Identifying and treating melasma is a continued challenge in aesthetic practice and the dermatologist author shares an insightful piece outlining some of the treatment options for topical bleach peel depigmenting approaches. A brief summary of current literature findings are explored which suggest a possible relationship between thyroid autoimmunity and melasma, as well as a potential link between low levels of zinc and melasma. A clear outline of the clinical presentation is discussed with diagnostic features and symptoms utilising a Wood’s lamp, supported by the rationale for topical approaches through effective downregulation of melanogenesis by controlling the production of melanin on various levels. Tretinoin, and its mode of action is explored in relation to melanocytes, with a detailed description of melanin synthesis, in relation to topical ingredients that suppress activity, such as hydroquinone, arbutin, antioxidants and kojic acid (https://en.wikipedia.org/wiki/Kojic_acid).

A comprehensive table outlining ingredients for lightening and bleaching topicals for melasma describes nine commonly used agents, which includes their mode of action, before, during and after melanogenesis. The author gives an interesting overview of some commonly used topical depigmentation protocols for melasma, based upon a bleach peel concepts, utilising a variety of topical ingredients and compounded prescription drugs, in a customised way to effectively treat melasma on a long-term basis. This is an excellent overview for aesthetic nurses with an interest in cosmetic dermatology treatments. 

Bleach peeling for melasma: an effective approach to treatment.
Zenker S.
JOURNAL OF AESTHETIC NURSING
2018;7(3):136-43.
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CONTRIBUTOR
Anna Baker

for Dalvi Humzah Aesthetic Clinical Training Courses in England; BJN Aesthetic Nurse of the Year 2016

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