Facial pigment issue worsening. Dark and white spots. Never pregnant, on birth control or spent much time in sun. Fraxel?(Photo)

Question

Hormone tests normal. What is the best treatment? For years I've used Elta MD Clear spf 46 followed by J Iredale makeup spf 20. Struggled with acne all my life. Accutane worked temporarily 15 yrs ago, but I lost 40% of my hair, and it didn't grow back. For past 8 yrs, my program is sulfer-based cleanser 2x day, duac in am, Tazorac pm. Pigment issues for 3 yrs now. Also use Quantum Healing Laser's Blue light for acne for about a year, but only on my jawline and nose. I eat right and exercise.

Ron Shelton, MD · Answer

Melasma, or facial hyperpigmentation, comes in different forms and some patients do have white discoloration as well (idiopathic guttate hypomelanosis). It is not reasonable to expect a 100% correction and NO doctor can guarantee success in reducing melasma.  There may be considerable improvement, but it's very important to realize that once someone has melasma, the treatment is not considered a cure, but maintenance. If you do obtain a good result, you'll probably have to go back to the doctor for further treatment in the future when the pigment returns.  Just a few minutes of unprotected sun exposure can bring it back overnight!Any treatment, chemical peel or laser, has a risk of postinflammatory hyperpigmentation in any patient but some skin types are more prone for this to happen.  Often the laser treatment is done in conjunction with the use of topical lightening creams to minimize the rebound darkening that can occur and the laser also helps the creams work best.Permea, which is a mild fractional laser of the Clear and Brilliant type, has helped gently reduce melamsa in many of our NYC patients at the Laser & Skin Surgery Center of New York. But, with all types of lasers, I have seen failures too. It's important to see an experienced doctor when having this treatment done for this condition.

William Groff, DO · Answer

Hi mipup-- this looks like melasma, which can be a very difficult condition to treat. Over the last 14 years, the laser that I have seen work the best is the Fraxel Dual laser using the 1927nm wavelength. Melasma can recur or even worsen so you make want to try more conservative measures first. Best, Dr. Groff

Joshua L. Fox, MD · Answer

Fraxel? Yes. But combination therapy is the best
treatment of your facial pigmentation problem.As has been mentioned, this can be a challenging condition to treat,
requiring a multifaceted approach with various creams, lasers, and peels all
adding possible benefit.You likely
won’t be happy with just one treatment of Fraxel alone.See your dermatologist to discuss the many
good options out there for you and to establish a relationship that can help
you get the long lasting improvement you want.

Michele S. Green, MD · Answer

When hyper pigmentation is the result of sun damage the Fraxel is a fabulous option. If the sun damage is Melasma then there are some different treatment options available. Clear and Brilliant which is a mini Fraxel can be effective as well as the Fraxel on the 1550 setting. I have also had a great deal of success with Cosmelan. For the best results please consult a board certified dermatologist with experience with Fraxel and cosmetic skin issues.

Lenore Sikorski, MD · Answer

Melasma
 is best treated with creams containing hydroquinone. It would be best 
to use a hydroquinone cream in the morning and a hydroquinone + 
tretinoin cream combination
in the evening. You can also use a vitamin c serum in the morning to 
help brighten your skin tone such as Skinceuticals CE Ferulic Acid.  
Fraxel 1927 is not recommended for melasma. Fraxel 1550 can be a 
consideration but I strongly recommend the hydroquinone
creams for at least 3 months and then I would recommend chemical peels 
before any laser treatments. I also recommend a good physical block 
sunscreen such as Elta SPF 45 (contains zinc oxide).

F. Victor Rueckl, MD (in memoriam) · Answer

You have melasma. This doesn't necessarily have anything to do with hormones. See a dermatologist in your area for treatment options. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

Facial pigment issue worsening. Dark and white spots. Never pregnant, on birth control or spent much time in sun. Fraxel?(Photo)

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