Is Picosure the best Melasma treatment for type IV skin?

Hyperpigmentation from any type needs a combination approach of peels like cosmelan,  lasers like clear and brilliant and aerolase or laser genesis, radiofrequency like venus viva, and constant skin care and sun protection.  Bimontly facials with silk peel dermalinfusion is essential to hydrate, exfoliate and infuse vitamins and antioxidants into the skin.  If you have acne you can do additional treatments and peels to get more improvement.  I suggest a formal consultation with an expert in lasers and peels. Best, Dr. Emer.

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, good luck.
------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 micropigmentation. You will also be sent home with an at-home care regimen to maintain your results.
-------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.
It is important to know that melasma is a moving target and requires patience and diligence to treat.
Best,
Anil Shah

Thank you for your question! I recommend doing a series of 4 Pico laser treatments to help improve the melasma. For maintaining the results of the laser, I start my patients on a 4% Hydroquinone and Retinol cream. Unfortunately, melasma can come back if you go out in the sun without protection, so it's very important to wear a good sunscreen every day.

I treat so many patients with melasma, especially those recently who have had Picosure.  The Picosure often makes the melasma worse and more difficult to treat in the future.  The best treatment for you would be to have Cosmelan.  Cosmelan consists of two medical peels spaced three weeks apart and the use of Cosmelan creams in conjunction with the products.  Strict sun avoidance is necessary to avoid a recurrence of your melanoma.  Best, Dr. Green

Pico lasers can help, however all lasers are ADJUNCTIVE therapy. Melasma 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. 
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