Soliman Mohsen Mohamed, Ramadan Shahira Abdel-Rahman, Bassiouny Dalia Ahmed, Abdelmalek Marwa
The Department of Dermatology, Kasr El-Aini University Hospital, Cairo University, Cairo, Egypt.
J Cosmet Dermatol. 2007 Jun;6(2):89-94. doi: 10.1111/j.1473-2165.2007.00302.x.
Melasma is a common acquired hypermelanosis that is difficult to treat. Several chemical peeling agents were used in treatment of melasma. Topical vitamin C was also used with minimal side effects.
To compare the effect of 20% trichloroacetic acid (TCA) peel alone vs. 20% TCA peel combined with topical 5% ascorbic acid in cases of epidermal melasma.
Thirty women with bilateral epidermal melasma (Fitzpatrick skin types III and IV) were divided into two groups (A and B, 15 patients each). Before therapy, digital photography and a melasma area and severity index (MASI) score were done for each patient. Groups A and B were primed for 2 weeks before TCA peel. Group B also applied 5% ascorbic acid topically once daily; 20% TCA peel was done for all patients weekly until clearance of melasma or for a maximum of six peels. Group B continued to use 5% ascorbic acid topically in between peels and during the 16-week follow-up period. Patients were assessed at the end of peeling sessions and at the end of follow-up by photography, MASI score, and a global evaluation by the patient.
Group B compared with group A showed a significant decrease in MASI score at the end of TCA peels (P < 0.001) and at the end of the 16-week follow-up period (P < 0.003). Global evaluation showed that 13 patients (87%) in group B improved or maintained their improvement compared with only 10 patients (67%) in group A.
Topical ascorbic acid combined with 20% TCA peel in melasma improves the results and helps in maintaining the response to therapy.
黄褐斑是一种常见的获得性色素沉着过度疾病，难以治疗。几种化学剥脱剂被用于黄褐斑的治疗。外用维生素C也有使用，且副作用极小。
比较20%三氯乙酸（TCA）单独剥脱与20% TCA剥脱联合外用5%抗坏血酸治疗表皮型黄褐斑的效果。
30例双侧表皮型黄褐斑（Fitzpatrick皮肤分型为III型和IV型）女性患者被分为两组（A组和B组，每组15例）。治疗前，对每位患者进行数码拍照并计算黄褐斑面积和严重程度指数（MASI）评分。A组和B组在TCA剥脱前均预处理2周。B组还每天外用一次5%抗坏血酸；所有患者每周进行一次20% TCA剥脱，直至黄褐斑消退或最多进行6次剥脱。B组在剥脱期间及16周随访期继续外用5%抗坏血酸。在剥脱疗程结束时及随访结束时，通过拍照、MASI评分以及患者的整体评估对患者进行评价。
与A组相比，B组在TCA剥脱结束时（P < 0.001）和16周随访期结束时（P < 0.003）的MASI评分显著降低。整体评估显示，B组有13例患者（87%）病情改善或维持改善，而A组只有10例患者（67%）。
外用抗坏血酸联合20% TCA剥脱治疗黄褐斑可改善疗效并有助于维持治疗反应。
