What will get rid of these dark spots, mask, melasma? (photos)

I have a horrible case of melasma that has white circles throughout, all over cheaks and little on forehead. Im 99% done with accutane. Ive had laser, didnt work, VI peel, etc, no help. Am I forever stuck? These photos show how it has a line even with my jaw. So embarrassed.

Doctor Answers 6

Melasma and Halo Laser

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Unfortunately, melasma is a chronic and complicated condition.  It is affected by sun exposure, use of hormones (or pregnancy), ethnic factors and even stress.  Melasma is usually inadequately treated because it can be epidermal, dermal or a mixture of both. Hydroquinone and peels address only epidermal melasma and the dermal component has not been addressed before.  I have successfully used Halo by Sciton with a two pass method.  I treat the epidermal melasma at a depth of 300 microns and then a second pass to treat the dermal melasma at a depth of 500-525 microns. This two pass method, along with pulse doses of hydroquinone and non-hydroquinone skincare throughout Bakersfield's very sunny year greatly treats the melasma.  Most melasma patients can then maintain their skin to a level that they wear tinted sunscreen only or only light makeup.  Appropriate physical blocking sunscreen (zinc oxide or titanium) applied 3-4 times per day is absolutely essential and requires constant vigilance on the part of the patient.

Melasma is stubborn, quick to come back if you have unprotected sun exposure and requires much effort from the patient but with Halo, there is a way to reduce and correct the amount of pigmentation. Halo has given melasma patients a second chance.  If you have a Sciton Halo provider in your area and they are unfamiliar with this protocol, please have them contact me.  Shelby Bentz MD


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Melasma can be treated using a 4% hydroquinone and retinoid.  This works for a few months and then needs to be transitioned  to a non hydroquinone skin brightener with retinol. Best of luck.  

Melarase creams for sun damage from melanoma

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The white spots likely represent sun damage. I would start Melarase creams with the Brightening Kit followed by fractional laser and light chemical peels. 


Dr. Karamanoukian

Los Angeles

Melasma requires treatment with someone who has experience

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Melasma is a difficult condition to treat. That being said, I have treated thousands of people with melasma in my career. While there is no cure- there are many ways to improve and keep it at bay. I utilize a comprehensive cream program and peels to control melasma and we have had great success with this. Seek a provider who has experience with treating melasma. I have spent my entire career treating melasma and teaching other doctors to treat it. 

Zein E. Obagi, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Melasma, and possible treatments.

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Melasma 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.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Once clearance has been achieved, I place patents on a maintainece program of Clear and Brilliant laser with ascorbic acid infusions. 

In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help.

More information on available treatments in the Web Reference below.  All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia 

Melasma and Sun Spots -- Best Treatment Is Clear + Brilliant / Aerolase w Microneedling PRP, Pro Yellow is Useful

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Melasma can be treated, but not cured. Every patient responds differently. Please see an expert to find what's best for you. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.