A prospective, randomized, split-face, controlled trial of salicylic acid peels in the treatment of melasma in Latin American women

Background: Melasma, a common disorder of hyperpigmentation, is often resistant to therapy. Although salicylic acid peels have been reported to be useful for patients with recalcitrant melasma, controlled trials are lacking. Objective: We sought to determine the efficacy of salicylic acid peels when added to hydroquinone in the treatment of melasma. Methods: Twenty Latin American women with moderate to severe bilateral melasma were treated with a series of 20% to 30% salicylic acid peels every 2 weeks for a total of 4 peels on one side of the face along with 4% hydroquinone cream to both sides of the face twice daily. The primary efficacy variable was reduction in pigmentation of the peeled side compared with the unpeeled side using narrowband reflectance spectrophotometry. Results: Eighteen patients completed the study. Although both sides had significant reduction in pigment intensity, there was no difference between the peeled and unpeeled side with all outcome measures. Limitations: Patients were limited to Latin American women and only 4 peels were performed. Conclusion: A series of four 20% to 30% salicylic acid peels are not effective in the treatment of melasma when added to twice-daily 4% hydroquinone cream.