Will a Peel make my melasma worse?

Question

Hi All, I had one IPL treatment a year ago and it brought out some melasma I never had. I didn’t go back to go more treatments because I was fearful It would get worse. My melasma will come and go — I recently went on a cruise so it’s back. Thankfully, it’s a mild case but definitely noticeable. I am schedule for a physician choice of Arizona Peel next week. Do you think this will make my melasma worse? I’m getting the peel to treat large pores, texture issues and mild melasma. Thanks!

Jeff Angobaldo, MD · Answer

Melasma is a very common skin condition in women 20-50 years of age. It is caused partly by sun, genetic, predisposition, and hormonal changes.  It is characterized by three location patterns, central face, cheekbone, jawline, and upper lip.  A beneficial treatment that targets melasma is with the palomar icon laser with the xf-1540 hand piece.  Patient needs to be pre-treated by applying a thin layer of hydroquinone 4%, morning and night, two weeks prior to treatment.  Please schedule a consultation with a physician before starting any treatments.

Raffy Karamanoukian, MD, FACS · Answer

After a thorough skin prep with Melarase AM and Melarase PM; we would recommend the Covalent peel to help exfoliate the skin and improve the melasma. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

David E. Berman, MD (retired) · Answer

the Picosure fires 1,000 times faster than other lasers. This means that there is NO DOWNTIME!!!! there is often not even any redness. you should plan 3 treatments, spaced one month apart. david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

IPL can cause what is known as rebound melasma and should never be used as sole therapy. Melasma 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.
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
  
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. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

Will a Peel make my melasma worse?

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