IPL Side Effects from Melasma Treatment

Dear Danai,
the hyperpigmentation after your procedure could be due to a few things. Regardless, it is probably not permanent and you should have treatment to hurry up the recovery. usually a bleaching cream combined with retin A and a cortisone cream resolves these tempory problems quite well. i like to do a few very light chemical peels to speed up the results as well. don't worry, these things happen to the best of us and are treatable
sincerely,
dr hansen

IPL, like all light based treatments, has the potential to improve as well as worsen melasma.  Ideally, melasma patients are first placed on topical treatments and sun avoidance.  If no improvement is noted, more aggressive treatments such as light based treatments or chemical peels can be employed to help improve the hyperpigmentation present.

If indeed you have melasma, IPL is not a recommended treatment option.  Although it may take longer to see improvement, topical creams such as hydroquinone can be effective in lightening the areas. 

You have two different issues going on. The striping on one cheek sounds different from the coffee stain on the other. The striping sounds like hyperpigmentation (brown discoloration caused by the trauma of the treatment) and the coffee stain sounds like your Melasma is showing up more clearly.
The IPL will only make your Melasma worse. We are not sure why your practitioner used an IPL for the treatment as it is not FDA approved and most if not all light based devices will make Melasma worse.
The striping you see is caused by a treatment where the energy level is too high. When this happens, the heat of the device focuses at the surface of the skin rather than lower levels, causing blisters or burns.
DO NOT have another IPL treatment from this practitioner as they do not know what they are doing! Find an experienced practitioner that can help you solve the problems that you now have. Hydroquinone bleaching creams are a good option for both problems. And do everything you can to avoid the sun as this will delay the healing process and worsen your Melasma.

IPL can leave discoloration and is not very effective on treating melasma.Darker skin people are not good candidates for IPL and often two weeks is not enough time for the tan to fades.Melasma can succesfully be treated mith Fraxel restore laser and pretreating the skin with hydroquinone, or bleaching cream improves the results.IPL seems to be working better for sundamaged skin or broken blood vessels on the face.

It is true that sun exposure can cause an unwanted response to IPL. The melanin is a chromophore for IPL meaning that it is a colored target that absorbs the light energy produced by the intense pulsed light. Too much chromophore and the skin can actually break down.
The tiger stripping is due to the actual shape of the ILP crystal. The bad news is that a "no-down time" treatment suddenly has a lot of down time. However, these will often heal completely on their own. Certainly avoid more photofacial at this particular office. Time will usually heal the stripping and one week is extremely early.
Also, be weary of treatments that claim to improve melasma. Bleaching products also tend to produce little improvement. On the other hand, if your melasma got more obvious with sun tanning, consider avoiding sun exposure, or use appropriate sun screen. This may help fade the melasma.

Hyperpigmentation of the facial skin requires the skills of an experienced skin expert. Melasma cannot be cured, but can only be treated. It is an ongoing process that will improve with laser, chemical peels, IPL, and topical creams.
Ironically, all of the treatments, excluding topical creams, can actually worsen the hyperpigmentation that they were meant to correct. Conservative treatment is mandatory.
Melasma and hyperpigmentation can occur from the following four factors:

Sun Exposure
Inflammation
Genetics
Hormones

If you experience hyperpigmentation following any given procedure, contact your physician in order to start topical treatments as soon as possible.

Melasma is discoloration of the upper cheeks, upper lip, or forehead, most commonly seen in women of childbearing age.  It tends to develop during pregnancy (hence its nickname "the mask of pregnancy") or while taking a birth control pill.  Regardless, its onset is triggered by the combination of estrogen and sun exposure.  No sun - no melasma.
Melasma is like a light switch, except one it is turned on, it can't be turned off... Stopping birth control pills will not make the melasma resolve completely.  After all, you still make estrogen...
That does not mean melasma can't be treated successfully.  The key is to avoid sun exposure strictly: avoid the sun in peak hours, use a broad-spectrum, high SPF (50+) sunscreen, applied liberally, and reapplied often, and wear a hat with a good brim.  Studies show that this alone is the main factor in reducing the darkness of melasma.  
You can also see a dermatologist to discuss treatments such as hydroquinone, which blocks the key enzyme that makes melanin, the brown pigment in the skin.
In theory, it is advisable to avoid treatments such as peels and laser - these may provide temporary benefit, but the melasma will always come back.  In addition, those treatments may in themselves cause change in your skin color (post-inflammatory hyperpigmentation). This might be what happened with the IPL.  If so, high SPF and patience are your best tracks forward.  Hydroquinone may help, but ask your provider if it is appropriate for you

I hope you're doing better now. Protecting your skin from the sun continues to be very important for you, especially as we're heading into spring.
Since melasma is a chronic problem, follow-up with a board-certified dermatologist can be critical for obtaining long-term good results. What you use on your skin can make a big difference.

The IPL treatment may be aggravating the melasma. Sometimes, hydroquinone and retin A formulations can improve the melasma.
 
Steven Wallach, MD
www.stevenwallachmd.com