Best treatment for olive skin with age spots, sun spots, melasma?

I'm 47, light olive complexion w/ pinkish undertones, brown eyes and dark brown hair; was very active in sports from age 7 through 20's-prior to the emphasis on the importance of sunscreen & sun damage to exposed skin. I tan easily and intensionally did it in my teens (it was "in"). At 29, before any sun damage is noted, I diligently and faithfully apply uva/uvb suncreen QD all year, rain or shine. UV protection hats and umbrellas are used at sporting events, for yd work, etc, otherwise I avoid sun exposure. Despite all these precautions, age spots/sun damage spots/melasma-whatever each doc wishes to call it- continue to multiply in number and intensify in color. Lab results are WNL(CBC,CMP,Lipids,FSH, LH,Est,thyroid,etc). After 1 year of 4% hydroq., 0.4 retin A., and 4 IPL Tx's, no significant improvement is noted. The treating dermotologist of IPL(Nashville) states that my tx options are limited, states it's hormone related. Not much available for my skin type/color. A plastic surgeon (Chattanooga) advises against CO2 resurfacing. I'm not sure what type/brand of device she uses, but she does not think I will have successful results. This consult was approx. 1 yr ago. My complexion is slightly darker than the 1st patient in Dr. Weiner's before/after photos. Ethnicity is hispanic (Spanish) dad and Swedish mom. The IPL tx's progressed as they predicted with flushing, slight thin scabs at pigmented areas followed by flaking off of scabs w/i 3 days. However, these areas left larger hyperpig marks at the locations where flaking of skin occurred. At $400 a treatment, I was informed that I would need to have at least 12 treatments. Perhaps he was hoping that eventually all hyperpig areas would run together. Sorry for the sarcasm, it has been frustrating. Continued HQ and Rentin A have no significant impact. Have you, Dr.'s P or W, successfully treated cases similar to mine with Fraxel repair? Or are there other options that the Dr.'s with whom I've consulted may not be familiar with or have access to? With so much new research and technology, there has to be a doctor willing to spend more than the obligatory 5 minutes of a consult to explore options that are hopeful in addressing this problem, or at least minimize it somewhat. Any suggestions are truly appreciated. Thanks.

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Dear AG, You may want to consider another option that may be far less expensive than multiple IPL's or lasers. We currently have found good, consistent outcomes with our melasma patients by using a depigmentation mask called Cosmelan from Mesoestetic. There is no hydroquinone in this product and is safe for all skin types. There also is no downtime involved other than the several hours that the clay-colored mask is left on. Approximately 95% of our patients are good responders. With the 5% that are not - we have found no connection to skin type or ethnicity. As Dr. Persky stated, there is no cure for melasma and it is chronic by nature. For sun spots/sun damage, we prefer to use Q-switched laser technology. However, Cosmelan offers improvement for this as well as brown acne scarring. Regardless of which treatment plan you choose, be diligent with daily sunscreen. L. Haney, RN

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