Efficacy of Combined Trichloroacetic Acid Peel and Topical Ascorbic Acid in Treating Epidermal Melasma

Background: Melasma, a common dermatological problem which has no standard recommended therapy. This study aimed to compare the clinical efficacy of combined trichloroacetic acid peel and ascorbic acid with trichloroacetic acid peel alone in epidermal melasma. Methods: A quasi-experimental study was conducted on 148 patients with epidermal melasma, in the dermatology department of Pak Emirates Military Hospital, Rawalpindi from August 2019 to January 2020. Patients were randomly allocated into two groups; Group A (n=74) was given trichloroacetic acid peel 20% (weekly) plus ascorbic acid cream (once daily). Group B (n=74) was given trichloroacetic acid peel alone (weekly). Melasma Area and Severity Index (MASI) scores were calculated at baseline visit, 6th week and 3rd month. Efficacy was measured as a reduction in post-treatment MASI score to ≤10. Post-stratification Chi-square test was applied considering p-value ≤0.05 as statistically significant. Results: The mean age of patients was 31.63±8.20 years with a predominance of female gender 117(79.1%). The mean duration of persistence of melasma symptoms was 42.59±21.56 months while Fitzpatrick type IV (51%) was revealed as the dominant skin type. MASI score at the baseline, 6th week and 3rd month visits were 18.11±3.49, 12.48±3.16 and 7.74±3.91, respectively. Overall, the treatment was efficacious in 106(71.6%) patients. Reduction in MASI score was significantly higher in group A (83.8%) than group B (59.5%). Conclusion: The combination of trichloroacetic acid peel and ascorbic acid was more effective than trichloroacetic acid peel alone (p=0.001) in the treatment of epidermal melasma. Keywords: Ascorbic Acid; Trichloroacetic Acid; Melasma; Efficacy.