The Cosmelan Peel is the most popular melasma peel as it addresses overproduction of pigmentation. This two phase peeling program incorporates an in-office mask application followed by a curated range of at home skin care products. 

Find out the pros and cons of this highly marketed solution for melasma. It may sway your decision to try this solution for your melasma pigmentation.

1. The Cosmelan Peel recovery

The recovery process ranges from 7 days, all the way to 14 plus days, more with Dermamelan. Here is what to expect-

• First 72 hours- swelling, itching, & redness. You can alleviate the symptoms by dosing up on antihistamines & cold compresses.  
• Some clinics offer LED lights, (via a process called photobiomodulation), however new research has shown that LED doses have to be exact, with specific wavelengths or this can make your melasma worse. 
• Day 4 to 5: reduction of swelling & itch. Peak of inflammation is over. 
• Day 6 to 8: skin starts to heal, skin is less red. 
• Day 8 to 14: skin starts to look normal; however there is a marked variability of downtime, depending on your skin’s sensitivity. 
• Involving aftercare- scroll to the bottom to see how important aftercare is following the Cosmelan peel. 

Make up can not be worn for a period of 7 to 14 days, depending on the amount of peeling. Once your skin has healed, expect some textural changes for 2 to 4 weeks. The good news after all this? In most cases a good reduction of pigmentation can be achieved within 2 weeks in most patients. To date, Cosmelan is one of the fastest ways to clear melasma pigment, at the expense of downtime. 

A comparison of downtime with other treatments offered at The Melasma Clinic- 

Treatment	Recovery	How soon for results	How good is it
Cosmelan	7-14 days	10-14 days	****
Pico laser	0 days	2-6 weeks	*****
Modified Vi Precision	3 days	10-14 days	*****
Glycolic acid peels	0 days	8-10 weeks	**

 

The ideal treatment really depends on your type of melasma, your expectations, downtime, skin sensitivities & budget. Though the Cosmelan peel is one of our favorite peels (but we prefer the Vi Precision Peel as this has less downtime), it really limits your work, exercise & social calendar for up to two weeks.  

2. Not all pigment responds to Cosmelan

Pigment is not pigment, melasma is not all melasma. Pigment diagnosis is essential for results. At The Melasma Clinic we diagnose pigment based on the pigment type & level in the skin. Why is this important? It is because pigment behaves differently depending on cause & depth within the skin. 

How do we diagnose pigment? We take into consideration clinical features based upon visual as well as dermatologic examination (if pigment cause or type is in doubt), for persistent, resistant or unusual causes of pigmentation, we may take a tiny (less than 1.5 mm) biopsy to examine under the microscope. Once the level of pigmentation is ascertained, we can then apply the correct treatment modality to effectively address the cause of pigmentation. 

Cosmelan, Dermamelan & novel peels like the Vi Precision Plus work best on superficial, high contrast epidermal pigmentation, including epidermal melasma, sun damage, freckles, as superficial forms of post inflammatory hyperpigmentation. For mixed pigment, including deeper involvement, the Cosmelan Peel may not be the treatment of choice as medical management combined with lasers gives the best results.  

Types of pigment amenable to Cosmelan Peel

• Superficial melasma that is high contrast 
• Superficial post inflammatory hyperpigmentation 
• Freckles
• Age spots & sun spots (superficial & early) 

Types of pigment that will not respond to Cosmelan mask/peel

• Low contrast melasma
• Dermal melasma
• Deep post inflammatory hyperpigmentation
• Deeper sun spots or age spots
• Drug induced hyperpigmentation
• Hori, Ota naevi
• Acanthosis nigricans
• Lichen planus pigmentosus, Ashy dermatosis
• Pigmentation demarcation lines
• Moles, Becker naevi, lichenoid keratosis, pigmented solar keratosis 
• Constitutional dark circles, perioral pigment
• Contact dermatitis, phytophotodermatitis
• Agyria  

 

3. Short duration of results

Melasma is a chronic condition, not unlike diseases such as thyroid, diabetes, and high blood pressure. The cause of melasma is genetic, modified by hormonal & UV-radiation factors. The natural history of melasma is one of chronicity, namely persistence over time, which waxes & wanes in severity. 

