Melasma is a common condition caused by overactive pigment producing cells that is often linked to pregnancy but has other causes as well including acne outbreaks, hormonal treatment, sun exposure etc. Treating melasma can be frustrating, since melasma tends to recur. A combination of laser treatments and products can be a effective treatment for melasma.
Once the underlying causes have been corrected or diminished, treatment should include topicals like triluma (combination, retin a, hydroquinone and topical steroid) and possibly other topicals like Kojic acid. Next, Intense Pulsed Light(IPL) treatments are effective as well as q-switched fractional laser treatments are also effective treatment. Additionally, TCA chemical peels can be helpful in refractory cases.
The first treatment is to make sure that you are using a complete sunblock with 50 SPF or better that blocks UVA and UVB rays. Any treatment will be fraught with disaster if continued sun exposure occurs. The second treatment is to eliminate the causative factors like hormone balance, pregnancy, illness, acne control, etc. Again, any treatment while the precipitating cause is not treated will have limited long term improvement.
A series of treatments with a mild resurfacing laser, such as the erbium laser resurfacing, combined with topical lightening creams and a retinol are effective at minimizing melasma. Daily sunscreen usage is also vital. Fraxel and Erbium laser provides significant improvement for a good percentage of patients, although some patients will find no or little improvement from these modalities.
A series of 5 or more fractional laser resurfacing treatments is usually required because the process takes time. For those who mention that fractional resurfacing can make the melasma worse, 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.
Additional therapies that may be used in those still unsatisfied with their results include the non-ablative fractional lasers, or more recently, low fluence Q-switched Nd:Yag 1064nm laser. 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.
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.
Unfortunately, melasma has no cure, and most people need to use topicals daily and repeat the laser treatments regularly. However, with the right regimen, melasma can be controlled.
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