What is the best treatment for melasma on Hispanic skin?

Question

I'm a female Hispanic who's had melasma for about 11 years on my cheeks. I thought it was due to using glycolic peels and not using sunscreen but I've read it can be hormone-related? I tried having laser resurfacing but the dermatologist I saw advised against it saying laser treatment on Hispanic skin wasn't very successful and told me to buy a LaRoche-Posay cream. I've tried tons of cream and nothing has helped. Please help!

Harold J. Kaplan, MD · Answer

Hello,Melasma is the most common skin condition we treat in our practice.  Despite our expertise with lasers, we never treat melasma with lasers or IPLs - not because it's not safe for Hispanic skin types, but because it's not a good approach to melasma.  Hormonal pigmentation tends to worsen with light based treatments, and research supports this time and time again with a known "rebound" effect of the discoloration.  We treat melasma for all skin types with only 6 or 8% hydroquinone.  Although there is no "cure" for the condition, a prescription strength topical product that is easy to use, non irritating, and effective (for over 90% of our patients), is the best approach.  Please see the below link for detailed information on how to manage your condition on a daily basis as well as before/after photos of our topical program in action.  We understand that melasma is a very emotional and frustrating condition.  Finding a balanced approach to a treatment plan is key, and ours has been rewarding for many.  Being that our practice is not in your state, we would encourage you to reach our website articles and find someone in your area to help.

Jeff Angobaldo, MD · Answer

Thank you for your question.   I would recommend to start using triluma morning and night six weeks prior to laser treatment. Fractional treatment is very effective for suppressing discoloration and evening out skintone.  Skinpen which is a microneedling device that would also be beneficial for getting rid of melasma.  The microneedling treatment helps to wake up your natural growth factors, shrink your pores, fade discoloration and acne scars, and help increase collagen and elastin production. You would do a treatment every 4 weeks and stay out of the sun as much as possible and always wear spf 50 broad sprectrum.  Always consult with your physician first before starting a treatment.

Anil R. Shah, MD · Answer

Hello, please refer to information below. 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 not 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

Jason Emer, MD · Answer

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. Melasma will need life-long maintenance. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Raffy Karamanoukian, MD, FACS · Answer

Hispanic skin that is olive or darker can become pigmented. I would begin the Melarase Brightening Regimen with Melarase AM, Melarase PM, Melapads, and Replenish to help with the discoloration. Best, Dr. KaramanoukianLos Angeles

Daniel Barrett, MD · Answer

Dear Belle111,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, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Hratch Karamanoukian, MD, FACS · Answer

You would need an in person examination but Melasma can be treated with a comprehensive approach.  You should avoid sun exposure with wide spectrum high SPF sun block and Spectrase is a great product for this. Consideration should be given to stopping birth control pills. As well, topicl creams like Melarase AM and Melarase PM have been shown to be very effective in our practice.Hratch L Karamanoukian MD

Davin Lim, MBBS, FACD - Account Suspended · Answer

A tailored treatment gives the best results. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. This is essential. 
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

What is the best treatment for melasma on Hispanic skin?

Answers (8)

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