Told I have Melasma. I have an autoimmune disorder and want my dark spots removed.

Q switch laser is not a longterm solution for melasma. I would start with the Melarase Brightening Kit followed by light fractional lasers. Best, Dr. KaramanoukianLos Angeles

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. See an expert for a formal evaluation. Best, Dr. Emer

I recommend that you do several things: avoid sun exposure, use sun block, use topical creams like Melarase.H KaramanoukianMD FACS

Melasma treatments must be combined and must be gentle. If you have an autoimmune disorder, your specialist will also check your endocrine function to ensure thyroid dysfunction is not a contributing factor. Ensure that you are under the care of a specialist and not a person with a Q Max device, as understanding how to treat melasma is important for 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

The picosure laser is a new laser that has game changing technology. it fires 1,000 faster than any other laser on the market. this allows you to significantly improve your hyper-pigmentation without the redness associated with a CO2, Fraxel or IPL laser. you should plan 3 treatments at least one month apart. david berman md