Cosmelan provides an initial solution lasting 3-4 months, however all patients will require a long term solution that prevents or at least reduces pigmentation from recurring, after the Cosmelan Mask & Cosmelan 2 treatment protocol. Though Mesoaesthetics (the company that makes Cosmelan) states that the peel can be repeated every year (or as frequently as every six months), most patients won’t want to spend 3-6 weeks of the year recovering from the peel itself. This is where dermatologists come in to help reduce or in some cases prevent melasma from returning. We do this with rotational therapy. Here is how we do it-

Rotational therapy explained- dermatologists will find the correct combination of treatments pertaining to your pattern, aggression, & chronicity of melasma. 

Skin care: we prescribe arbutin, ascorbic acid, azelaic acid, cysteamine, kojic acid, botanicals, retinoids, retinol, niacinamide, hydroquinone & other topicals in a mix of concentrations to help suppress pigment. The exact percentage of these ingredients are tailored according to your pigment pattern & depth. 

Medically prescribed medications: can modify the vasculature of skin in addition to addressing photodamage. We use various mixes of retinol & retinoids such as tretinoin & retinoic acids. 

No downtime chemical peels: AHA or alpha hydroxy acid peels (lactic, glycolic, mandelic acids) as well as BHA or salicylic acid peels are useful in chemoexfoliation of pigment. Novel peels such as the Vi Precision Plus (which we modify) are better substitutes compared to long downtime Cosmelan or Dermamelan peels. 

Lasers to address pigment: Our favorite include pico & nano lasers in addition to fractional lasers. Lasers build up & strengthen the basement membrane of skin, reducing the chances of melasma recurrence. 

Treatment type	Results	Duration of treatment course	Downtime or recovery
Cosmelan	Fast	3-4 months	10-14+ days
Medical prescription	Slow	Variable, 12 months	Nil
Laser therapy of melasma	Intermediate, around 2-4 weeks	3-6 months	Nil

4. Cosmelan is not safe in pregnancy

One of the most common causes of melasma pigmentation is of course pregnancy, & hence why melasma is called the mask of pregnancy. Of utmost importance is the compatibility of skincare ingredients that treat pigmentation with pregnancy. The bottom line? Cosmelan mask-peel, Cosmelan MD & Cosmelan 2 is not compatible with pregnancy due to the addition of key ingredients including retinoids, salicylic acid hydroquinone (8%) in the MD formulation. 

Cosmelan Mask
Azelaic acid – safe
Retinoic acid– unsafe
Kojic acid- not recommended
Phytic acid- safe
Ascorbic acid– safe
Arbutin- unknown but thought to be safe in low concentrations

Cosmelan 2
Kojic Acid- unknown
Phytic Acid- safe
Salicylic acid- only in very low concentrations
Ascorbic Acid- safe
Retinyl Palmitate- unsafe

Cosmelan MD
Hydroquinone– unsafe

The above are guidelines regarding key ingredients, however the relative safety will depend on the concentration of active ingredients, with the exception of topical retinoids which are universally avoided during pregnancy. 

So, now that we have established that Cosmelan 2, Cosmelan MD & the Cosmelan Mask is not safe in pregnancy, can they be employed postpartum, in lactation & what are the substitutes we use at The Melasma Clinic? 

Lactation & postpartum; all components have relative safety based upon the absorption rate & pharmacokinetics.  

Substitutes & what our clinicians employ to treat melasma in pregnancy.

Here is our preferred way to safely & effectively manage melasma in pregnancy. 

