How do I treat melasma and hyperpigmentation in my 50s?

Hi! Thank you for your question. Melasma is one of the most difficult skin conditions to treat as it is triggered by hormones and exacerbated by heat. What this means is that while most pigmentation issues respond well to lasers such as IPL, Melasma has a tendency to get worse after heat is exposed to the area. Here are my recommendations for treating Melasma, -------Lasers- The safest way to treat melasma via laser is with a laser that fires in Picoseconds. This is to insure a careful heating of the skin not to further exacerbate the melasma. Here in my office we use the Piqo4 Laser by Lumenis. It is the only laser proven to treat melasma safely and effectively.
------Chemical Peels- Peels such as the Melanage Peel or the Reve Peel offer safe results for patients with Melasma. A combination of acids and non-acids penetrate the skin to lift micropigmentiaton. You will also be sent home with an at-home care regimen to maintain your resutls.
Hydroquinone can sensitize the skin so I would recommend to discontinue about 3 days prior to any treatment that you get done. Most patients resume about 7-10 days after but it also depends on how their skin is healing.It is important to know that melasma is a moving target and requires patience and diligence to treat.
Best,
Anil Shah

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, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Dear amazed510,I would have to examine you but Melasma can be treated with a comprehensive approach.  Stopping or changing the birth control medication, avoidance of UV and direct light, and also retinol and hydroquinone treatment. You should always use sunscreen.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello and thank you for your question.  In our practice we have had some patients see excellent results with PicoSure treatments for melasma.  You usually want to think initially terms of a series of treatments spaced about 4 weeks apart, and then maintenance treatments once every 6-12 months after that. 
With that being said, everyone is different and not all patients respond to melasma treatment in the same way. Melasma can be a challenge to treat and in some cases, heat can make it worse..  For that reason, after a proper consultation where we discuss the procedure, treatment goals, realistic expectations, etc., we usually do a small test spot to start so that the patient can see the process and results that can likely be expected.  Our patients have been very satisfied with the opportunity to "preview" what the likely outcome will be by going through the test spot process.
We recommend a skincare routine that uses SkinCeuticals products and have a few that we recommend specifically for Melasma patients and have seen some great results with.
All the best to you! 
 

Thank you for your question.  Melasma is very difficult to treat and heat often makes it worse.  Start by looking for prescription strength 4% Hydroquinone (HQ).  Do not buy it over the counter or off the internet.  Laws vary by state.  In Texas, physicians can prescribe and dispense in office.  We have been very successful using the PicoSure laser with the FOCUS and / or Flat Lenses eliminating hyperpigmentation with a series of treatments.  Our protocol is a series of very low pulse count combined with using our chiller unit blowing cold air.  FOCUS lens treatments have the extra benefit of reducing fine lines, wrinkles and scars.  This is one of our go to treatments for patients older than 40 and worried about the signs of aging.  The PicoSure laser is SAFE for ALL SKIN TYPES.  Start with sunscreen every day!  Once you have treated your hyperpigmentation to your satisfaction, you will probably need a follow treatment every 6 to 12 months depending your level of re-pigmentation.  Best of luck.

The Picosure laser is the most effective treatment for melasma. you need to plan at least 3 sessions, each spaced a month apart. you must always use an excellent sunblock. if you have any ethnicity to your skin, we like to pre-treat with HQ for 2-3 weeks and also do a Vipeel before starting the Picosure treatments. There is little to no downtime with the Picosure laser.
david berman md

NO doubt your melasma will dramatically improve in the first week or two, only to rebound back with vengeance. Go slow with melasma, let a dermatologist who is an expert in this field help or guide you.Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments. 



I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’) 



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 according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher. 

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin. 



All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.