Does melasma get worse if it the skin is irritated by exfoliating?

You're smart to ask. The answer is yes. Anything that creates inflammation can make your Melasma worse. And anyone who's had to deal with dark spots and blotches knows just how quickly the skin responds to insults.Exfoliation is fine as long as it's done right. Each skin type has its own triggers. Those with ethnic skin get the worst of it as even cooking can make spots pop up.You can use a soft brush to clean and exfoliate at the same time. Personally I'm a big fan of Clarisonic but it's not in everyone's budget. Even a hand held facial brush can help - just be sure the bristles are soft.What you want to avoid are harsh abrasive scrubs, high concentrations of glycolic acid exfoliants and the high pressure microdermabrasion machines that use crystals.Controlling your melasma is best done with sun protection - and heat protection. Saunas and hot tubs are not your friend because they create enough heat to trigger melanin production. You should be using a full spectrum sun block every day...and I mean every day. As to vitamins - a balanced one a day is probably sufficient. If you have vitamin deficiencies, you'll want to attend to that, but generally, no supplement is going to prevent or eliminate your melasma.Most people could be kinder and gentler to their skin. Exfoliants have their place but they can sometimes create more of a problem if they are over-used or used incorrectly.

Melasma can only be treated. Please read. 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

Melasma can make your skin look mottled and hyperpigmented. Melasma is usually caused by endogenous and exogenous hormones, the sun, inflammation, and possibly thyroid dysfunction. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of light fractional laser, depigmenting lasers and IPL, vascular pulsed dye laser, and Covalent peels.

Recommended Creams: Melarase Brightening Kit

MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Best, 

Dr. Karamanoukian

Realself100 Surgeon

Exfoliation can make melisma worse.  Any irritation or inflammation of the skin can worsen melasma.  Vitamins likely will not help your condition.