- Best ResultsAre very rare
- Treatment Recovery0-1 days
- Procedure Time10-20 minutes
- Skin SpecialistNot performed
- Duration of ResultsMakes melasma worse
- Back to Work0-1 days
- Cost $-$$
Microneedling is an excellent treatment modality for many skin conditions. Melasma is not one of them. In most cases, microneedling worsens this condition. The gold standard for treating melasma is a combination of sun protection, pigment inhibitors & low powered lasers. Some cases can improve with superficial peels.
FactsFacts on Melasma Microneedlng
- Microneedling is an effective dermatological treatment
- It is best utilized to enhance absorption of topicals
- This is achieved with conservative needle lengths of 0.1 mm
- The vast majority of microneedling is performed deeply
- Hence this treatment can worsen melasma
- Melasma treatment is multimodality
- This means sun protection, topicals, tablets, lasers, & peels
What is microneedling?
As the name suggests, microneedling uses tiny needles to break the surface of the skin. Needles can be delivered via four ways-
- A roller, also known as a dermal roller
- A pen, also known as derma pen, or skin pen
- A stamping device, known as a derma stamper
- A needle that penetrates the skin & delivers energy, also known as RFM or radiofrequency microneedling
What was the original concept of microneedling for melasma?
To increase penetration of topicals, namely mesotherapy. This got lost in translation as beauticians (and even dermatologists) went for deeper needles. This really screwed up the real purpose of needling. There is nothing wrong with the logic of microneedling as it was intended for melasma.
What went wrong was the extension of needling to stimulate collagen production via direct dermal remodelling. This meant deeper needles. That really fu*ked up the intention of it’s real purpose. If one sticks to very superficial needles that only cause controlled epidermal injury, namely, to breach the stratum corneum (to allow increased absorption of tyrosinase inhibitors) then the logic is plausible.
Microneedling is not the treatment of choice for melasma, in fact neither are lasers, it is only one of the many arms of melasma treatment.
Why does it make melasma worse?
Many providers use needles that extend into the dermis. This compromises the basement membrane (BM, the layer that separates the top part of the skin, the epidermis from the dermal layer).
Pigment cells live in the epidermis. In melasma there is often a ‘leaky’ BM. Breaking the BM results in more melanocytes to drop out into the dermis, this results in dermal melasma / dermal melanocytosis. This makes melasma worse & harder to treat.
What is the consensus for treating melasma, without the marketing bullsh*t?
Melasma should be approached with science, & not marketing. Here are the tiers of melasma management based upon science. Your dermatologist will guide you through this treatment ladder.
First tier: absolute sun protection. Hats, umbrellas, tinting, plus sunscreen. Use a high factor SPF twice a day, regardless of sun exposure.
Second tier: pigment inhibitors. This includes hydroquinone, arbutin, ascorbic acid, Kojic acid, azelaic acids, & botanicals such as bearberry.
Third tier: plasminogen modulators & vascular modifiers including tranexamic acid, either topically or better still orally.
Fourth tier: lasers including QSL nano or dermal toning. AHA peels.
Fifth tier: lasers including low energy thulium, pico, vascular. Novel peels.
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Why is melasma different from other causes of pigmentation?
Put simply it is genetic. Technically it’s genetic with a drive from external factors including UV, hormones, heat & iatrogenic causes.
The idea of treating melasma is to decrease the output of melanin (pigment) from melanocytes. Sounds easy, but it is far, far more complicated. There are many factors that dermatologists consider including contribution from blood vessels, basement membrane integrity, hormonal input & sources of radiation (UV to IR spectrum).
What is the concept of lasers for melasma?
Lasers employed for the treatment of melasma do one of five things-
- They reduce pigment transfer from the pigment cell to the skin cells. It is called selective photothermolysis, in other words putting the pigment cell to sleep & not beat the sh*t of out if.
- Increase absorption of topicals that quieten down the pigment cell. An example is low power, low density thulium lasers.
- Repair the leaky basement membrane. High risk, but in theory it can be done.
- Reduce the blood vessels that interact with pigment cells. This is the job of vascular lasers & yellow light lasers.
- Encourage transepidermal & dermal exfoliation of pigment. This was how 1550 Fraxel got approved. Looking back, it was a silly way of treating primary melasma, but it can be used as last line treatment.
Are pico lasers the bomb?
