What can I do for rosacea and melasma? Is there a treatment that works? (photos)

What can I do for my rosacea and melasma? I have tried hydroquoinone, peels, ipl, Excel v and laser genesis. Laser genesis made it worse with little dark marks on my upper right cheek. I am currently on finecea but it doesn't seem to be helping. I am willing to travel anywhere for treatment.

Doctor Answers 4

Melasma and rosacea.. treat each as a unique condition

Rosacea is very complex and a tailored treatment program give the best results. This is because there are many types of rosacea (telengtctatic or capillaries, flushing and redness, acne like rosacea, ocular rosacea and even rhinophyma rosacea.)

To add to the complexity, everyone has different flare factors- Sunlight, stress, foods, chemical irritants, creams, changes in temperature, alcohol. The list goes on. 

A detailed history, together with a treatment tailored according to YOUR type of rosacea will give the best results. As a guide, I use a combination of -

1. Lasers ( to treat redness, broken capillaries, rhinophyma, flushing)- best laser is the V BEAM. IPL can be used, but usually not as effective. Laser toning using the long pulse Nd Yag at 1064 can help with background redness. 

2. Creams - anti inflammatory

3. Tablets -anti - inflammatory and sometimes low dose Vitamin A. 

4. For females- Mineral make up is recommend, over make up that contains parabens. 

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.In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help.  

For the best results, consult a dermatologist for both medical and laser treatment options. 

Kind regards.

Dr Davin S. Lim.

Laser Dermatologist.


Brisbane Dermatologist
4.7 out of 5 stars 61 reviews

Halo and BBL

The Sciton laser BBL with Halo for combination therapy will help with your melasma and Rosacea. A pre-treatment compound cream for a few weeks pre and post-procedure is reccommended. The BBL can be done the same day as the Halo. The BBL will target capillaries, reducing the appearance of Rosacea. The Halo will reduce appearance of melasma mask, as well as target any sun spots/pigmentary issues. Both of these treatments will induce collagen production in the skin. Using Alastin products pre and post-procedure will increase elastin and rid your skin of its debris resulting you with a more even skin tone.

Kian Karimi, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Melasma and Sun Spots -- Best Treamtent Is Clear + Brilliant / Fraxel 1927 with Microneedling PRP, Pro Yellow is Useful

There is no "cure" for melasma but there are great treatments. We are doing a clinical trial now on clear + brilliant with bleaching and microneedling and getting amazing results. I suggest you see an expert. You will need lifelong treatment, sun protection, skin care. But these treatments can give you improvement and then you maintain. Rosacea can be treated with pulsed dye laser/vbeam or yellow laser at same time.  Best , Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Laser treatments...

Thank you for your question.  It appears form your pictures you have melasma not rosacea.  If topical bleaching creams like hydroquinone based products, for example TriLuma have not worked you can consider the Fraxel Dual or Clear and Brilliant Permea.  In particular the 1927 Thulium which is in both of the aforementioned lasers works extraordinarily well for pigment like melasma.  Both will require a series of treatments.  Regards, Dr. Matt Elias

Matthew Elias, DO, FAAD
Fort Lauderdale Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.