Melasma Treatment for olive tone skin

Problem started after taking doxy & OBCyrs ago. I have the classic butterfly all over cheeks, plus large spots on nose bridge, upper lip, & all over my forehead; only chin is spared. I am religious about no sun & use only zinc+ sunblock every day; been on hydroqu 2%, then 4, now 8% compounded plus Retin A etc for ~1.5 yrs. I have my daughter's wedding in 4 mos. Would chem peel &/or laser work for deep pigment; if the latter, which types are best for olive skin? I am wary RE: even worse outcome. Thanks!

Doctor Answers 4

Difficult melasma in olive skin

Treating melisma in individuals with darker skin is always delicate.  I believe using stronger than 4% hydroquinone with tretinoin is not likely to produce better results.  First and foremost is daily sunblock with greater than a 50 SPF, even a small amount of sun will undo the best efforts.  Secondly there are other agents that can be added such as Elure and Niacin which inhibit pigment formation.  Lastly things can be sped up by very cautious use of Intense Pulsed light on low energy settings about every 3-4 weeks.  Peels can sometimes worsen matters by causing post inflammatory pigmentation.

Miami Dermatologic Surgeon
4.3 out of 5 stars 6 reviews

Melarase creams to the face for melasma

In our office, we utilize the Melarase AM and Melarase PM creams as the most effective modality for skin lightening related to melasma on the face. 

Raffy Karamanoukian MD FACS

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Melasma Treatment

Pigmentation is difficult to treat especially for olive skin; you have to be careful because if something too aggressive is done it can cause more damage. I have found great success with the Cosmelan and Cosmelan MD treatment in my office. It is very effective on Asian, Hispanic, Caucasian, Indian and African American skin, it is usually the first step I take before moving on to more aggressive treatments like lasers.

For you I would recommend a Cosmelan MD treatment, it consists of a mask that is worn on the skin for 6-12 hours this mask includes Retin-A, Hydroquinone, and 15 other lightening agents like Kojic Acid. After the initial mask there is a maintenance cream that is applied to the face starting 3-5 days after the mask.
This maintenance cream is used for 1 month and then my patients come in for an evaluation. If the patient is happy they continue with the maintenance cream to prolong the benefits and to improve their skin. If the patient would like additional improvements then at this point their skin is prepped to receive a laser with a lower possibility of causing more pigment.

It is important to keep in mind that pigmentation can be improved and controlled with the use of maintenance creams however new pigmentation can be created depending on your lifestyle. For best protection from new pigmentation; try to stay out of the sun between 10-3, wear a hat and sunblock of SPF 50 should be worn daily.

Nissan Pilest, MD
Irvine Dermatologic Surgeon
4.7 out of 5 stars 19 reviews

Melasma Options

Hi Joana.  If you are on 8% HQ now, we would not go any higher.  In addition, there is some concern about long term uninterrupted use of high strength HQ.  In our practice, when patients use any HQ over 4%, we require that they take 1 month off after being on the product for 3 months.  

As an option for a short term fix, there are some peels out there, VI, Cosmelan, BLUe, etc that may be able to help you prepare for the wedding.  None of these are permanent solutions, but it may be possible to help you look better short term.  It would not be advisable to do these closer than 2 weeks from the wedding just in case you have a bad reaction.

Regarding lasers, we would not advise that you use any lasers for Melasma at any time.  We know from having treated hundreds of Melasma patients that many have tried Fraxel, Q-switched lasers, IPL and the like.  A full 50% of these patients end up having their Melasma worsen, even in situations where it improved initially.  We do not recommend lasers or IPL for Melasma for this reason.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.