Recurring melasma patch after lasers and peels?

Question

I have a brown melasma patch on the side of my left cheek. I got it during my pregnancy. That was 7 years ago. Since then, I go for regular lasers and chemical peels at doctors clinic. Each time after removal, it grows back to the same size and shape. Lightening creams don't work for me. Im not sure what else to do because it keeps coming back. Surgical removal?

Jason Emer, MD · Answer

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, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Jeff Angobaldo, MD · Answer

Thank you for your question.   I would recommend to start using triluma morning and night six weeks prior to laser treatment. Fractional treatment is very effective for suppressing discoloration and evening out skintone.  Skinpen which is a microneedling device that would also be beneficial for getting rid of melasma.  The microneedling treatment helps to wake up your natural growth factors, shrink your pores, fade discoloration and acne scars, and help increase collagen and elastin production. You would do a treatment every 4 weeks and stay out of the sun as much as possible and always wear spf 50 broad sprectrum.  Always consult with your physician first before starting a treatment.

Raffy Karamanoukian, MD, FACS · Answer

Skin discoloration is a very prevalent problem in women over the age of twenty.  It is also increasingly common in men with increased sun exposure, but mainly occurs in women. 
Risk factors include thyroid disease, sun exposure, hormones, pregnancy, family history, PIH, and birth control. Melarase AM and Melarase PM have been extremely effective in reducing pigmentation associated with skin discoloration and hyperstimulation of melanocytes. 
In my practice, patients with hyperpigmentation benefit from twice daily application of the creams. Melarase AM in the morning, followed by Melarase PM in the evening. Melarase AM contains four active sunblocks, so additional sunscreen is not needed unless your sun exposure is very high or you had a recent procedure/laser. SPF of 30. Melarase PM contains active skin lighteners to even out skin pigmentation. If you are concerned about the development of pigmentation, contact our office to discuss details and to obtain a regimen for Melarase. Laser therapy works but must be combined with a therapeutic topical program before and after therapy. 
Recommendations:  5-step Daily Brightening Kit has everything you need to improve dark spots, skin discoloration, melasma, and hyperpigmentation caused by sun exposure, hormones, scarring, and the environment. It’s a powerful daily brightening kit that can help bring out your skin’s natural, healthy glow. Ideal for use on the face, neck, and hands. 
Includes: Melaclenz, Melapads, Melarase AM, Melarase PM, Elevase, and Spectrase
Best, 
Dr. Karamanoukian
#Realself100 Surgeon

Hratch Karamanoukian, MD, FACS · Answer

Malaysian and Asian skin types are prone to hyperpigmentation and treatment side effects with lasers, peels. Melasma needs long term commitment with skin care and avoidance of skin factors such as sun exposure (Spectrase Sun Block) which has wide UV spectrum and SPF 30+ protection. 
Daily good habits with topicals may well help you chieve your goals with a good skin system like the Brightening Kit from KareSkin (see link). You may want to start with Melarase and Pigmentation Correction Complex. Scler-X from another vendor is for PIH relief (see link). 
Melarase AM is non hydroquinone based. 
Clear + Brilliant laser can be added once you start your pretreatment with topicals. 
Best
H Karamanoukian MD FACS

David E. Berman, MD (retired) · Answer

if you have skin types 1-4 (ie your skin is not very dark) , you should get the Picosure laser. this is a breakthrough laser for melasma and hyperpigmentation. there is little to no redness because it fires 1,000 times faster than other lasers. this means you can return to work immediately after a treatment. you will need to use a great sun block. you may want to us in addition a hydroquinone cream.david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

This is rebound melasma, and is very commonly seen after IPL and strong laser devices (such as Fraxel RePair, Fractional lasers with high energy and high strength chemical peels). The aim is to markedly decrease energy levels and peel strength as to not aggravate the pigment producing cells. 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

Robert T. Buchanan, MD (retired) · Answer

There are several problems with what you have said. Lasers and peels are not the best way to treat melasma, though they do work. An IPL that has a very restricted light output is generally the best physical way of treating it. Even then, none of these are permanent and none really treat the pigment cells. at the problem will always recur.  You can slow down the recurrence, however, by use of a good zinc oxide sunblock with at least 8% zinc oxide DAILY. Other UVA sunblocks are not practical since they need to be applied every hour if you are outside and every 2 hours if you are inside. The zinc oxide block only needs to bee reapplied if you rub or wash it off. Generally, though, my preferred method of treating melasma is with the Obagi Nu-Derm System, a facial cream system that works 2-3 times better than anything else to treat the problem. It does require continuous use or the problem will recur.

Recurring melasma patch after lasers and peels?

Answers (7)

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