Photofacials improve epidermal melasma but not dermal or mixed types
Melasma can be epidermal (superficial), dermal (deep) or mixed. The superficial form of melasma should be amenable to treatment with IPL, the other two forms are not and in fact may darken in response to IPL treatment.
One doesn't need to be pregnant to get melasma. Melasma is usually due to a combination of hormones and sun exposure. The hormones may be from pregnancy, birth control pills or just natural hormones a woman has. Men sometimes get melasma as well.
If any treatment of melasma is undertaken, it is absolutely essential to have a broad spectrum sunscreen applied daily to the face, at least SPF 50. No exceptions, as even a little sun exposure can cause the hyperpigmentation to recur.
Melasma is sometimes able to be treated successfully with IPL and or lasers. However, the condition may worsen if overly treated. We prefer to first treat with Hydroquinone, Kojic Acid, and Retin-A for 6-8 weeks. Then we consider a chemical peel, and last a laser treatment. With laser, we treat very low, careful to not get the patients too hot, and test spot first. We stress sunscreen with Zinc or titanium bases, and reapplication every 4 hours. So, can you be treated with IPL…yes, but not a great first choice.
Avoid IPL to treat suspected melasma
We have not found IPL to be an effective way to treat melasma. In fact, in certain cases, IPL treatment can make the melasma appear to be worse. The best option to treat melasma is using topical bleaching creams - such as hydroquinone. However, if you truly do have melasma, you should understand that it can be very difficult to treat. You should also be especially careful about wearing sunscreen, and covering the affected areas from sun exposure (i.e. wearing hats).
Photodamage responds well to IPL. Melasma not so.
Melasma tends to be too deep in the skin to respond to mild treatments like glycolic peels and skin bleachers. The response to IPL is also disappointing due to the depth of the pigment in the skin. These treatments are much better for more superficial sun damage. Generally with these services, the sundamage portion is improved but not so much the melasma. For many this is satisfactory. It often comes down to what treatment costs and this varies. Keep your expectations low. I would not recommend deep CO2 laser for this as this can stimulate extra pigment. Deep chemical peels can unpredictably depigment the skin. Ultimately there is no substitute for a personal consultation.
We perform IPL as well as glycolic peels in our office. For patients with melasma we always recommend the glycolic peels in conjunction with hydroquinone bleaching creams. They work better in our experience, than the laser for this condition. The peels can also help acne.
If you are taking an oral contraceptive that can worsen melasma. Sun protection including a hat (really) and sunscreen of spf 30 or higher is imperative.
Hope that helps.
Madeline Krauss, M.D.