Melasma returning between PicoSure treatments. Is this normal? (photo)

Question

I had 2 PicoSure treatments for melasma. No improvement from #1, but after #2, where she did 2 passes, within 3 days I had lightening of the melasma, particularly on the forward part of my cheeks. 2 weeks later, all the melasma has returned. I am using Lytera 2.0 (having a break from sustained HQ 4% use), retinal 0.1%, vitamin c, AHA/BHA cleanser, sunscreen, makeup, floppy hat, and Heliocare. Why is it back so fast? Is it clearing by layers? Is this return between treatment normal? Help!

Monika Soni, MD · Answer

Thank you for your question! It is important to stress that Melasma can not be cured. Picosure will treat existing spots but it will not prevent new ones from forming. Sometimes, Picosure can even trigger melasma. I am sorry that your provider hasn’t been honest with you. Best of luck!

Davin Lim, MBBS, FACD - Account Suspended · Answer

I am sure your dermatologist should have educated you with the pathogenesis and recurrence of melasma. This is a medical condition and not a cosmetic condition. The use of VEGF 1 modulators and tyrosinase inhibitors in conjunction with laser is ideal. Once melasma has improved optimally I then use other methods, apart from Pico to keep it in remission - my favourite remission lasers include nano QSL and C and B. Be guided by your dermatologist with your melasma management.  
Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

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 according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher.

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

Melasma returning between PicoSure treatments. Is this normal? (photo)

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Melasma returning between PicoSure treatments. Is this normal? (photo)

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Everything you need to know about PicoSure

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