Commentary on Combined Jessner Solution and Trichloroacetic Acid Versus Trichloroacetic Acid Alone in the Treatment of Melasma in Dark-Skinned Patients

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The point that serial Jessner's Solution + Trichloroacetic Acid (TCA) produced better MASI scores than serial TCA alone is demonstrated by the authors.1 The results are not spectacular, but no hydroquinone was used between the peels performed every 2 weeks. This technique reflects the effect of the peels alone.2
The actual clinical results may have been better with topical hydroquinone in between peels, but this would have negated seeing what the peel alone would do, and the use of different strengths of bleaching formulas along with JS + TCA would be interesting to note for future measurement of maximum clinical results. The use of retinoids may be too harsh in this skin type, and the strengths of hydroquinone used can produce different clinical results because strengths greater than 4% can also cause irritation and post inflammation pigmentation. Kojic acid, azelaic acid, or arbutin 5% might be a substitution in these patients.3 The exact determination of which topical to use with JS + TCA for melasma treatment would be good material for future study.
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