Is IPL Laser the Best Melasma Treatment?

Question

Hi, I have very large melasma patches on my cheeks and forehead.  A consultant at my local hospital prescribed me with quinone cream, which was very difficult for the pharmacist to get hold of as it is banned in our country (U.K). I have been given advice by a local clinic on IPL laser and wondered if this would be good for me.

Raffy Karamanoukian, MD, FACS · Answer

Melasma is characterized by hyperpigmentation on the face that has four main causes:

Genetics
Sun exposure
Hormones
Inflammation

One of the most effective treatments is a topical combination of prescription hydroquinone and tretinoin.  Keep in mind that treatments for melasma are not permanent as the above mentioned causes cannot be entirely eliminated.

Anil R. Shah, MD · Answer

Greetings,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

Larry S. Nichter, MD, MS, FACS · Answer

Melasma is a common disorder that is often
difficult to treat.  It isn't unusual for a patient to become frustrated
after trying  a variety of treatments in an attempt to  obtain
satisfactory results.  Like most other complicated skin conditions, a
combination of treatments paired with the proper skin regimen works best!
Topical de-pigmenting agents  such as hydroquinone or other melanin
inhibitors along with a topical tretinoic acid to increase skin cell turnover,
 hastens the fading of uneven patches.  This commitment along with
specific medical-grade chemical peels, appropriate  laser treatments and
diligent protection , can enhance the likelihood of reducing or resolving
melasma !

#melasma
 #chemicalpeels # unevenskincolor

Sam Naficy, MD, FACS · Answer

IPL is not a good treatment option for melasma.  Using a topical hydroquinone cream with tretinoin (Retin-A) may be a better option.

Harold J. Kaplan, MD · Answer

We believe that IPL (and Fraxel for that matter) treatments are the worst choice for Melasma for the vast majority of those that have it. Melasma can be an epidermal (upper skin), dermal (lower skin) or mixed (dermal and epidermal) condition. We have found that the only results we have achieved for treating Melasma were achieved with Q-switched laser technology and only in cases for epidermal Melasma. But so few patients have just epidermal Melasma that many actually get worse after light based treatments such as q-switched lasers, Fraxel and IPL treatments. Every patient that has come to our office after receiving Fraxel or IPL treatments elsewhere has had their Melasma worsen after treatment.  
We will begin trials shortly using the Hoya Conbio Medlite C6 (or later) q-switched laser on skin type IV patients (Asian and Hispanic).  Although we have used q-switched laser technology for Melasma in the past, the results were mixed with only 50% getting better and the other half getting worse. Our new protocols will take into account research that has been ongoing in Asia for several years with much higher energies and much shorter duration between treatments. Until we complete this research we will continue to treat Melasma with topical (hydroquinone based creams) treatment programs only.

Cynthia Stolovitz, MD · Answer

HI
I would not recommend IPL for melanoma. it can make the situation worse .The best treatment for Melasma is creams with Hydroquinine such as Obagi Nuderm. In some case a Q switch laser can be used but only in qualified hands.

Shlomit Halachmi, MD, PhD · Answer

Melasma is discoloration of the upper cheeks, upper lip, or forehead, most commonly seen in women of childbearing age.  It tends to develop during pregnancy (hence its nickname "the mask of pregnancy") or while taking a birth control pill.  Regardless, its onset is triggered by the combination of estrogen and sun exposure.  No sun - no melasma.
Melasma is like a light switch, except one it is turned on, it can't be turned off... Stopping birth control pills will not make the melasma resolve completely.  After all, you still make estrogen...
That does not mean melasma can't be treated successfully.  The key is to avoid sun exposure strictly: avoid the sun in peak hours, use a broad-spectrum, high SPF (50+) sunscreen, applied liberally, and reapplied often, and wear a hat with a good brim.  Studies show that this alone is the main factor in reducing the darkness of melasma.  
You can also see a dermatologist to discuss treatments such as hydroquinone, which blocks the key enzyme that makes melanin, the brown pigment in the skin.
Avoid treatments such as peels and laser - these may provide temporary benefit, but the melasma will always come back.  In addition, those treatments may in themselves cause change in your skin color (post-inflammatory hyperpigmentation).

Michele S. Green, MD · Answer

I have had many patients who were treated with Melasma in the past with the IPL laser and their melasma were made worse and later more difficult to correct because of the previous laser.  I would recommend TCA peels combined with Hydroquinones and Retin-A or Cosmelan peels.  Please consult an expert in melasma for the best treatment.  Best, Dr. Green

Dennis Gross, MD · Answer

IPL is a great option for treating melasma. IPL is sensitive enough to not cause any further damage and can also be combined with various chemical peels to reach the pigmentation occuring in different levels of the dermis. There are certainly other pigment seeking devices that may be a bit more aggressive, but IPL is certainly a safe and effective option to start with.

Steven Wallach, MD · Answer

IPL treatment can sometimes help melasma although it is tough. Some alternatives include treatment with hydroquinone and retin-A based products. These creams provide a slow treatment that should hsow improvements over a few months.

Is IPL Laser the Best Melasma Treatment?

Answers (11)

More Laser Resurfacing Questions

WE SEND PRETTY
EMAILS

Answers (11)

More Laser Resurfacing Questions

Confused About Laser Resurfacing Treatments After Disappointment with CO2

Do Gemini Laser Treatments Get Rid of Freckles?

What's the Best Makeup or Concealer That Covers Up Melasma?

What's the Best Way to Get Rid of Age Spots on Asian or Ethnic Skin?

What Effect Does Sun Exposure Have on Melasma?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS