Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned Patients

BACKGROUND Melasma is a common challenging pigmentary skin disorder especially in dark-skinned females urging them to seek medical help. Many modalities of treatment are available, but none is satisfactory. OBJECTIVE To compare safety and efficacy of combined trichloroacetic acid (TCA) (20%–25%) and Jessner's solution versus TCA (20%–25%) alone in dark patients with melasma. MATERIALS AND METHODS The study design was a split face, right-left, assessor-blinded, randomized controlled study. Twenty-four adult female patients (skin phototypes IV–V) with bilateral melasma were treated for 6 sessions at 2 weeks intervals. Clinical assessment of the 2 sides of the face with Melasma Area and Severity Index (MASI) score was performed, and photographs were taken before and after the peeling course. RESULTS Both therapeutic modalities showed significant decrease in MASI score, which was significantly lower on the side treated with both Jessner solution and TCA. There were significant negative correlations between the percentage of improvement of MASI score and both age of the patients and duration of the melasma. CONCLUSION Dark skin melasma can be treated with both regimens safely and effectively; however, combined Jessner solution and TCA is more effective.