1. Baseline photoprotection: SPF 50+, with tint as the latter protects against visible light. 95% of melasma patients neglect proper sunprotection, so read this carefully. 2 finger lengths twice a day, regardless of sun exposure. Get this correct before spending money on skin care products, read it 3 times.
2. Active skin care anti pigment ingredients that are safe in pregnancy: they include ascorbic acid, azelaic acid, glycolic acid, botanicals, lactic acid, & niacinamide. Our picks?
   
   
   • L-ascorbic acid coupled with vitamin E & ferulic acid under your sunscreen applied in the morning. 10-20% L-ascorbic acid.
     
   • Azelaic acid gel in the evening.
3. Chemical peels that are safe in pregnancy: include glycolic acid, lactic, phytic & mandelic acids. Peels can be conducted every 2-3 weeks. Unsafe peels include salicylic & retinoic acid peels.
4. Lasers in pregnancy: though safe as lasers are essentially concentrated beams of light, the clinical team at our clinic will convince you not to undertake laser therapy until you are postpartum as pigment is unstable during your pregnancy. 

5. Melasma recurrence & rebound

Cosmelan & novel peels are quick solutions to a chronic disorder. Think of it as an insulin shot for diabetic patients, or a steroid shot for an inflamed osteoarthritic knee. Cosmelan provides a fast reduction of melasma signs within 2 weeks, with a solution extending to 3 to 4 months with the Cosmelan 2 home pack. 

Melasma is a chronic disorder, we can not provide a reliable & reproducible ‘cure’, much like how we can not ‘cure’ thyroid disease, diabetes, high blood pressure & most chronic diseases. The answer lies in long term management of this condition. Think of how we manage high blood pressure. Lifestyle changes are paramount, for high blood pressure it’s exercise, reduction of salt, stress etc…, for melasma it is the reduction of ultraviolet, visible & infrared radiation.  

The Cosmelan mask & the aftercare only provides a 3 to 4 month solution for melasma. To be fair, other mainstream commercial treatments do the same – think Dermamelan, Melapeeling, Vi Precision Peels & even pico laser treatments. The solution hence lies in how your physician approaches long term management of melasma. 

Briefly, here is how we do this –

Step one: pigment resolution phase.

This can be with peels such as Cosmelan, Dermamelan, Vi Precision Plus, novel peels, or various lasers such as fractional pico or even older Q switch dermal toning devices. Most clinics don’t progress beyond this point. 

Step two: rotation therapy, addressing skin changes as well as mitigation of unique triggers to each patient. 

Our clinicians will find the best topicals for rotational therapy, namely the combination of creams such as cysteamine, niacinamide, arbutin, ascorbic acid, licorice root extract & more to help prevent pigment production. Radiation sources are identified as rate limiting factors that may account for recurrences. Vascular inputs are addressed with systemic therapy & or vascular lasers. 

Step three: repair of basement membrane & dermal remodeling to change the cytokine profile of cellular elements.

This requires understanding of the factors which contribute to melasma. Pigment production is only the end result of a highly complex interplay between various cell types within the skin itself including the endothelial cells (vessels), mast cells (histamine release), fibroblasts (cytokines, growth factors & collagen 4 production), macrophages (cells that ingest pigment), keratinocytes (skin cells), the basement membrane (hold the skin together) as well as the melanocyte itself. 

Changing the environment in which these cells interact is the key to long term remission &, in some cases curing melasma (it is not as simple as finding a cure internally or treating the source of melasma). Remodeling of these elements takes time, often 12 to 24 months following steps 1 & 2. We achieve this via tailored laser programs, peeling & of course skin care. 

What are the advantages of Cosmelan Mask Peel?

Now that we established the 5 reasons why we don’t like the Cosmelan Mask system, why do we stock & perform this peel? 

Fast results with Cosmelan

Novel peels such as Comelan, Dermamelan, Vi Precision Plus & Jessner TCA all have superfast results for most forms of pigmentation. Cosmelan results are much faster than even the most powerful lasers such as Picoway, Picosure, Picosure Pro & Fraxel. 

