Melasma refractory to topical triple combination (hydroquinone + tretinoin + steroid) is treated with a chemical peel. Which peeling agent is preferred for darker skin types (Fitzpatrick IV–V) to minimise post-inflammatory hyperpigmentation risk?
- A Glycolic acid 20–35% superficial peel ✓
- B Phenol (Baker's formula)
- C Trichloroacetic acid (TCA) 35–50%
- D Jessner's solution with TCA 35%
Correct answer: A. Glycolic acid 20–35% superficial peel
Explanation
Superficial chemical peels with glycolic acid (AHA) at 20–35% are the safest option for darker skin types (Fitzpatrick IV–V) and are used in melasma to enhance depigmentation. Deeper peels (TCA 35–50%, phenol, Jessner's+TCA) carry significant risk of PIH and scarring in darker phototypes. Mandelic acid and salicylic acid peels are also preferred for darker skin. Phenol is reserved for fair-skinned patients with deep rhytides.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.