Melasma treatment can be effective in the majority of patients. This type of skin pigmentation is commonly seen in Brisbane due to its high UV rating. It is a unique form of hormonal pigmentation that is mostly seen in women. Melasma can be improved by up to 80% with a combination of prescription creams, gentle chemical peels and special lasers.
- The cause of melasma is a mix of genetics, UV exposure and hormones
- This is a special form of pigmentation that presents on the upper lip, around the eyes, and forehead area. Melasma is often patchy, and motley in appearance
- The majority of melasma can be improved with a combination of clinical chemical peels, compounded prescription creams and special lasers
- The degree of improvement will depend if melasma is epidermal, mixed or dermal.
- IPL should not be used to treat melasma, as this often can worsen skin pigmentation
- Lasers such as 1064 QSL and Picosure Focus can improve melasma. I prefer these gentle lasers over Fraxel laser for the treatment of this form of pigmentation
- Melasma usually returns unless a prevention plan is undertaken after treatment
- My melasma prevention plan is a combination of creams, TCA peels or Clear+Brilliant lasers with Vitamin A, B, C infusions
Melasma is also known as hormonal pigmentation or cholasma, a conditon that is very common in Queensland. It presents as patchy pigmentation on the forehead, under the eyes and on the upper lip. This pattern, together with certain clinical and microscopic findings are classic for this condition.
Melasma is caused by a combination of genes, UV rays, and hormones. It is more common in pregnancy and may occur after taking the birth control pill.
Why is melama vital to diagnose? It is because melasma is a unique form of pigmentation and ‘sun damage’. Unlike other types of pigmentation, melasma has to be treated in a special way, namely to inactivate the pigment producing cells before any peels or laser is performed.
Failure to inactivate pigment cells worsens this condition. IPL should not be used to treat melasma as rebound is seen in nearly all cases. I use gentle lasers such as Q Switch laser and Picosure Focus to treat this unique form of pigmentation. Melsama treatment is a medical solution and not a cosmetic one, and should be treated by Specialists.
Patchy pigmentation and upper lip darkening are signs of melasma. Never undertake IPL for this form of pigmentation.
The optimal melasma treatment will depend on the type of melasma you have. The majority of patients will have mixed melasma- this means your pigmentation lies on the surface as well as deeper in the dermal layers of your skin. The best method of treating this form of melasma is with a combination of creams, gentle chemical peels and laser.
- Sun protection and sunscreen forms the basis of treatment. If you are sun exposed for 20 minutes without sun block, all the work you may have accomplished to fade your melasma will be undone.
- Creams- I use a mixture of fading creams, including bleaching agents, Vitamin A, as well as Vitamin C creams.
- Peels- my favourite peels include AHA or glycolic, VITA peels, or lactic acid peels. TCA at very low concentration can also be used.
- Lasers- I use Q Switch laser over Fraxel laser. Q Switch is ideal for dermal melasma, this forms part of the 3 C Program. I prefer Picosecond laser or Q Switch lasers over Fraxel. Never undertake IPL, as this often makes melasma worse.
The best treatment for your melasma will depend on the type of melasma you exhibit, and your skin type (skin colour).
In summary the best treatment for melasma is a regime of –
- Chemical Peels
- 3C Laser Program for skin colour, clarity and collagen
More on the 3C Laser Program
This is one of the most common reasons for melasma to worsen. Despite education of beauticians and cosmetic GPs, IPL is still performed on melasma. In 90% of cases this treatment will worsen melasma. Some cases of epidermal melasma can respond to IPL, but only if the pigment producing cells are kept at bay before treatment.
The reason why IPL worsens melasma is because of the excessive heating of skin with this treatment. IPL stands for intense pulse light. This light is converted to heat energy that in turns stimulates excessive pigmentation. Low level laser on the other hand, decreases the activity of melanocytes, namely addresses one of the causes of melasma.
Yes, but laser melasma treatment has to be gentle and exact for cases of this form of pigmentation. Laser can also be useful for dermal melasma. Unlike IPL, the aim of laser is not to heat up melanocytes (pigment producing cells), but to decrease the transfer of pigment from these cells to the skin. This is a gentle treatment process and takes 5-6 sessions before results can be seen.
My melasma treatment laser of choice is the Q Switch laser. A treatment program consists of a trail of 5 sessions spaced 2 weeks apart. There is no downtime following Q Switch laser. If you respond to this trial of laser, you can continue on the program.