In most cases, results are seen within a week or two (once the peel resolves). Pico lasers on the other hand take an extra week to three before results are seen, with maximal results from lasers at month 2 to 3. Peel results are maximal within 2-4 weeks, so the results of Cosmelan are 3-5 times faster than laser treatment of melasma. The flipside is that lasers can potentially address deeper pigment, whilst superficial peels like Cosmelan will not. 

Addresses superficial pigmentation

Peels can address most forms of superficial pigmentation, without the need for a firm diagnosis. Lasers on the other hand will require tweaking with settings & wavelengths. Think of lasers as a ‘smart bomb’ or guided missile, as specific wavelengths of light are required to address pigment in different levels. 

Cosmelan peels on the other hand are a fire & forget way of ‘carpet bombing’ superficial pigment, hence why they are readily used in cosmetic clinics & aestheticians as they provide peeling of the superficial layers of skin, without the requirement of diagnosis. 

Simple instructions & packaging

Cosmelan mask comes with Cosmelan 2 cream. The mask is an in-office procedure, the pack, including the home use Cosmelan 2 is then used at home for a period of 3-4 months. Keeping things simple with matched products (including the awesome Melan 130 sunscreen), ensure that the journey is as easy as it gets. It takes the guesswork out of pigment treatment, & hence why it is a favorurite amongst  junior aestheticians & dermal therapists. 

Trusted branding

Cosmelan & the more intense Dermamelan peels have an established reputation in the aesthetic industry.

Relative safety with Cosmelan

Side effects to Cosmelan are rare, providing your specialist follows the guidelines. Unlike topicals such as hydroquinone (found in Cosmelan MD), tachyphylaxis & exogenous ochronosis (darkening of pigment) is not an issue with the Cosmelan mask & Cosmelan 2. 

Allergies are very rare & should be differentiated from skin irritation, which is super common. Your Cosmelan practitioner will know the difference between irritation & true allergies as they can discuss repeat open application testing as well as patch testing to various components of the peel. 

Tips & tricks to manage your pigmentation

1. See a dermatologist or dermatology clinic for pigmentation diagnosis. Not all cases of pigmentation will resolve with Cosmelan peel or mask. 
2. Identify the depth of pigmentation, as this is crucial to results. 
3. Treat the source of inflammation, especially in cases of active acne or lichenoid disorders. 
4. Initiate medical therapy, novel peels or lasers based upon the pigment type.

Overview of chemical peels for melasma pigmentation

The Melasma Clinic in Sydney & Brisbane offer a range of chemical peels, based upon pigment type, downtime & budget. 

The most cost effective peels are AHA, BHA & retinoic acid peels. These peels have downtime ranging between 0 to 3 days, & typically require 3-6 sessions for best results.

TCA peels are excellent for sun damage, but are high risk for melasma patients. The most effective (& cost effective) peel is a modified Vi Precision Plus peel. This peel is half the price of Cosmelan with a recovery time of only 1/3 . 

Peel type	Recovery	Efficacy	Costs
Cosmelan	10-14+ days	Excellent	$$$$
Vi Precision Plus	3 days	Excellent	$$
Retinoic acid	3 days	Moderate	$
Glycolic acid AHA	0 days	Low	$
Salicylic acid BHA	1-2 days	Low	$

 

Summary & points regarding melasma peels

Fastest results? Cosmelan, Dermamelan & Vi Precision Plus.

Longest recovery? Cosmelan & Dermamelan peels. 

Fastest recovery? Glycolic & lactic acid peels, no recovery!

Best bang for buck peel? Vi Precision Plus (Half the price of Cosmelan) 

Disappointing peels? Lactic, salicylic acid, and mandelic acid peels.

Cheapest peel? Glycolic & retinoic acid peels.

Best peel for deep dermal melasma? Phenol peel. 

Peel vs laser? Peel for faster results, laser for better results with no downtime. 

Sensitive skin? Avoid peels, go for lasers. 

