In addition to continued sunblock and hydroquinone, is the profractional laser effective in reducing melasma? Is there a significant risk of making the melasma worse? Is there an optimal laser setting to mitigate this risk? Thank you!
Is the Profractional Laser Effective in Reducing Melasma?
Doctor Answers 2
Laser treatment for melasma
Melasma can be of three varieties:
- Well-defined border
- Dark brown color
- Appears more obvious under Wood’s Lamp
- Responds well to treatment, such as with hydroquinones, chemical peels, retinoids, etc.
- Ill-defined border
- Light brown or brown-gray color
- Unchanged under Wood’s Lamp
- Responds poorly to treatment
- Combination of light and brown patches
- Partial improvement with treatment
Fractional laser treatments have been shown to work for the dermal and mixed forms of melasma. Unfortunately this is not an ideal treatment, as there are no ideal treatments for deeper forms of melasma. Photofacials have been reported to make superficial melasma better but deeper forms worse.
Normally, I have my patients use a hydroquinone topical for a month prior to deeper melasma treatment with laser. However, you don't want to use hydroquinones continuously as that can result in paradoxical hyperpigmentation, called exogenous ochronosis.
So far you are doing well in terms of sun protection and hydroquinones. I would advise limiting the duration of hydroquinone treatment. Sun protection is essential as even a small amount of sun exposure can significantly worsen the melasma.
Hormones also play a big role. If a woman is on birth control preparations, the melasma may be extremely difficult to eradicate.
ProFractional Laser is Effective for Melasma
As your question suggests, melasma is a difficult condition which requires a multipronged approach. Reducing the formation of pigment via bleaching agents such as hydroquinone is one important part of treatment. Extremely meticulous sun protection is also crucial in tipping the balance away from more pigmentation.
As an ablative laser modality, ProFractional can vaporize tissue in the epidermis and dermis, thus removing some of the pigment. With ProFractional, several treatments are typically planned.
Many physicians experienced in this area feel that Coag (adding thermal energy in a non-ablative way) should be avoided when choosing settings for a patient with melasma to decrease the risk of developing more pigmentation from the inflammatory post-laser response.
Mark Lucarelli, MD, FACS