Chemical peels are most effective for treating epidermal forms of melasma. Melasma can manifest in both the epidermis (the outer layer of the skin) and the dermis (the deeper layer). The distribution of pigmentation in these layers determines the primary depth of melasma.

The depth of melasma can be assessed through clinical examination, dermatoscopy, Wood’s light, or, in more severe cases, a skin biopsy. A biopsy can also help differentiate melasma from other pigmentation disorders, such as ochronosis, post-inflammatory hyperpigmentation (PIH), and other causes of skin pigmentation. For those with dermal melasma, chemical peels may have limited efficacy.

The peeling process typically begins 48 to 72 hours after the application of the cream and generally lasts for about one week, depending on your skin type, if you have prepped your skin with the recommended pre-treatment peels . For the majority of patients, peeling occurs within 4 to 7 days. However, in approximately 20% of patients, the peeling can extend up to 8 to 10 days.

A realistic expectation for the Cosmelan-Dermamelan peel is an improvement of 50-80% after one application. Patients with primarily epidermal or mixed melasma tend to achieve better initial and long-term results compared to those with primarily dermal pigmentation.

With proper application of post-peel products and consistent sun protection, a positive outcome can be anticipated. It is important to understand that peels, lasers, and creams do not cure melasma; they only manage its appearance. This peel can be repeated every 6-18 months as needed.

The most crucial aspect of pigmentation treatment is an accurate diagnosis. Chemical peels for melasma require careful patient selection, as not everyone is suitable for this treatment. The Dermamelan and Cosmelan peel is suitable for:

*Patients with primarily superficial melasma (epidermal more than dermal)
*Individuals seeking the greatest improvement in the shortest time
*Patients who adhere strictly to sun protection measures
*Those with less than 90 minutes of recreational sun exposure per week (including incidental UV exposure from activities like running, hiking, or swimming)
*Individuals without medical contraindications to vascular modulators

A consultation is essential for every patient. During this consultation, you can express your concerns freely and confidentially. After a thorough assessment and examination, a tailored treatment plan will be provided, and the most appropriate treatment options will be discussed. Generally, over 80% of patients experience a good to excellent outcome following novel peels for melasma.

This Dermamelan and Cosmelan peel is a graduated “soft” peel, distinct from TCA, TCA/Jessner peels. Side effects are rare, but the following should be noted:

*Prolonged redness and skin irritation, which may last longer than 10 days
*Extended peeling and skin flaking, which can persist for up to 12 days in some patients
*Rebound pigmentation, where melasma may return in certain patients
*Tightness and swelling, typically lasting 5-7 days
*True allergic reactions, occurring in approximately 2-3% of patients