How Effective Are Frequent TCA Peels for Melasma?

Several light TCA peels at $175-250 each at 2 week intervals followed by twice daily cortisone lotion for 2 weeks and daily sunscreen and nightly triple bleach cream works amazingly to resolve melasma. Once clear then you use the triple bleach weekly and a daily sunscreen to prevent recurrances. 
 

Melasma is a very stubborn problem where you must deal with the treatments to alleviate the melasma, but, also prevent new areas from forming and recurrence of the melasma. TCA treatments can have varying strengths. The lower the percentage, the weaker the peel and the less deep the peel will penetrate. If it is a 10% TCA peel it can take several peels to get to the level of the skin where the melasma has originated, and still may not alleviate the melasma.
Combination products that include Hydroquinone, Retin A, and a hydrocortisone if there is an inflammatory component will help decrease the melasma and prevent recurrence. Also, sunscreen is essential.

You may want to consider the combined use of TCA plus a hydroquinone, Retin-A, and steroid preparation which may provide additional and more rapid response to treatment.

In the right hands, TCA peels are very effective for melasma. In the wrong hands they can lead to a worsening of the condition. Choose a dermatologist with lots of experience in pigmentary problems.

It is much more effective to combine a good skin care (Obaji) , with peels to treat melasma.
The skin is prepared for 6 weeks then start a series of peels and add triluma and TCA peels. Maintain with Obaji skin care and sunblock. If you are on hormones such as birth control and can stop then do so.

Melasma is caused by various factors such as hormones, sun and skin type. The more pigment in the skin the greater risk of developing melasma.
I would recommend talking to a knowledgeable dermatologist about all your option, including skin creams, lasers, peels and sun screens. In order to obtain a lasting result, I recommend adding a pro-active skin care regimen.
I hope this helps.
Dr. S

Superficial chemical peels like TCA (lower strengths), glycolic acid, Jessner's solution and salicyclic acid are a great treatment for melasma...and in my opinion, they are the best. treatment for melasma. You will need a series to obtain the desirable result. It is also helpful to be on a good skin regimen which usually consists of a retinoid like Retin-A, a bleaching agent with hydroquinone and a great sunscreen.
I hope you find this answer helpful.