Is it possible to have both melasma and vitiligo?

it is very hard to correct vitiligo. The Picosure laser is the most effective treatment for melasma. you need to plan at least 3 sessions, each spaced a month apart. you must always use an excellent sunblock. if you have any ethnicity to your skin, we like to pre-treat with HQ for 2-3 weeks and also do a Vipeel before starting the Picosure treatments. There is little to no downtime with the Picosure laser.
david berman md

Very complex hence not many answers. The answer is yes. It is rare and hence the case I saw last week demonstrates the rarity of this condition. You can either pigment the vitiligo or fade the melamsa. The outcome is better in the later with YOUR condition, why? Because its a small patch around your eyes. Now, if I were to go the opposite and try to re pigment vitiligo, that could also be an option, but not in your case. This is because the contrast will be marked, meaning more obvious melasma, and gradual repigmenation of vitiligo. In some cases a biopsy is needed to confirm, but the 3 shades on examination, especially on your lower cheeks both sides, coupled with lack of pigment within hair follicular units suggest vitiligo. Melasma is a very common cause of skin pigmentation. It can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This forms the foundation of all treatments. 



I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 



In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.