Melasma on face. Please help me (Photo)
Doctor Answers 6
Melasma treatments explained in the video
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.
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
No treatment during pregnancy
We stick with 4% - 8% hydroquinone in a liquid gel form. To see the results click on the link below. We would advise that you do not start this program until you are done breastfeeding.
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Melasma Can Be Improved Significantly By Combined At-Home & In-Office Treatments
As a rule, I generally am very conservative about treating an aesthetic condition, such as melasma, during pregnancy and nursing. While many topicals are very likely completely safe for use during this period of time, since we are dealing here with an entirely aesthetic condition, my inclination would be to wait until you are finished nursing before starting any therapies. In the meantime, sun protection to prevent worsening of the problem is strongly recommended.
When the time does come, I have found a combination of at-home routine use of bleaching agents (either containing hydroquinone, kojic acid, arbutin or licorice extract) along with in-office peels containing glycolic acid, Jessner's solution to be quite successful in treating this chronic, recurring, troubling problem. Just the other day, I saw a 52 year old woman in a one-month follow-up after only one in-office treatment of Jessner's solution to the darkest areas on her cheeks, forehead and nose and high strength glycolic acid peel to the surrounding normal skin who, to her absolute delight, sustained a more than 80 percent lightening of her melasma that had plagued her, according to her history, for about twenty years.
While the above results are quite dramatic and the pace of improvement somewhat unusual, they can serve to give you encouragement that there are effective treatments available when the time is appropriate to seek active treatment.
Finally, medical microneedling combined with certain topicals is the buzz for melasma treatment at the current American Academy of Dermatology annual meeting going on right now. Another point made there is that lasers, by contrast, since they generate heat (which, like light, can increase pigmentation), possess the potential for actually aggravating melasma. So be cautious about this when the time comes.
Once again, I wish you all my very best.
Melasma and Pregnancy - NYC
You need to stay completely out of the sun, especially if you live in California. You need to use a complete sun block and a hat every day so that the melasma doesn't get worse. Since you are pregnant, I would not contemplate treatment now. After your delivery you can consult a physician who specializes in Melasma and inquire about Cosmelan treatment. Best, Dr. Green