A doctor referred specifically to fair-skinned patients for Photofacials. I am Asian and have darker skin. Is it true that Photofacials tend to make discoloration (melasma) worse? What would you recommend I use for my skin problem?
Doctor Answers 6
IPL treatment basics: How to improve results for photofacials and melasma
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It is very risky to treat someone with melasma with photofacials. I recommend starting with a topical hydroquinone first.
Melasma treatment is difficult in darker skin
Melasma in a common problem in darker or "ethnic" skin. There is not universally effective treatment, and yes, some treatment such as IPL can induce clinical worsening. I find it best to approach melasma treatment with a combination approach using topical treatment (e.g hydroquinone), laser or phototherapy, and chemical peels. Each treatment should be designed specifically for individual patient. Most importantly, you will need to find a physician with an ample experience in treating darker skin types with melasma.
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You are right that in many cases, you can get worse outcomes with a photofacial on melasma. We prefer to start with chemical therapy first, and use light as a last resort.
IPL for the Asian patient
Intense pulsed light can be provided for a limited subset of Asian patients (those with very light skin). It is crucial that the physician have experience with Asian skin as it is true that IPL / photofacials can darken skin in certain situations. Bleaching creams and some chemical peels can improved melasma, but may not completely eliminate it.
Very few things make the melasma better
Your concerns are appropriate. Photofacial works best when there is a big color separation between the background skin and the issues to be treated. In your case, the color separation between your darker skin and the slightly darker melasma is minimal. Generally it is not possible to make a difference without also treating the natural skin color. Additionally, many individuals with darker skin find that the photofacial will stimulate hyperpigmentation. It is important to be aware of these issues. The melasma can be difficult if not impossible to treat. The important issue here is to not harm the skin in an effort to improve it.