sunscreen.
What is the Cosmelan Peel?
Cosmelan is ideal for patients who are seeking a gentler alternative to Dermamelan. The latter is 30-40% stronger (more peeling, longer downtime) compared to Cosmelan peel mask.
The majority of melasma peels I perform are of the Dermamelan subtype. This is because Dermamelan is stronger, hence removes more unwanted pigmentation in the one session.
Both Dermamelan & Cosmelan peels have a success rate of around 80% provided patient selection is adhered to. If you have primarily dermal melasma, peels will not be effective.
Do I use TCA peels?
At least 2-3 times a day, but not for melasma. My last medium depth TCA for melasma was in 2007.
TCA if done correctly & at low concentrations of 6-8% can help exfoliate pigment. Higher concentrations of TCA, including Jesser TCA can result in marked improvement of melasma at the 2 week mark, however rebound is universal.
What is a retinoic acid or retinol peel?
This is one of my favourite peels. It consists of retinoic acid ranging from 1 to 7 percent. Not a typo, there is no decimal before the number. To put things into perspective, these peels are between 50 to 150 times stronger than over the counter retinol. Retinoic acid can be used as part of rotational therapy for melasma.
There are 3 ways I deliver retinoic acid.
Firstly, with straight application to the skin, washing off after 6-12 hours. This is the gentlest way. Peeling for 3-6 days can be expected.
Secondly following an acetone scrub or a modified Jessner peel. Expect to peel for an extra 24 to 48 hours compared to de novo application.
Thirdly laser assisted delivery, most used lasers include the 1927 thulium & low power CO2. Peeling ranges from 7 to 14 days.
Are lasers better than peels?
I am afraid so. No, I am not biased, I do love peels. In truth I perform several peels a day, but in the context of melasma, lasers are better because they give precise levels of energy. Peeling can work, but you have got to be conservative.
Lasers decrease the activity of melanocytes, hence pigment production is reduced. Some peeling agents do the same, but lasers are more accurate.
What is the best laser for melasma?
The Picosure Pro is the best laser for pigmentation, including melasma. It provides the fastest clearance with the highest margin of safety. In summary-
- Results seen within the first 10 days
- No downtime
- No flare up of pigment
- Minimal discomfort
- A series of treatments provides the best results
Do chemical peels have side effects?
Yup, the higher & stronger you push the peeling agent, the higher the risks. The most common side effect is worsening of melasma, or post inflammatory hyperpigmentation. If you don’t know what you are doing, you can cause a nasty burn.
Can I DIY peels at home for melasma?
You can try, but it’s not a good idea. When my team performs chemical peels for melasma, we are still sh*t scared of worsening the condition. In the context of melasma, peeling is on a razor’s edge. If you must, start off with a combination of AHA- BHA wash as tolerated. Add some pigment correctors as listed below. Tranexamic acid can be used topically.
What’s the best treatment for melasma?
The TOP 3 best things for melasma are-
- Sunscreen. Lots of it. Minimum of 4ml per day, regardless of sun exposure. If you breathe, & can walk, chances are you will get some collateral sun exposure.
- Pigment inhibitors- proper prescription HQ. You should rotate with kojic acid, citric, retinoic, azelaic & ascorbic acids, arbutin, liquorice root extract & bearberry extract. Your dermatologist will have their own recipe.
- Vascular & plasminogen modulators. These require a prescription.
Who to see if you have melasma?
For a review & solutions, book with my nursing & clinical team. They will be able to see you within a few weeks. This will save you a wait time & a consultation fee with myself. They will diagnose & manage your melasma accordingly. More complex cases are seen by me. Chances are, your melasma won’t be complex.
How much are chemical peels?
Peels start from $96. These include lactic, glycolic, mandelic & retinoic acid peels. I discourage TCA for melasma. Most patients will benefit from a series of peels conducted every 2-4 weeks. If I can give you some advice- lasers are better for melasma. Simple nano lasers are cheaper, safer & more effective than pico lasers.
Davin’s Viewpoint on Chemical Peels for Melasma
To cut through all the marketing hype with peels, let me distil down for you. If you are wanting a fast result & don’t mind the downtime of 5-10 days, & cost is not a problem, the answer is Dermamelan or the Cosmelan Peel.
If you are after a conservative peel, retinoic acid is my pick for melasma pigmentation. It can exfoliate pigment & can help with other aspects of melasma such as background photodamage.
Lactic acid is my third pick. It is more conservative than glycolic acid & has barrier restorative function. Though I love the tactility of peels, lasers are usually better. They are more effective, cost effective & have a much lower side effect profile than peeling.
Pico lasers are far better as they have no downtime, cost less and have a higher clearance rate as compared to peels. As always, these modalities are combined with topical creams, oral t.acid & of course SPF.
For Sydney melasma patients, please book in with my therapist at Dr Van Park’s Clinic in the Eastern Suburbs.
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