Zenker_revised1.qxp 19/5/09 5:02 pm Page 46
Aesthetic Dermatology
Treating Melasma – A New Dermatological Approach
Sabine Zenker
Medical Director, Private Clinic for Dermatology and Aesthetic Dermatology,
Medical Director, Dr Zenker Cosmetics, Munich, and Consultant Dermatologist, L’Oréal Paris
Abstract
The treatment of melasma is one of the most challenging for dermatologists because of the prolonged time to response and the substantial
relapse rate when therapy is discontinued. Melasma is a common disorder of hyperpigmentation that is typically characterised by brown or
grey–brown patches on sun-exposed facial areas. Melasma poses a substantial emotional and psychosocial burden on patients. As it occurs
commonly in the general population it is of wide interest for control. Traditional depigmenting agents such as hydroquinone, which are highly
effective and very well known, raise several safety concerns (e.g. ochronosis, atrophy, carcinogenesis and other local or systemic side
effects). Therefore, one must avoid long-term exposure, especially when high concentrations are prescribed. Hydroquinone is one of the best
depigmenting agents but there are many other effective drugs to treat pigmentation disorders, including kojic acid and tretinoin. Chemical
peels are one of the preferred indications for hyperpigmentation. The efficacity of a medical antichloasma peeling depends on many very
important factors: the percentage and combination of depigmenting agents, the consistency and composition of the treating agent/vehicle,
the method and time of application, the peeling intensity and the experience of the doctor. We have established a new dermatological peel
to treat melasma. Our experience is based on a 4.5-year monitoring study that included over 300 patients. The DepiFastPeel
®
(DFP
®
) is a
superficial to medium-depth chemical peel. It is applied in the form of a masque comprising peeling and depigmentating ingredients. It stays
on the skin for several hours. After four to five days the superficial layer of the skin peels off gently. The post-peeling treatment consists of
a cream that must be applied for approximately three months. The DFP is effective, painless and requires only a short down-time. It never
causes side effects such as scarring or worsening of chloasma. We state and want to emphasise that the use of depigmenting agents such
as hydroquinone, kojic acid and tretinoin in combination is much more effective. A deep but superficial peeling of the skin is essential for a
good clinical outcome. Application of the agents in DFP in the form of a specially designed peeling mask is safe and easy. A home-care
programme after the treatment is indispensable. The DFP can be a very effective method of treating chloasma without side effects.
Keywords
Chloasma, melasma, medical peeling, depigmenting agents
Disclosure: The author has no conflicts of interest to declare.
Received: 19 February 2009 Accepted: 30 April 2009
kontakt@dr-zenker.de
The treatment of melasma is one of the most challenging from the Despite the fact that melasma is a benign and easily diagnosed disease,
point of view of a dermatologist. As it is a common condition, it is of clinicians must rule out melanoma and its precursors and must be able
broad interest for control. Hypothetically, the condition is self-limiting. to distinguish and diagnose skin manifestations of systemic diseases.
However, spontaneous resolution is time-consuming and
unpredictable and it may take months to years to resolve normal My personal non-satisfying and not very promising experience in
pigmentation. The major problems in treating chloasma are the treating patients with many of the ‘classic’ currently available
prolonged time to response, the inconsistency of response to therapies motivated me to take a new path in treating chloasma. As a
treatments, the unpredictability regarding the result after any peeling expert, I decided to invent an individual, adjustable,
procedure and the substantial relapse rate when the therapy is assessable, clearly defined and dosable medical peeling treatment.
discontinued. Treating this dyschromia is also challenging due to the The goals of treatment are to treat and manage chloasma effectively,
feared post-inflammatory hyperpigmentation after inflammation- to cause no side effects, to treat in a painless and easy-to-perform
inducing therapies. manner and to have an appropriate management tool in case of an
eventual relapse of the disease. In order to be in a position to treat
Melasma poses a substantial emotional and psychosocial burden on chloasma successfully and properly, it is important to be reminded of
patients. Many undergo multiple therapies, from cosmetic treatments the basic features of the disease.
to ineffective or even aggressive medical treatments, that do not
solve their problem or even make it worse. Some patients spend a Melasma
fortune on treatments over the years. Others hide away, feeling Melasma is a common disorder of hyperpigmentation, typically
ashamed and stigmatised. characterised by brown or grey–brown patches on sun-exposed
46 © TOUCH BRIEFINGS 2009
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