Best Melasma Treatment for African American Skin?

Unfortunately, there is no cure for melasma. Because of this, it is one of the most emotional skin conditions that we treat. The goal for the treatment of melasma is improvement and control or suppression of a condition that is considered chronic. With that said, there are many that claim good outcomes with lasers and/or topical products. In our opinion, lasers (including Fraxel) do not consistently provide benefits and, in many cases, the condition is worsened by lasers. Because you are of a darker skin type, this must be taken into consideration as well.
We currently have good success (improvement) with two topical regimens that we offer. Medium to darker skin types have a higher predisposition of having a negative reaction (post-inflammatory hyperpigmentation = darkening of the skin) if the topical regimen is too harsh. Be certain to choose a practitioner that will help you decide which treatment plan is best based upon your skin type, past modalities used, and ask for before and after photos of actual patients. Far too often, patients are prescribed strong topical regimens with very little patient education or monitoring. Whatever you decide, be diligent with sun protection daily by using a broad spectrum sunscreen.

Hello, please see information below. 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 not 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

There are many great treatment protocols for melasma. I would begin with Melarase AM and Melarase PM followed by Melapads to help with pigmentation. Melapeels can help hasten exfoliation and help remove old pigmentation.

Best,
Dr. Karamanoukian