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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 91 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. |