How Effective is Spectra Laser in Treating Melasma. How Many Treatments Are Required? Are There Better Alternatives for Asians

unfortunately, whether aggressive or mild laser treatment, melasma can worsen from the stimulation of the pigment cells during the healing process. Some excellent results have been obtained with the use of Fraxel laser, the Restore and Dual, but melasma can come back, rather readily, and all treatments have a risk of post inflammatory hyperpigmentation, including the Portrait plasma resurfacing. Combined use of lightening creams and sunscreens are important, along with sun avoidance.

 

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs

 

Hi Confused.  Hopefully we can provide some insight.  We do not use the Spectra q-switched laser, but we have the Medlite C6.  Both are q-switched Nd:Yg lasers.

We have performed trials using the Medlite to treat Melasma.  The problem we encountered is that the Melasma sometimes gets worse.  We think that epidermal Melasma (very superficial) responds well but that dermal Melasma, which is hard to reach because it is in the lower layer of skin, responds by getting darker after treatment. 

Because neither hydroquinone nor lasers are a cure for Melasma and because lasers can sometimes make the condition worse and are much more expensive, we have decided to use only hydroquinone based programs.  

The irritation you are experiencing with the hydroquinone product is because it has Retin A in it.  There are HQ products out there (ours is 8%) that do not have Retin A.  If your product does have Retin A and you are getting irritated, you need to give the body time to acclimate to it, which means using it every other day or every third day in the beginning.

The bottom line is that we are NOT advocates of using lasers for Melasma. It works poorly, is expensive and many times make the issue worse.

Melasma is one of the most difficult skin care problems that we, as cosmetic dermatologists see on a regular basis. And the fact that you are Asian does not make things easier, because skin of color has more melanin or pigment in the skin to begin with, so this just makes things more difficult, but definitely not impossible, so do not give up hope and this can be controlled. First and foremost, find a board-certified dermatologist in your area, and learn the various treatment options that are available for you. Remember, however that whatever we do, we are treating melasma, and that there is not a cure for the disease, so sun protection and proper skin care post anything we do, is the most important thing out there. I like to tell patients that I am going to treat theirmelasma by walking up a staircase, starting at the bottom and working our way up based on response and how things are going. We always start with the proper topicals – and most of these will include a hydroquinone or one of the newer non-hydroquinone topicals that have become very popular amongst dermatologists. Patients will then learn about chemical peels and the benefits of chemical peels for the treatment of melasma — and all of these procedures are safe for Asian skin. If after a series of chemical peels does not help, then we introduce the lasers and light sources into the mix — from IPLs to non-ablative fractional lasers to the Q-switched lasers like you are asking. We have done quite a bit of work over the years on these skin care products for melasma and for many of the lasers so we think, using this approach, allows us to get the best results with the least invasive techniques. Also remember this — some of the lasers out there have an FDA clearance for melasma and many non-dermatologist equate this with cure — it is a treatment and you need to understand this before going to someone who will tell you that they can cure your melasma with this laser or that — they cannot.

Dear Confused Asian female,

 

I have the Lutronic Spectra laser in my practice and lecture about melasma and laser treatment nationally at dermatology meetings.  Melasma is frustrating and I explain to patients that we can control but not cure melasma.  It requires maintenance treatment.

 

That being said, the Spectra does a superb job at improving melasma.  I use a series of 12 weekly treatments with this Nd:YAG laser.  The key to melasma is avoiding heat.  IPL, Fraxel, and other pigment lasers can introduce too much heat on darker skin types and worsen this condition.  I have several Asian, Hispanic, and darker skin types previously burned by IPL treatments that have had remarkable success in their melasma with the Spectra.