What's the Best Way to Treat Melasma?

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?

Doctor Answers 19

Best Treatment for Melasma?

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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.

Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Melasma is treatable!

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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!

Tanya Kormeili, MD
Los Angeles Dermatologist

PERMEA laser for Melasma Treatment

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Permea laser treats at the 1927 nm wavelength and is safe for all skin types and the treatment of melasma.
The PERMEA is a revolutionary, gentle laser skin care treatment, clinically proven to fight the effects of aging skin. The laser is a safe, non-surgical option with little-to-no downtime after treatments. Skin tone and texture is noticeably improved after each treatment and best of all, 

#melasmatreatments  #clearandbrilliant   #permealasertreatment

There is no one best way to treat melasma

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Melasma is a clinical challenge where nature and nurture matter. Your dermatologist should tailor a skin care routine appropriate to your skin type that will help to maximize clinical benefit of whatever modality you choose. Our clinic is a melasma center of excellence in the Bay Area with most comprehensive technology for melasma, even in the setting of ethnic skin including Picosure, Spectra, GenesisPlus, Clear and Brilliant lasers as well as our proprietary LumaBright, an enhanced Melanage vitamin A chemical peel. There is no one best way to treat melasma. Much will depend on your tolerance of downtime associated with LumaBright peel vs. patience required with series of laser treatments.

William Ting, MD
Bay Area Dermatologic Surgeon
4.5 out of 5 stars 14 reviews

Best topical treatment for melanin pigmentation and melasma

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I have written a book about Melasma and believe that a regimented protocol is required for proper treatment. In my own office in Los Angeles, I begin with a topical regimen using Melarase AM, Melarase PM, and MelaPads. This treatment protocol tackles the major contributors of melasma occurence, including but not limited to hyperstimulation of melanin production and UV exposure.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Combination Treatment Works Best for Melasma

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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

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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.

Jeffrey C. Poole, MD
Metairie Dermatologic Surgeon
4.3 out of 5 stars 6 reviews

Melasma Treatment

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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 needs a comprehensive cream program and chemical peel

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chemical peels, sun avoidance, and a comprehensive cream program will help melasma. We see A LOT of melasma in our office. I generally avoid heat based treatments including lasers for melasma. 

Sameer Bashey, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

How do you treat melasma?

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There are many aggressive treatments as you can read on this Q&A. Start with some topical products like melarase am and melarase pm and evaluate your situation in 3 months. See the link below for more information. 

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.