Treat Your Melasma… With Acid?

The cosmetic market is filled with acid treatments for melasma that promise you excellent results, but what’s the difference between these ingredients? Today, we’re going to talk about your treatment options, how each type of acid works, and potential side effects.

Learn more:

• What exactly causes melasma?

How Do Acids For Melasma Work?

When you hear the word ‘acid’, you might think about the high-concentration acids in science labs or the scary chemical peel Samantha had in the “Sex and the City” series. However, acids can be quite beneficial for your skin – as long as you use them in the right amounts.

Acids for melasma work in one or more of the following ways, depending on the ingredient:

• They increase the skin cell’s turnover rate, getting rid of old or dead cells and allowing new skin cells to grow.
• They inhibit the formation of pigment in your skin cells to prevent further dark patches from forming.
• They act as a depigmenting agent to physically lighten dark skin patches.
• They reduce inflammation that can cause further skin darkening.
• They act as an antioxidant to reduce the free radicals in your skin and promote healthy skin glow and appearance.

Melasma is a chronic condition, meaning that it is not curable. In addition, melasma is notoriously difficult to treat. What this means is that any kind of treatment – acid or otherwise – must be used consistently for the best results. Only one application is not enough to restore your skin’s appearance.

Now that you know how acids work to improve the appearance of melasma, let’s talk about the different treatment options.

Types Of Melasma Acid Treatments

Tranexamic acid

Tranexamic acid is a synthetic derivative of the amino acid lysine that can be given as a topical, oral, or intradermal treatment. It works to treat melasma by blocking the creation of melanogenic factors that stimulate the production of melanocytes (pigment-producing cells).

Studies have shown that oral tranexamic treatments are more effective for treating melasma than topical or intradermal administrations. A study in 2012 followed 74 patients that took oral tranexamic acid for six months (Wu). After the study, more than 60% of the patients showed excellent results.

Learn more:

• Is tranexamic acid effective for treating melasma?

Kojic acid

Kojic acid is a by-product of certain fungi species that is mostly used in beauty products and cosmetics. It works by blocking the creation of tyrosinase, the enzyme found in melanocytes, which are the cells that produce melanin (skin pigment). Raw kojic acid is not recommended for use on its own as it can cause skin damage.

A split-face study done on 40 women with melasma showed that kojic acid was more efficient when combined with glycolic acid and hydroquinone (Lim). All of the women were treated with a combination of glycolic acid, hydroquinone, and kojic acid on one half of their faces. Hydroquinone and glycolic acid were administered to the other half of their faces. The results of the study showed that the inclusion of kojic acid led to superior results.

Azelaic acid

Azelaic acid is a naturally occurring derivative from wheat, rye or grains. Azelaic acid works by inhibiting tyrosinase production that leads to skin pigment production and preventing further skin darkening with its anti-inflammatory characteristics. Additionally, this treatment can help patients brighten and even their skin tone.

Azelaic acid is a topical treatment that comes in foam, cream, or gel form. When it comes to treating melasma, azelaic acid works best in combination with tretinoin. One clinical study showed that a combination of 20% azelaic acid and tretinoin enhanced the benefits of treatment (Breathnach).

Glycolic acid

Glycolic acid is one of the most studied acids in the alpha-hydroxy-acid (AHA) family. This derivative of sugar cane treats melasma by stimulating cell turnover and the production of new, healthy skin cells, as well as by inhibiting the formation of pigment-producing cells.

Unfortunately, there aren’t any studies dedicated to exploring the effectiveness of glycolic acid on its own. Glycolic acid is generally combined with other ingredients at a concentration of 5 – 10% (Bandyopadhyay). In combination with other acids like hyaluronic acid and hydroquinone, it can be very effective in treating melasma.

Mandelic acid

Mandelic acid is a natural derivative of bitter almonds that belongs to the alpha-hydroxy-acid (AHA) family. In comparison with other AHA acids, it’s the most gentle, and thus the most appropriate for sensitive skin.

There are no published studies to demonstrate the effectiveness of mandelic acid for melasma on its own. However, when combined with salicylic acid, mandelic acid can be an effective way to treat any type of hyperpigmentation. Mandelic acid is often used in chemical peels because of its anti-inflammatory effects and compatibility with other types of ingredients and treatments (Sarkar).

Lactic acid

Lactic acid is an organic acid that is part of the alpha-hydroxy-acid (AHA) family. The main function of this ingredient is to treat hyperpigmentation or acne spots, but it has shown successful results in treating melasma as well (Cherney).

One 2001 study treated 20 volunteers who had melasma with lactic acid at a concentration of 92%. Only 12 patients finished the study, but all showed significant improvement in their pigmentation without any side effects (Sharquie). Another study that treated patients with a lactic acid facial peel at a concentration of 82% resulted in similarly positive results (Singh).

Salicylic acid

One of the most popular exfoliating acids in the cosmetic world is salicylic acid, an ingredient that can be derived from plants such as white willow or wintergreen leaves. Salicylic acid belongs in the beta-hydroxy-acid (BHA) family. It treats melasma as an anti-inflammatory and also has an effective exfoliation function to promote new skin growth.

88% of participants in one study saw moderate to significant improvement after five salicylic acid chemical peels at concentrations of 20% and 30% (Grimes).

