{"id":19714,"date":"2021-05-18T11:29:10","date_gmt":"2021-05-18T18:29:10","guid":{"rendered":"https://www.realself.com\/news\/?p=19714"},"modified":"2023-10-17T16:07:39","modified_gmt":"2023-10-17T23:07:39","slug":"microneedling-for-melasma","status":"publish","type":"post","link":"https://www.realself.com\/news\/microneedling-for-melasma","title":{"rendered":"What Dermatologists Want You to Know About Microneedling for Melasma"},"content":{"rendered":"

The patchy brown pigment of melasma<\/a> is among the most prevalent, challenging, and emotionally charged conditions that dermatologists treat. “It’s unbelievably common—affecting easily a billion women worldwide—and [can be] incredibly upsetting,” notes Dr. Jeffrey Dover<\/a>, a board-certified dermatologist in Chestnut Hill, Massachusetts. “I literally have women between the ages of 25 and 65 coming into the office, crying with this, on a daily basis.” The majority fall within skin types II through V on the Fitzpatrick Scale<\/a>, he adds.<\/p>

While melasma is fueled by UV light, just like sunspots, and influenced by hormones, as with acne<\/a> and the marks it leaves behind, melasma is far harder to squelch. In fact, the devices commonly used to eviscerate the discoloration associated with those issues tend to make melasma worse by virtue of their heat, which can spark more pigment formation in the weeks following treatment. Fearing this rebound effect, dermatologists have come to lean on heat-free solutions, like gentle chemical peels<\/a> and, more recently, energy-free microneedling<\/a> treatments—typically, in conjunction with potent fade creams and strict sun avoidance.<\/p>

While not everyone sees microneedling as a home run for melasma, emerging research <\/a>supports its success in hundreds of cases, across skin tones—attributing its efficacy, in large part, to the channels it creates in the skin. These carefully oriented punctures serve as tiny portals, allowing select lightening agents to seep into the skin’s deeper layers, which are impossible to reach with ordinary creams. But the benefits of microneedling don’t end there.<\/p>

Ahead, dermatologists reveal the exact characteristics that make melasma so tenacious and share the specific microneedling protocols they’ve devised to tame it.<\/p>

Interested in microneedling?<\/small><\/div>Find Doctors Near You<\/a><\/div>

Why is melasma so difficult to treat?<\/h2>

Melasma can stain the epidermis, or topmost layer of skin, as well as the deeper dermis—and oftentimes affects both. “The epidermal component usually clears with lightening creams, but the dermal component is really resistant to treatment,” Dr. Dover says. <\/p>

Beyond the placement of pigment, what make melasma so difficult to tamp down are the omnipresent stimuli responsible for its creation. Since the condition is fueled primarily by female hormones and sunlight, “you have these two really strong forces trying hard to make melasma—and we can beat it back, but it’s sort of like the neverending army,” says board-certified Boston dermatologist Dr. Papri Sarkar<\/a>. “We don’t have a great way to cut off the stimulus for melasma.” There are things docs can do to help curtail it, however.<\/p>

Melasma is perpetuated by both endogenous estrogen—our own innate supply, which waxes during pregnancy and wanes with menopause—as well as exogenous sources, like birth control pills and hormone therapy. While derms don’t meddle with inherent hormones, “we do try to suggest that women [with melasma] stop the Pill, if they can, and use alternate forms of contraception,” says Dr. Dover—though he notes, “we never stop it if someone needs it for endometriosis or another medical problem.” Working with patients’ gynecologists, they may transition melasma sufferers to a low-dose pill, or if safe and appropriate, wean them off external hormones completely in order to reduce the instigative effect on pigment production.<\/p>

Equally unrelenting is the sun—which is why most derms won’t even attempt to treat melasma with anything other than sunscreen and prescription creams during the UV-intense summer months. “That’s fighting an uphill battle,” says Dr. Dover. “Five minutes in the sun can actually reverse a month of treatment.” Whether inside, outside, or in the car, broad-spectrum sunscreen with a high SPF is mandatory—as are hats with circumferential brims wide enough to shield melasma hot spots, like the forehead, upper lip, cheeks, and nose. <\/p>

How can microneedling help minimize melasma?<\/h2>

Unlike pigment-targeting lasers, tuned to seek and vaporize excess melanin, mechanical microneedling, through a series of clean, controlled punctures, “effaces a certain depth of skin, including the epidermis and superior dermis, where we see melasma,” Dr. Sarkar explains. “We’re essentially getting rid of that and forcing the surrounding skin [via its healing mechanisms] to make brand-new, fresh skin that hasn’t yet experienced the effects of hormones and sun.” (As a nice bonus, needling also ramps up collagen growth and gives a pretty glow.)<\/p>

How deep providers go generally depends on a few factors—the location of the pigment (again, epidermal versus dermal); the patient’s propensity to create more melanin as a result of inflammation (aka postinflammatory hyperpigmentation, or PIH, a common risk with darker skin); the overall sensitivity of the skin (someone prone to rosacea or hives, for instance, may require a milder, shallower treatment); and the amount of downtime a patient will tolerate. That said, derms are working within a range of 0.5–2.5 millimeters when microneedling. “But I almost never use the same setting on the whole face,” Dr. Sarkar adds. She’ll vary her depth across the face, based on the density of the pigment she’s aiming to eliminate (needling more aggressively on more melasma-rich zones) and the thickness of the skin (the cheeks can accommodate a greater depth than, say, the under-eyes or nose).<\/p>

The tunnels made during microneedling allow doctors to funnel medications directly into areas of concern—and many derms believe this to be the true magic of microneedling for melasma. “I love microneedling as a means of assisted drug delivery,” says Dr. DiAnne S. Davis<\/a>, a board-certified dermatologist in Dallas. “By creating tiny injury zones or columns, I am able to then apply active ingredients that can further help to treat pigment in my melasma patients”—a practice she finds to be generally safe and effective even for her patients of color, who are prone to PIH. <\/p>

In a new study<\/a> published in the Journal of the American Academy of Dermatology<\/em>—a review of 459 melasma patients, from seven different countries—researchers found that “topical therapy with microneedling improved melasma severity with a large effect … beyond eight weeks [and] best results seen at 12 weeks.” According to Dr. Dover, a co-author on the paper, the fine print attached to this procedure should read: “Microneedling does help melasma when used with topical therapy—but on its own, it’s not effective.” <\/p>

Related: The 11 Best Skin-Care Products for Hyperpigmentation and Melasma, According to Derms<\/a><\/em><\/p>

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