title: Efficacy of Trichloro-Acetic Acid Peel Alone Versus Combined Topical Magnesium Ascorbyl Phosphate for Epidermal Melasma.
abstract: OBJECTIVE
  To compare the efficacy in terms of reduction in melasma area and severity index (MASI) score by more than 10 of a combination of 20% trichloro-acetic acid peel plus 5% topical magnesium ascorbyl phosphate versus 20% trichloroacetic acid peel alone in the treatment of epidermal melasma.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Department of Dermatology, Lady Reading Hospital (LRH), Peshawar, from May 2012 to May 2013.
  
  
  METHODS
  Patients aged 18 - 65 years, with Fitzpatrick skin type III-V were divided into two equal groups having 74 patients each. Detailed history was taken and Wood's lamp examination done to rule out mixed and dermal melasma. Melasma area and severity index (MASI) score was calculated for every patient. Priming was done for all patients with tretinoin cream applied once daily at night for 2 weeks, and to use a broad spectrum sun block cream before sun exposure. Patients in group Awere subjected to combined treatment, i.e. trichloro-acetic acid peel 20% (weekly) plus magnesium ascorbyl phosphate cream (applied once daily), while patients in group B were subjected to trichloro-acetic acid peel 20% (weekly) alone. Treatment was continued for 6 weeks. After completion of treatment, MASI score was recalculated. Proportion of patients with significant MASI score reduction was compared using chi-square test with significance at p < 0.05.
  
  
  RESULTS
  Male and female patients were 11 (14.9%) and 63 (85.1%), respectively in group A, whereas 13 (17.6%) and 61 (82.4%) in group B. The mean age in group Awas 30.28 ±8.08 years, and 29.36 ±6.84 years in group B. Significant MASI score reduction in group Awas seen in 60 (81.1%) patients and in group B 49 (66.2%, p= 0.040).
  
  
  CONCLUSIONS
  Combination of trichloro-acetic acid peel and topical magnesium ascorbyl phosphate cream was significantly more effective than trichloro-acetic acid peel alone in treatment of melasma.
authors: Department of Dermatology, PGMI, Lady Reading Hospital, Peshawar.
authors: Fatima
authors: F
authors: Murtaza
authors: Department of Dermatology, Hayatabad Medical Complex, Peshawar.
authors: Abdur Rahim
authors: AR
authors: Bangash
authors: Department of Pediatrics, Combined Military Hospital, Skardu.
authors: Arshad
authors: A
authors: Khushdil
authors: Department of Dermatology, PGMI, Lady Reading Hospital, Peshawar.
authors: Sahibzada Mahmood
authors: SM
authors: Noor
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; 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; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage; D008274:Magnesium / Q000008:administration & dosage*; D008297:Male; D008548:Melanosis / Q000188:drug therapy*; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D007641:Keratolytic Agents; D014238:Trichloroacetic Acid; D008274:Magnesium; D001205:Ascorbic Acid