Please, help me with my horrific melasma. (Photo)

You have dermal and epidermal melasma. I would start with the Melarase Brightening Kit followed by fractional laser with Clear and Brilliant and a light chemical peel series. Best, Dr. KaramanoukianLos Angeles

Thank you for sharing you photo and I'm sorry to hear about how your son commented about your skin.  It sounds like you tried many many options but you should never give up.  I highly suggest you look into PicoSure Focus treatment for your melasma.  Not only will it improve your skin pigmentation it will also improve your skin texture as well because it is the only laser on the market proven to stimulate elastin production.  To find a Picosure specialist I your office please visit cynosure.com or Picosure.com .  Your treatment will need a few sessions. Some patient see improvement after 1-2 sessions others might need 4-8 sessions. Everyone is different. I absolutely love this treatment and have seen it do miracles to people's faces. Good luck.  Best, Dr.Avaliani

I recommend getting a formal evaluation with a cosmetic dermatologist. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. See an expert. Best, Dr. Emer

Pictures suggest melasma. A multimodality approach to melasma is key to successful reduction in hyperpigmentation and ongoing maintenance. You would need an in person examination but Melasma can be treated with a comprehensive approach.  You should avoid sun exposure with wide spectrum high SPF sun block and Spectrase is a great product for this. Consideration should be given to stopping birth control pills. As well, topical creams that are non hydroquinone based. Sclerovase. Melarase AM and Melarase PM are hydroquinone based products that relieve melasma pigmentation. I have been shown to be very effective in our practice.

Having treated melasma my entire career- I have found laser to be a poor choice to treat melasma. Lasers can worsen melasma or only temporarily make it better. A much better option is a good skincare program sun protection, and a controlled depth blue peel. 

Thank you for your question and for submitting your photos.  It's impossible to make an exact diagnosis without assessing you in-person.  However, based on your photos, you do appear to be experiencing melasma - a form of hormonally-induced hyperpigmentation of the skin, most often seen in young women on birth control and during pregnancy.  Melasma is a chronic condition, and there's no single treatment that will make it go away forever.  That said, it can be brought under control and managed, though it requires a combination of treatments, including meticulous and consistent home skincare as well as in-office procedures.  I would be wary of any provider who claims that a single product or procedure will cure you of your melasma.  
The single most important thing you can do to prevent your melasma from getting worse/recurring is strict sun protection (SPF 30 or greater, preferably a physical sunscreen with zinc oxide or titanium dioxide) every single day, on all exposed skin.  In general, almost all patients with melasma are sensitive to direct sun exposure and hormonal triggers (pregnancy, oral contraceptives, in-vitro fertilization).  That said, we are learning more and more about new triggers for melasma.  I find that some patients are sensitive to heat, indirect sun-exposure (sun on the arms and hands triggering melasma despite good sun protection on the face), exercise, and even diet.  In addition to strict sun protection, I generally recommend a combination approach, including prescription strength skin lightening medications at home (with vitamin C, hydroquinone and Retin A), as well as medium depth chemical peels, and microneedling.  Lasers are not consistently beneficial for melasma, and sometimes the heat from the laser can actually trigger melasma flares.  I generally reserve laser treatments for the most resistant cases of melasma, after they have not responded to other treatments.
I would recommend scheduling a consultation with a cosmetic dermatologist for a formal assessment and to discuss your treatment options.  Best of luck!

I do not believe that lasers help Melasma. In many cases using lasers makes melasma worse. We have tremendous success treating melasma with a combination of an aggressive skincare program and the Obagi blue peel. Seek a doctor familiar with treating melasma who has experience. Treating melasma incorrectly (with lasers) can make the melasma worse and even more difficult to treat in the future. 

the picosure laser fires 1,000 times faster than any other laser for there is little to no redness after a treatment. you will need between 3-6 treatments spaced a month apart. This laser is expensive to buy so you may have to search for one. Most likely to be found in plastic surgeons and derms' offices and not likely to be found in a spa. There is no perfect treatment and if you get a lot of sun exposure, it could come back. good luckdavid berman md

See a dermatologist who has an understanding and interest in this condition. Combination treatments gives the best results. 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. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams.

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.

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