title: Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study.
abstract: BACKGROUND
  Melasma is a common acquired hypermelanosis that is difficult to treat. Several chemical peeling agents were used in treatment of melasma. Topical vitamin C was also used with minimal side effects.
  
  
  OBJECTIVE
  To compare the effect of 20% trichloroacetic acid (TCA) peel alone vs. 20% TCA peel combined with topical 5% ascorbic acid in cases of epidermal melasma.
  
  
  METHODS
  Thirty women with bilateral epidermal melasma (Fitzpatrick skin types III and IV) were divided into two groups (A and B, 15 patients each). Before therapy, digital photography and a melasma area and severity index (MASI) score were done for each patient. Groups A and B were primed for 2 weeks before TCA peel. Group B also applied 5% ascorbic acid topically once daily; 20% TCA peel was done for all patients weekly until clearance of melasma or for a maximum of six peels. Group B continued to use 5% ascorbic acid topically in between peels and during the 16-week follow-up period. Patients were assessed at the end of peeling sessions and at the end of follow-up by photography, MASI score, and a global evaluation by the patient.
  
  
  RESULTS
  Group B compared with group A showed a significant decrease in MASI score at the end of TCA peels (P < 0.001) and at the end of the 16-week follow-up period (P < 0.003). Global evaluation showed that 13 patients (87%) in group B improved or maintained their improvement compared with only 10 patients (67%) in group A.
  
  
  CONCLUSIONS
  Topical ascorbic acid combined with 20% TCA peel in melasma improves the results and helps in maintaining the response to therapy.
authors.affiliation: The Department of Dermatology, Kasr El-Aini University Hospital, Cairo University, Cairo, Egypt.
authors.forename: Mohsen Mohamed
authors.initials: MM
authors.lastname: Soliman
authors.forename: Shahira Abdel-Rahman
authors.initials: SA
authors.lastname: Ramadan
authors.forename: Dalia Ahmed
authors.initials: DA
authors.lastname: Bassiouny
authors.forename: Marwa
authors.initials: M
authors.lastname: Abdelmalek
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D001205:Ascorbic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D002615:Chemexfoliation / Q000009:adverse effects / Q000379:methods*; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005148:Facial Dermatoses / Q000628:therapy*; D005260:Female; D006801:Humans; D008548:Melanosis / Q000628:therapy*; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage; D014238:Trichloroacetic Acid / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D003879:Dermatologic Agents; D014212:Tretinoin; D014238:Trichloroacetic Acid; D001205:Ascorbic Acid