What's the best way to get rid of melasma? Can melasma ever be completely cured or will melasma treatment only reduce it?
Best Way to Get Rid of Melasma?
Doctor Answers 11
Understanding the causes of melasma: Hydroquinone
Understanding the causes of melasma is the most important step in treating the condition. Melasma is characterized by excessive deposition of pigment in the skin, usually the face.
The causes include:
- Hormones: Estrogen and progesterone work on cell receptors on melanocytes to stimulate the production of melanin. Hormones can increase as a result of birth control pills, estrogen replacement, phytoestrogens, and pregnancy.
- Sun Exposure
- Active inflammation of the skin from skin diseases or acne
Once you control the cause, there are many options including Hydroquinone topical cream, chemical peels, IPL, lasers including Fraxel.
The primary focus of treatment is that there is no cure for melasma, but rather, only treatments. It is a lifelong process that will have to continue as long as the causes continue.
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Hydroquinone programs for melasma work best
We have heard from just about every single Melasma patient in our office that they have tried and failed a Hydroquinone treatment program. About 70% of these patients are happy to see after the treatments that they have improved dramatically using a different type of HQ program.
Over the counter and standard prescription strength hydroquinone treatments vary typically between 2% and 4% with 4% being prescription strength. The difference with the Celibre Medical program is that the HQ treatments we use vary between 6% and 14% (for the masks). Using higher doses can lead to much better results and more side effects, which is why we closely monitor our patients on a monthly basis and require that they only go on the program for 3 months consecutively. Because Melasma is a condition not cured but managed, our patients are on HQ for 3 months and off for 3 months. In between they use other products for depigmentation but without the HQ active ingredient.
We are currently performing trials using using the Hoya Conbio Medlite laser with high fluence (energy) high frequency treatments, but have not begun offering this to the general public. The protocols we are using for the trial are based on research from Asia, where Melasma is very prevalent.
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I like Cosmelan® for melasma, but prevention is key.
Photoprotection is important
Melasma is primarily induced and exacerbated by sun exposure, and may be triggered by hormonal therapy such as oral contraceptive use or hormone replacement therapy, pregnancy, endocrinologic disorders, and dilantin therapy. First and foremost in any melasma treatment plan daily photoprotection is essential. Many times I find that the number one cause of melasma treatment failure is inconsistent use of photoprotection. Primarily I recommend patients use good sunscreen that has broadspectrum coverage (UVA/UVB) and at least SPF 30 (I prefer Elta MD) and wearing it daily even after clinical symptoms fade. In the office I typically evalaute the depth of pigment with a Wood's lamp, which can roughly estimate if pigment is in the upper layers of skin and will be amenable to topical therapy with hydroquinone and retinoids, or if it will require a deeper treatment with a chemical peel. Laser can be used as well. As melasma has a tendency to reoccur (particularly in darker skin tones) consistent use of a retinoid and photoprotection can help prevent flares.
Melasma is a common condition that is difficult to treat. Usually a combination of treatments, including lightening creams, chemical peels, and/or lasers are used to improve it. The most important part of any treatment regimen is sunscreen and strict sun protection. A board-certified Dermatologist can create the treatment plan best for you.
Effective Melasma treatment
Melasma is a common condition caused by overactive pigment producing cells that is often linked to pregnancy but has other causes as well inclduing acne outbreaks, hormonal treatment, sun exposure etc.
The first treatment is to make sure that you are using a complete sunblock with 50 spf or better that blocks UVA and UVB rays. Any treatment will be frought with disaster if continued sun exposure occurs. The second treatment is to eliminate the causative factors like hormone balance, pregnancy, illness, acne control, etc. Again, any treatment while the precipitating cause is not treated will have limited long term improvement.
Once the underlying causes have been corrected or diminished, treatment should include topicals like triluma (combination, retin a, hydroquinone and topical steroid) and possibly other topicals like Kojic acid. Next, intense pulsed light treatments are effective as well as q-switched lasers are also effective treatment. Additionally, TCA chemical peels can be helpful in refractory cases.
The best way to get rid of melasma is to stay out of the sun.
Melasma is a poorly understood disorder of too much melanin. In some people it is easy to treat by standard methods of photo-protection:
- Stay out of the sun
- Use a good sunscreen
In other people, no matter what we do it won't go away. But even in those people, avoidance of the sun's ultra violet (UV) light is beneficial.
There are numerous chemical and light based treatments for melasma, but photo-protection is the corner stone for all of them; and it's done by the patient and not by the doctor.
Melasma is an extremely difficult condition to combat consistently.
Limited sun exposure and its effects through a good sunscreen helps.
Fraxel and Erbium laser provides significant improvement for a good percentage of patients, although some patients will find no or little improvement from these modalities.
Consult with an experienced and licensed physician who can explain more thoroughly your options and likelihood of success.
Good luck and good health.