الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
psychosocial and emotional distress, and reducing the
quality of life of the affected patients.
Melasma is classified into one of three histologic types: epidermal, dermal,
and mixed. The number of melanocytes is usually not increased, but the
melanocytes are usually larger, more dendritic and more metabolically active.
Sanchez et al used Wood’s light findings to classify melasma into four different
types: epidermal, dermal, mixed and Wood’s light unapparent.
The exact causes of melasma are unkown, although some triggering
factors are described, such as sun exposure, pregnancy, use of oral contraceptives,
hormone replacement therapy, use of cosmetics and photosensitizing drugs,
steroids, inflammatory processes of the skin, and stressful events, in addition to
genetic, racial and environmental factors
The Melasma Area and Severity Index (MASI), an outcome measure
developed to provide a more accurate quantification of the severity of melasma
and changes during therapy.
The MASI score is calculated by subjective assessment of 3 factors: area
(A) of involvement, darkness (D), and homogeneity (H), with the forehead (f),
right malar region (rm), left malar region (lm), and chin (c), corresponding to
30%, 30%, 30%, and 10% of the total face, respectively.
The aim of melasma treatment is to eliminate already existing
pigmentation and to block de novo pigmentation.
The choice of treatment options of their combination depends mainly on
the type of melasma, severity of melasma, effectiveness of prior treatments, and
expectations of the patient.
Chemical peels are well‐known modalities of treatment for melasma.
Mechanism of the action of chemical peels in melasma is the removal of
unwanted melanin by causing a controlled chemical burn to the skin.
Sixty female patients of melasma were selected for the study, The patients
were divided According to woods light examination into three groups, The first
group with superficial melisma (epidermal), the second group with deep melasma
(dermal) and the third group with mixed melasma. Each group was subdivided
into three subdivisions. Chemical peeling using 70% Glycolic acid, 20-25% TCA,
30% salicylic acid will be used on each subdivision separately. The patients were
selected from the Outpatient Clinic of Dermatology, Andrology and STDs
Department, Faculty of Medicine Menoufia University Hospital.
Every patient was subjected for 6 session of chemical peeling every 2
weeks for 12 weeks. MASI scoring was calculated for each case before and after
sessions for follow up.
Summary
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The study results showed that the epidermal pattern was the most common
pattern of melasma encountered in 45% of cases, followed by the mixed pattern
33.3% and the dermal pattern 21.6%.
The TCA 25% effect according to MASI score showed statistically
significant decrease in the mean MASI score after 6th session in epidermal group
(P=0.028) and mixed group (P=0.043), while in dermal group there was a
statistically non-significant decrease in the mean MASI score after 6th session
(P=0.102), and in comparison among the three sub groups, there were a statistically
significant difference in mean MASI score between groups according to MASI
score, where dermal group showed the lower score (P=0.008).
The Glycolic acid 70% effect showed statistically significant decrease in
the mean MASI score after 6th session in epidermal group (P=0.012) and mixed
group (P=0.043), while in dermal group there was a statistically non-significant
decrease in the mean MASI score after 6th session (P=0.180), and in comparison
among the three sub groups there was a statistically significant difference in mean
MASI score between groups according to MASI score, where dermal group
showed the lower score (P=0.029).
The Salicylic acid 30% effect, regarding the epidermal and mixed groups
there were a statistically significant decrease in the mean MASI score after 6th
session (P=0.018, P=0.043) respectively, while in dermal group there was a
statistically non-significant decrease in the mean MASI score after 6th session
(P=0.317) and in comparison among the three sub groups There was a statistically
non-significant difference in mean MASI score between groups.
The effect of the three chemical peelings were compared according to
MASI score. There was a statistically non-significant difference in mean MASI
score between them according to MASI score (P=0.649).
The Comparison between the therapeutic effect of the three chemical
peels in relation to each subgroup, revealed that the MASI Change showed
statistically significant difference between the three chemical peels in mixed
melasma (P=0.036), where the highest MASI Change was observed with TCA
25%. On the other hand, the MASI change between the three chemical peels was
not significant difference with both epidermal and dermal melasma sub groups
(P=0.833, P=0.910) respectively.
Regarding side effects, patients were asked to evaluate discomfort and
side effects were watched closely of the three chemical peels used, we observed
that post inflammatory hyperpigmentation is common with TCA group, while in
Glycolic acid group erythema was the most common side effect and in Salicylic
acid group erythema and burning sensation are more common than post
inflammatory hyperpigmentation.