High density, but low energy Fraxel can be used to treat melasma, however this laser can also make this condition worse. I only reserve Fraxel for patients who fail the 3C Program or the Picosure Focus laser.
Fractional lasers such as CO2 and Erbium have been reported to improve melasma, however most of these studies are from Korea and Japan- areas where the UV index is much lower than in Brisbane. I never treat melasma with ablative lasers as this will always result in rebound pigmentation. My melasma treatment program spans over 10 weeks.
Yes. There are many papers on melasma treatment with Fraxel laser, however I try to avoid this treatment IF you have not had medical treatment nor have trialled Q Switch lasers. Here are my reasons for holding back on Fraxel-
- Not everyone will improve with Fraxel laser. If you have pure sun damage and sun spots, Fraxel is our treatment of choice, but if you exhibit melasma, Fraxel has a chance of making it worse. I do use a less powerful version of Fraxel known a Clear+Brilliant to maintain results following melasma treatment.
- All patients who undergo Fraxel MUST be on a fading agent of hydroquinone and Lytera. This will reduce the chance of rebound.
- All other treatments are far more cost effective than Fraxel. Fraxel cost over a thousand dollars- that is the cost of over 10 peels or nearly 8 Q switch laser treatments. For melasma you may need up to 4-5 Fraxel treatments. We don’t encourage patients spending upwards of 4-5 thousand dollars for results that are not guaranteed.
- Fraxel has a downtime of 2-5 days, other treatments do not. Fraxel is the last line in my treatment protocol for melasma.
In summary, Fraxel is an excellent method for treating sun pigmentation, sun spots, and freckles, however I do not endorse this treatment for melasma.
This patient responded well to Fraxel laser.
The natural history of melasma is to recur over time. Part of my treatment program is to reduce or prevent recurrence with the use of creams and sun protection. Developing a melasma recurrence prevention regime is important.I use a combination of peels, Clear+ Brilliant lasers, as well as vitamin A, B and C skin infusion to help reduce melasma recurrence.
A high factor SPF 50+ sunscreen is best. As a daily sunscreen I like La Roche Posay 50+ Anthelios.
Sunscreens only form one part of sun protection- sun avoidance and a broad brimmed hat is essential.
Lytera is a fading cream that does not contain HQ or hydroquinone. It is less irritating that high strength HQ, and can help fade the epidermal component of melasma. I incorporate Lytera in to most of my melasma prevention protocols, along with the Clear+Brilliant laser. I do not believe that Lytera is effective enough as a sole melasma treatment cream, its use is in preventing or reducing the chances of rebound melasma.
Melasma treatments are more affordable than you think.
You will need a good high factor SPF sunscreen to form the basis of your melasma management.
As a guide-
- Compounded creams start from $70
- Chemical peels (clinical strength lactic acid, AHA or VITA peels) $98
- Q switch laser from $149 per session
- Picosure Picofacial laser $790 per session
- Fraxel laser from $790 per session (4 for 3 package, see below)
I do not recommend Fraxel Laser as an initial treatment for melasma, as other treatments carry less risk. Fraxel laser starts from $740 per session * Package deal of 4 Fraxel lasers at $2990
By Dr Davin Lim
This is one of the hardest and most poorly managed skin conditions. Despite continue education to the cosmetic industry, including beautician and cosmetic GPs, hundreds of cases of IPL are performed weekly for melasma. Only 10-20% will improve with this treatment, however the majority will worsen. Not all melasma can be treated or improved. Deep melasma or dermal melasma will not improve with creams or peels. Fortunately the majority of cases are ‘mixed’, namely superficial and deep, and hence the majority of cases can be improved. The key to treating this condition is with a mixture of gentle AHA peels that exfoliates surface pigment, and also creams that ‘turns off’ the pigment producing cells.
If laser is performed, it has to be gentle and not agitate melanocytes, or melasma will worsen- the laser of choice is Q switch laser. I tend not to use Fraxel for this condition because of the fact that some cases can worsen with this treatment. New lasers such as Picosure Focus has shown great promise in the treatment of melasma and sun induced pigmentation.
Developing a melasma prevention plan is very important as this condition can be treated but not cured. I like the Clear+Brilliant laser together with Vitamin A, B, C skin infusions to help reduce recurrence. I can not over emphasise the need for sunscreen and hats year round.