My personal experience with treating my melasma with the Cosmelan peel

Dr Van Park, Cosmetic physician | Founder of The Melasma Clinic

Little do my patients realize that I have suffered from melasma, hence the motivation to start The Melasma Clinic with my other half in 2024. 

My melasma pigmentation worsened with my two pregnancies to the point where I found it difficult to cover it up with makeup. I tried the usual mix of retinol, ascorbic acid, niacinamide & countless cosmeceuticals & peels. Biting the bullet in 2016, we started stocking the Cosmelan peel & mask in my clinic, primarily to treat my melasma! 

The results were great, better than any product, but at the expense of downtime! It took me two whole weeks to recover from the peel, but it was well worth the hassle. Skin was swollen & inflamed for over one week, with a noticeable difference in melasma pigmentation after that. Would I do it again? Absolutely, if there was no other option. Fast forward to 2024, we have other highly effective treatment options that give great results, without the need to take time of work.

We have modified the Vi Precision Plus peel to give equally good results, without the prolonged recovery of Cosmelan- think 3 days of mild flaking. Timed correctly (application on a tuesday or wednesday), peeling starts & finishes over the weekend. 

The biggest improvement I have had in pigmentation over the past few years was with the pico laser. The advantage of lasers over Cosmelan and chemical peels is that laser treatment of melasma has no downtime. It literally takes two to three minutes to perform. The results however, are slower than peels, but the overall effectiveness, personally, is better. 

Cosmelan aftercare

Cosmelan Mask/Peel application time depends on your skin type (constitutional skin color), however this is modified according to your skin sensitivity. As a guide- 

Skin Type I-II	Skin Type III-IV	Skin Type V-VI
Leave on 6-8 hours	Leave on 8-10 hours	Leave on 10-12 hours

• After the time indicated has elapsed wash the skin with a gentle cleanser and water. Do not use a washcloth to remove the mask. Foam the cleanser up with water and finger tips. You may have to do two to three cleansers to remove the mask.
• Pat dry and apply the Melan Recovery

Day 1-6 

AM:
1. Cleanse
2. Apply bland moisturizer or hyaluronic Acid with no ‘actives’
3. Apply Melan Recovery (can be applied a few times for comfort throughout the day)
4. Apply Sunblock (AM only). Melan 130 is included in the pack. 

PM:
1. Cleanse
2. Apply bland moisturizers or Hyaluronic Acid
3. Apply Melan Recovery

Day 6 to 14 to week 12 

AM:
1. Cleanse
2. Apply a pea size amount of Cosmelan 2
3. Apply Hyaluronic Acid or bland moisturizer
4. Apply Melan Recovery
5. Apply sunblock Melan 130 that is included in the pack

PM:
1. Cleanse
2. Apply pea size of Cosmelan 2
3. Apply Hyaluronic Acid
4. Apply Melan Recovery
5. Apply Light Moisturizer

Quick hacks to reduce marked inflammation following the Cosmelan peel. 

Ideally your clinic will manage your peel reaction as clinicians can diagnose the difference between skin irritation & skin allergies to the constituency of the Cosmelan peel. 

For marked skin inflammation: prednisone po. Stat 50 mg tapering to 25 mg before abrupt stop at day 4. 

Adjunct: AFO ointment tds under wet wrap occlusion for 24 to 48 hours. Can extend to day 3 to 4 if marked inflammation. Further use should be covered with doxy, mino or EES for a period of 2-4 weeks depending on risks of POD with CS use. 

LEDs can be used to modulate inflammation, ideally with a fluence of less than 50 mj/cm 2 for the duration of each treatment, avoiding blue LEDs. Yellow & red light permissible for photobiomodulation of inflammation in conjunction with the above protocol.

Post inflammation your clinic can perform a ROAT or repeat open application test to see if you have an allergic reaction (uncommon) or an irritant reaction (more common). If ROAT is positive, patch testing may be prudent as melasma is chronic, & you may be required to use future ‘actives’. Your clinic can arrange individual testing of ‘actives’ as well as preservatives found in Cosmelan.