ABSTRACT Objective To evaluate the efficacy and safety of medium‐deep chemical peels for melasma in a diverse population using quantitative and subjective methodologies for comprehensive outcome assessment. Methods A case series of 42 melasma region treatments was conducted from March 2023 to December 2024. Treatments included 30% phenol with 0.8% croton oil or a two‐step protocol of 30% glycolic acid followed by 35% trichloroacetic acid (TCA) with 0.7% croton oil. Quantitative pigmentation analysis utilized the weighted skin intensity (WSI) ratio via Fiji ImageJ software. A panel of 20 experts conducted subjective evaluations based on standardized photographs, rating pigmentation reduction, skin tone uniformity, and overall appearance. Statistical analyses included the Wilcoxon signed‐rank test and heatmap visualizations. Results Quantitative analysis showed significant improvements in pigmentation, with mean WSI values increasing from 78.99 ± 19.58 (untreated) to 88.33 ± 22.05 (treated; Z = −5.495), p < 0.001). Heatmaps confirmed uniform pigmentation reductions. Among 42 treatments, 38 showed positive changes ( Z = −5.092, p < 0.001). Experts identified 94.4% of cases as post‐treatment and rated pigmentation reduction as Grade 4 or 5 in 87.5% of responses, with similarly high ratings for skin tone uniformity (69.4%) and overall appearance (79.4%). Conclusion Medium‐to‐deep chemical peels, utilizing phenol‐croton oil or TCA, demonstrated significant efficacy in reducing pigmentation, enhancing skin regeneration, and improving overall skin quality. Quantitative analysis and specialized clinical assessments confirmed their role as a targeted and effective approach for melasma treatment. These findings support using medium‐to‐deep peels as a personalized therapeutic strategy, offering a scientifically validated option for managing refractory melasma.
Scardua et al. (Fri,) studied this question.