A Comparative Study of the Efficacy of Chemical Peels and Microneedling in the Treatment of Moderate to Severe Melasma.

BACKGROUND

Melasma is a chronic, relapsing hyperpigmentation disorder that commonly affects individuals with darker skin phototypes, leading to significant cosmetic and psychological distress. Despite various treatment options, achieving lasting improvement with minimal side effects remains challenging.

OBJECTIVE

To compare the efficacy and safety of microneedling with tranexamic acid and vitamin C versus 15% trichloroacetic acid (TCA) chemical peeling in the treatment of moderate to severe melasma.

METHODS

This was a comparative interventional study conducted at Shifa International Hospital from November 2024 to June 2025, including 120 patients with moderate to severe melasma, allocated equally into two groups. Group A underwent microneedling with tranexamic acid and vitamin C, while Group B received 15% TCA chemical peels. Modified Melasma Area and Severity Index (MASI) scores, Physician Global Assessment (PGA), and Patient Global Assessment (PtGA) were recorded at baseline, 4, 8, and 12 weeks. Adverse effects were documented. Data were analyzed using appropriate statistical tests, with p<0.05 considered significant.

RESULTS

Both groups showed significant MASI score reductions over 12 weeks (p<0.001 within groups). The microneedling group improved from 9.11 ± 4.09 to 5.21 ± 2.05, while the TCA group improved from 22.97 ± 4.36 to 13.16 ± 4.49. The between-group difference was statistically significant (p = 0.006). By week 12, at least 60% improvement was achieved in 18 patients (30.0%) in the microneedling group compared with 10 patients (16.7%) in the TCA group. Moderate improvement (40-59%) was observed in 22 patients (36.7%) receiving microneedling versus 16 patients (26.7%) receiving TCA peels. Minimal improvement (<20%) was more frequent in the TCA group (14 patients, 23.3%) compared with microneedling (8 patients, 13.3%). Adverse effects were reported by 22 patients (36.7%) in the microneedling group and 35 patients (58.3%) in the TCA group. Temporary redness was most common, affecting 16 patients (26.7%) in the TCA group and 10 patients (16.7%) in the microneedling group. No severe adverse events occurred.

CONCLUSION

Both 15% TCA chemical peeling and microneedling with tranexamic acid and vitamin C are effective in treating moderate to severe melasma. However, microneedling demonstrated superior pigment reduction, higher patient satisfaction, and fewer side effects. It may therefore be considered a safer and more effective first-line procedural therapy, particularly for individuals with darker skin phototypes prone to postinflammatory hyperpigmentation.