My melasma got worse recently, and no treatment gives permanent results. What's my prognosis?

Question

I am very upset since my melasma spread to my upper lip recently after laser hair removal. The old spots on my cheeks never lifted with chemical peels or triluma. so, i know new pigmentation that's covering the entire upper lip is also permanent. I am really sad that prognosis for this disease is just so bad. I wish there was a way to minimise the symptoms to give patients their confidence back.

Anil R. Shah, MD · Answer

Greetings, see below for effective treatments. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please note it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

Raffy Karamanoukian, MD, FACS · Answer

I would use a combination of light chemical peels, Melarase AM, Melarase PM, and Melapads to help improve the melasma. Clear + Brilliant laser is best for maintenance. Best, Dr. Karamanoukian Los Angeles

Gustavo A. Diaz, MD · Answer

Melasma is a very frustrating problem for patients. There are several things that you can do to improve your condition, but the most important thing is that you need to learn how to live with it. There is no treatment that will give you permanent results.1. Sun protection and avoidance. In my opinion this is the key in order to prevent more melasma. You can improve your melasma, but just a few minutes in the sun without sunblock and you will lose all of the improvement that took you months to achieve.2. Avoid irritation of the skin. If you have acne or irritation of the skin after a peel or because you used some products, you will worsen your melisma.3. Use hydroquinone products wisely. Short term hydroquinone is great, but non-hydroquinone alternatives are needed for the long term control of melasma.4. IPL - Intense Pulse Light (IPL) used wisely will improve melasma without downtime.5. Light chemical peels - mild chemical peels will help shed some of the pigment at the superficial skin layers without irritation the skin.Consult your board certified Facial Plastic Surgeon for help with this problem.Hope this helps,Dr. Gus Diaz

Davin Lim, MBBS, FACD - Account Suspended · Answer

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. Real Self Advisory Board

My melasma got worse recently, and no treatment gives permanent results. What's my prognosis?

Answers (4)

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