Stubborn Melasma on my Wife's Face?

Question

My wife has melasma spots on her face. Her dermatologist who treated her with IPL. After the treatment, the spots turned brown. A few days later, as the brown area faded, the skin came out lighter. As recommended by the dermatologist, she put on sunscreen, wear UV blocking hat (with a front plastic that covers almost the whole face), and put on Triluma cream. Her Ob/Gyn also said she had no hormone problem. But her melasma came back shortly after stubbornly. What else can she do?

Rebecca Fitzgerald, MD · Answer

IPL is a great quick start way to begin the process of managing Melasma, but skin will continue to produce melanin. Triluma and other hydroquinone-containing products help suppress melanin production, but they are not all a sure-fire fix. And long term hydroquinone use can become its own problem.

	Birth control pills can cause melasma  and some are more problematic than others. Heat itself can worsen melasma- even something as innocuous as getting hot from standing over a stove, working out, going into a sauna or spending even short times in a hot tub. Anything that causes your body to heat up conceivably can also call out to the melanocytes to go to work and produce pigment.

	Windows in a car - or in your home or office - typically don't provide UV protection, so daily use of sun protection, whether you go out or not, is a good idea.

	We will use peels, customized skin care regimens, IPL and even a dermaroller/skin care mix to help patients manage their melasma. It's generally an ongoing process.

	Those with mixed heritages generally suffer more from melasma as the genetic instructions call for more melanin and melanin expression.

Raffy Karamanoukian, MD, FACS · Answer

Long term topical management is important. I regularly give lectures on melasma and begin patients on topical Melarase creams for at least 6 to 9 months. IPL alone will not help the situation.

David P. Melamed, MD · Answer

Here is what to do:
	- First, do not use IPL to treat melasma
	- Second, use broad spectrum sunscreen and skin lightener products
	- Third, seek a qualified skin specialist in your area who knows how to treat melasma to provide the correct laser treatment. One of the new technologies that are effective in treating melisma is Tribeam. Most lasers rely on heat to remove pigment but Tribeam seeks to remove pigmented lesions without heat.  The laser pulse is so rapid that a sound wave shatters the pigment into tiny particles and the body's own processes carry the pigment out of the system and it begins to lighten.

Mark Taylor, MD · Answer

Your wife may have started out with Melasma and ended up with Post Inflammatory Hyperpigmentation. The Cosmion Mask used with 20% Vitamin C and M2 products is effective and safe for both Melasma and Post Inflammatory hyperpigmentation. Refer to the article published in The Journal of Drug in Dermatology, January 2013.

F. Victor Rueckl, MD (in memoriam) · Answer

Often people with melasma need a combination of therapies. Because melasma lies at a very deep depth in the skin layers, IPL can't get to all of it. It absolutely does help and will pull a lot of the discoloration out, but to get to the deeper layers, a treatment like Cosmelan (which is a multi-step mask and topical treatment) is very effective. Additionally, your wife should go in for a maintenance IPL treatment every 4-6 months. Treating melasma is an on-going process.

Stubborn Melasma on my Wife's Face?

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