I am going crazy because of melasma, nothing seems to work...what to do?

There are many precipitors for melasma and pigmentation. I would start with the Melarase Brightening Kit with Melapads, Melarase AM, Melarase PM, and Replenish; followed by a combination of Covalent peels, Yag laser, and light fractional laser. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

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 (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

The vi peel is effective for melasma and safe in any color of skin. There is no downtime. In addition the q switched laser usually used for tattoo removal can lighten or eliminate melasma in a few sessions with no downtime. If necessary both these treatments can be combined but no different days to lighten melasma but touch up sessions may be necessary.

I do agree that this is one of the MOST CHALLENGING conditions to treat. A dermatologist can guide you according, additional tests should be conducted to exclude endocrine causes (very rare).Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments. 

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 

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 according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 


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