Hyaluronic acid

Hyaluronic acid is naturally produced by the human body. Most of it is found in our skin and its main function is to retain moisture to keep your skin well hydrated. Hyaluronic acid may also help improve skin aging and treat fine lines and wrinkles.

There aren’t many published studies that focus solely on this acid for melasma treatment. However, one study found that hyaluronic acid combined with hydroquinone and glycolic acid showed positive results in patients (Ibrahim).

Sun Protection: An Essential Part Of Any Melasma Treatment

As you can see, each of these acid treatments works differently to improve your melasma. What’s most important to remember is the daily use of sun protection for positive changes and long-term results. This is especially important after acid treatment, since many of these ingredients can make your skin become more sun-sensitive.

Potential Side Effects Of Acid Treatments

As we already mentioned, melasma acid treatments work by increasing the cell turnover time, exfoliating the top skin layer, and allowing the new skin cells to show. However, as with any kind of medication, there can be side effects.

It’s important to remember that some side effects are normal and indicate that your treatment is working. Redness and dryness are typical side effects of new treatments – but don’t worry. As your skin gets used to the treatment, these side effects will go away.

Common side effects of acid treatments for melasma include:

• Burning sensation
• Redness
• Tingling
• Peeling
• Swelling
• Itching
• Dryness

If you experience an extreme reaction to any melasma acid treatment, such as an allergic reaction, it’s important to stop using the treatment immediately and contact your dermatologist

Learn more:

• Side effects of common melasma treatments

Final Thoughts

Melasma is a condition that is not easy to treat, but it can be managed with patience, sun protection, and diligent treatment. Each of the acid treatments for melasma that we’ve discussed can be beneficial for your skin, but choosing the right one for your skin can be tricky.

References

• Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303–309. doi:10.4103/0019-5154.57602 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807702/
• Breathnach AS. Melanin hyperpigmentation of skin: melasma, topical treatment with azelaic acid, and other therapies. Cutis. Published January 1996. https://www.ncbi.nlm.nih.gov/pubmed/8654129
• Cherney K. Lactic Acid Peel: Benefits, Side Effects, Products, and More. Healthline. Published March 8, 2019. https://www.healthline.com/health/beauty-skin-care/lactic-acid-peel#benefits.
• Grimes PE. The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. Published January 1999. https://www.ncbi.nlm.nih.gov/pubmed/9935087/.
• Higuera V. Mandelic Acid: Benefits, Uses, Vs. Glycolic Acid, and Precautions. Healthline. Published November 27, 2019. https://www.healthline.com/health/mandelic-acid#takeaway
• Ibrahim ZA, Gheida SF, El Maghraby GM, Farag ZE. Evaluation of the efficacy and safety of combinations of hydroquinone, glycolic acid, and hyaluronic acid in the treatment of melasma. Journal of cosmetic dermatology. Published June 2015. https://www.ncbi.nlm.nih.gov/pubmed/25847063.
• Lim JT. Treatment of melasma using kojic acid in a gel containing hydroquinone and glycolic acid. Dermatologic surgery:official publication for American Society for Dermatologic Surgery [et al.]. Published April 1999. https://www.ncbi.nlm.nih.gov/pubmed/10417583
• Nall R. Salicylic Acid Peel: What to Expect, Benefits, and More. Healthline. Published December 1, 2019. https://www.healthline.com/health/beauty-skin-care/salicylic-acid-peel#side-effects
• Nall R. Glycolic Acid for Acne: Is It Effective? Healthline. Published February 26, 2020. https://www.healthline.com/health/beauty-skin-care/glycolic-acid-for-acne#side-effects
• Papakonstantinou E, Roth M, Karakoulakis G. Hyaluronic acid: A key molecule in skin aging. Dermato-endocrinology. Published July 1, 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583886/
• Sarkar R, Bansal S, Garg VK. Chemical peels for melasma in dark-skinned patients. Journal of cutaneous and aesthetic surgery. Published October 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560164/
• Sharquie KE, Al-Tikreety MM, Al-Mashhadani SA. Lactic acid as a new therapeutic peeling agent in melasma. Dermatologic surgery:official publication for American Society for Dermatologic Surgery [et al.]. Published February 2005. https://www.ncbi.nlm.nih.gov/pubmed/15762205
• Sarkar R, Arsiwala S, Dubey N, et al. Chemical Peels in Melasma: A Review with Consensus Recommendations by Indian Pigmentary Expert Group. Indian J Dermatol. 2017;62(6):578–584. doi:10.4103/ijd.IJD_490_17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724304/
• Singh R, Goyal S, Ahmed QR, Gupta N, Singh S. Effect of 82% lactic acid in treatment of melasma. Int Sch Res Notices. 2014;2014:407142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897467/
• TodayShow. Are ‘actives’ the key to improving your skin? TODAY.com. Published May 13, 2019. https://www.today.com/style/what-are-acids-do-you-need-them-your-skin-care-t150357
• Watson K. Azelaic Acid for Acne: Uses, Benefits, and Precautions. Healthline. Published January 7, 2019. https://www.healthline.com/health/azelaic-acid-acne#alternative-treatments
• Wu S, Shi H, Wu H, et al. Treatment of melasma with oral administration of tranexamic acid. Aesthetic plastic surgery. Published August 2012. https://www.ncbi.nlm.nih.gov/pubmed/22552446?dopt=Abstract

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.