Should you have a peel to treat your melasma?

Should you have a peel to treat your melasma? #askdrnatalia

If you have melasma, you have probably searched google to find some treatment ideas. One of the most well-marketed treatments for pigmentation is an in-office peel that goes by a variety of brand names (Cosmelan appears to be the most popular) and costs anywhere from £600 and up per treatment.

The peel is a mix of cosmetic purported ‘anti-pigment’ ingredients like kojic acid, phytic acid, ascorbic acid, arbutin, mandelic acid and glycolic acid. The marketing will tell you that it should reduce pigmentation by 95% after 30 days. Does it work? And does it last? Is it worth the money (and the downtime)? In my review of melasma treatments (Spierings Journal of Cosmetic Derm 2019) I found very little high-quality evidence to support the use of chemical peels in the treatment of melasma. In my ‘treatment ladder’ I listed it as third line and only in combination with first line treatments.

Chemical peels are definitely not anywhere near as effective as the marketing material may have you believe and, if some improvement is seen, it is short lived. Unless you are going to commit to doing one of these peels every 1 to 2 months possibly forever, peels are not a realistic or (for most) financially feasible way of clearing melasma in the long-term.

The same applies to the use of lasers for melasma. Don’t believe the marketing and please don’t get tricked into parting with possibly thousands of pounds in cash for one of these peels.