Multimodal Melasma Treatment with Chemical Peels, Microneedling, and PRP

Conclusions

• Melasma is best approached with multimodal therapy that combines photoprotection and topicals with selected procedures rather than relying on a single intervention.
• Superficial chemical peels can improve melasma, but evidence does not clearly show one peel formulation is superior, so gentler agents are generally preferred, especially in skin of color.
• Pre-procedure priming, careful patient selection, and minimizing inflammation are important to reduce complications such as overpenetration and post-inflammatory hyperpigmentation.
• Microneedling appears to help melasma both by enhancing transdermal delivery of topical agents and by inducing epidermal and dermal remodeling.
• Microneedling results tend to improve with repeated treatments and are best when combined with adjunctive topical therapies such as tranexamic acid.
• Radiofrequency microneedling and deeper dermal-targeting approaches may be particularly promising for reducing relapse, but they need more study.
• Platelet-rich plasma may reduce melasma severity when used intradermally, but the evidence is still limited and inconsistent, so it should be considered experimental or adjunctive.
• Deep chemical peels, including phenol-croton oil approaches, may produce durable remission in selected refractory melasma cases by remodeling the reticular dermis.
• Overall, the presentation concludes that gentle procedural treatments can accelerate improvement, while more aggressive or less standardized options require further research before routine use.