Melasma Treatment With Combined Chemical Peels and a Novel Topical Agent Containing an Antiestrogen and a Vascular Endothelial Growth Factor Inhibitor

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I read with interest the clinical improvement observed after combined treatment of melasma with Jessner solution and trichloroacetic acid by Abdel-Meguid and colleagues .1 The authors concur with earlier investigators that repair processes in the epidermis or dermis or both after the application of the chemical exfoliating agents result in efficacy of this modality in the management of melasma.2,3 However, the pathogenesis of melasma is multifactorial; hence, interventions that address more than one of the condition's influencing factors would likely enhance its resolution. I recently introduced a novel approach to the treatment of melasma: application of a topical agent that contains an antiestrogen (such as a selective estrogen receptor modulator [tamoxifen or raloxifene] or an aromatase inhibitor [anastrozole or tetrozole or exemestane]) and a vascular endothelial growth factor inhibitor (bevacizumab).4 Application of this topical agent after combined Jessner solution and trichloroacetic acid chemical peeling might further enhance the percentage of improvement of the melasma area and severity index score in patients with melasma. Investigation of concurrent or sequential treatment with combined chemical peels, and this novel topical therapy for melasma is warranted.
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