is there any surgery that can lighten the dark spots? what surgeries do you recommend? are skin lightening creams affective, which skin lightening cream brands do you recommend?
What's the Best Way to Treat Melasma?
Doctor Answers 16
Best Treatment for Melasma?
Hello 4423. We actually disagree with Dr. Lupo on this one. We have used laser treatments for Melasma and not only is the recurrence rate very high, but patients can actually get worse. This was the most troubling issue for us. While the Fraxel is FDA approved, we have found that most patients that underwent this treatment were unhappy.
We use high strength hydroquinone bleaching programs (6-8%) with a 3 month on, 1 month off treatment protocol. We have found with the two programs we use - Cosmelan MD and a proprietary compound - that we get about an 80% response rate. Good luck.
Melasma is treatable!
Melasma is the result of excess pigment distrubted throughout the skin. The pigment is called melanin and is made by melanocytes in the body.
To treat melamsa effectively a combination approach has to take place:
1. strict sun protection - even on cloudy days there is a UV factor! A great SPF that protects against UVA and UVB at least 30 and above.
2. Creams that have active ingridients that decrease melanin production, such as Hydroquinone or Azeleic acid. They can be applied at home.
3. Chemical exfoliation such as peels or retinoic acids that help gently remove the pigmentation off the skin.
4. Removing any skin irritation that can inflame the skin and cause further darkening in a response called post-inflammatory hyperpigmentation
Caution: If you have ethnic skin (i.e. not blond with blue eyes!) you are at least for getting an exacerbation in the melasma with too aggressive a treatment. Make sure you see a doctor who has experience with ethnic skin!
In my experience, certain lasers can really make melasma worse in the long run. Make sure you are in great hands!
PERMEA laser for Melasma Treatment
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There is no one best way to treat melasma
Combination Treatment Works Best for Melasma
Melasma, or increased color deposits to areas of the face, responds best to a combination of:
1) Fractional laser resurfacing - non-ablative, where the energy is focused under the skin to break up the pigment color. A series of 5 or more treatments is usually required because the process takes time. The newer lasers, like the Lux1540 by Palomar have demonstrated good results and are tolerable. For those who mention that fractional resurfacing can make the melasma worse, I would like to mention that proper patient selection is important. Selecting patients that have a tan or darker skin, or who will not follow sun protection measures may see a worsening of the condition. Also, pre and post treatment with hydroquinone combination topicals helps.
2) Sun avoidance, sun protection and sunscreen. Melasma is triggered by visible light. Sunscreens block ultraviolet light. Even with good sunscreen and a window, sunlight can darken melasma, even if it has been treated.
3) Hydroquinone topicals, in combination with others like a glycolic acid and a retinoid (Retin-A or similar). Hydroquinone in concentrations up to 4% block the transfer of the pigment color from the cells that produce it to the cells that store it. By blocking this transfer, treatment results are better and the benefits are extended. Concentrations higher than 4% hydroquinone, especially when compounded can increase the risk of oochronosis, an untoward bluish discoloration of the skin and a known side effect of hydroquinone.
4) Maintenance therapies like various peels, microdermabrasion, topical antioxidants like Vitamin C and alternative non-hydroquinone pigment reduction products may also help, but they are likely to be less effective or best for maintenance.
These are the most effective treatments. There are many others being marketed and these may help in combination with the above.
Multi-modal approach best for Melasma
Melasma is a frustrating and difficult condition to clear. Many people only find improvement, without total clearance. Treatments begin with avoidance of estrogen containing products and the regular use of a sunscreen with broad spectrum UVA/UVB coverage, as well as physical protection from the sun (hat, glasses etc.). The basis of most all Melasma treatment plans also incorporates a bleaching agent (most commonly Hydroquinone from 2-8%), Tretinoin (such as Retin-A), and a low potency steroid cream mixed together. This combination is a time tested effective therapy. Further topicals such as Glycolic Acid, Vitamin C, Mequinol, Kojic acid and Azelaic Acid are also used.
Chemical Peels are the next "step up" in treatment-- again using agents such as Glycolic Acid or Jessner's Solution in addition to your topical regimen.
Additional therapies that may be used in those still unsatisfied with their results include the non-ablative fractional lasers (such as Fraxel), or more recently, low fluence Q-switched Nd:Yag 1064nm laser (for which we use the Ultralight Q). It appears that the low fluence (energy) treatment for melasma is actually much better than the more typical higher fluence treatment we use in other pigmented conditions.
Melasma can be a very difficult and frustrating condition to treat. Use of birth control pills and pregnancy are two common situations when melasma will first appear, along with sun exposure. If possible, birth control pills should be stopped (especially if melasma if resistant to treatment), and daily sun protection and sunscreens are essential. Hydroquinone, often referred to as a bleaching cream, is effective, and is often combined with Retin-A and a topical steroid. Chemical peels and the Fraxel re:store DUAL laser can also be effective, but usually are added to treatment with hydroquinone. Melasma is often treated long-term to prevent recurrences and maintain improvement. Best of luck to you.
Melasma has multiple causes and therefore has multiple treatments. It is likely a lifelong condition but can be held under control. Steps to successfully treat melasma include
-Avoid UV light and exposure and wear daily sunscreen
-Investigate hormonal causes
-Use of topicals (skin lighteners, retinols, etc)
-Use of chemical peels (i.e. melanage, etc)
-Use of LASERS (i.e. IPL, erbium, Nd:YAG, ablative treatments)
You can create more even toned skin through the state-of-the-art treatments we offer. But long-term results depend on staying out of the sun and wearing a daily broad-spectrum sun protection whenever you are out in the sun, driving in your car, or sitting by a window (the sun’s UV rays can penetrate through glass).
Melasma Treatment Options
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.