Nope, far from it. Pico lasers are great at treating post-inflammatory hyperpigmentation. I have used them for the past 7 years- everything from Picosure to Picoway. They can give good results, but this is rare. I prefer old fashioned nano QSL as they are more effective & cost effective. Additionally, the chances of pigment flare up is much less compared to pico lasers.
What about chemical peels?
Maybe you don’t have access to lasers. Peels can help. The thing to remember is that peels must be gentle. My preference is glycolic or lactic acid, low concentration at 15 to 25%. Peels work by exfoliation of pigment, they do not suppress melanin production, hence they are not my preferred method.
What is Dermamelan & Cosmelan?
There are novel peels. See the webpage for more info. I use these peels if-
- Patients cannot have lasers, namely geographical constraints.
- Melasma is primarily epidermal, or mixed.
- The patient understands photoprotection
- Ideally patients are on vascular moduators
What is tranexamic acid?
This is a plasminogen & vascular modulator. Majority of dermatologists use this tablet to reduce vascular input to your pigment cells. This is a prescription tablet. Your specialist will take an appropriate medical history to ensure you do not have any contraindications. Tablets are more effective than creams.
What happens if your melasma got worse with microneedling?
I may be able to help you, depending on how bad things are. If your melasma is dermal (grey, dusky), it is much harder. I would rather treat epidermal flare ups from IPL compared to deep microneedling exacerbated dermal melasma.
Can I improve all types of melasma?
No. I cannot. I can improve 80-90% of cases. Despite optimal sun protection, pigment inhibitors, tablets, lasers & peels, 10-20% of cases of melasma are resistant.
We are in an infinitely better position to treat melasma now than ever before. Perhaps in the next decade more research will reveal better solutions for resistant melama.
Why is sun protection so important?
50 percent of pigmentation can fade with proper sun protection. This means hats, umbrellas, tinting as well as sunscreens. Use a high factor SPF 50+, minimum of four mls a day. You should use a 50ml tube within 2 to 3 weeks.
If you don’t take sun protection seriously you are wasting your time, effort and money trying to fix your pigmentation.
What other factors flare up melasma?
Hormones & heat. Melamsa can worsen with pregnancy & IVF. Additionally, heat generates IR or infrared radiation. This can worsen pigmentation. Sources of IR include cooking and saunas. You don’t really need to worry about computer screens as a primary source of heat & radiation until you get your photoprotection down pat.
Who to see for melasma treatment?
Book an appointment with my nursing team at Clinic Cutis. They have been taught how to assess & treat the majority of melasma cases. I can provide input for more challenging cases or if the diagnosis is in doubt.
My team will treat your pigment, without the hard sell. We view melasma as a medical condition, so you won’t be hammered with expensive packages.
What if you really want to try microneedling?
OK, let’s say you wanna give it a go, what now? If you are insistent on microneedling as the treatment of choice based upon your research, you can ‘give it a go.’ Here are some hints to do it safely.
- Use a max of 0.1 mm, that’s right 1/10 of a millimetre. This is the approximate thickness of your epidermis.
- Use a stamper over a roller or a pen. With a stamper you can’t go deeper than the needle. With a pen you have the temptation of rotating that dial to go deeper, and deeper, then deeper still.
- Make sure your sun protection is absolute. This means SPF like twice a day minimum, hats, umbrellas, tints etc…
- Make sure your pigment cells are asleep. See a dermatologist for prescription creams & pigment inhibitors.
- If you must, stamp once every 7 to 14 days. Stamping is designed to increase penetration of topicals. If you break the basement membrane of your skin, it is counterproductive *in the context of melasma management
- Take photos, do a comparison. This is the only way you are going to get an objective assessment of your pigmentation.
Davin’s Viewpoint on microneedling for melasma
Wow, what a spike in cases over the past two to three years. This follows the upward trend of using microneedling for everything, including melasma, skin rejuvenation, wrinkles, acne scars, hair loss, dark circles, & haemorrhoids. Maybe not the last condition, but you get the drift.
If we catch micro needling stuff ups early enough, we can make a difference. If not, it is difficult to improve dermal drop out. It is not that I am against microneedling, as I use this daily to treat scars, mainly to increase the absorption of CS topically. Providers just need to apply the correct indication for a treatment. For more on melasma, book an appointment with my clinical staff at Cutis Dermatology.
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