Melasma Treatments

Melasma At A Glance

  • Best Results2-10 treatments
  • Treatment Recovery0-7 days
  • Procedure Time5 min
  • Skin SpecialistDermal therapist, nurse
  • Duration of ResultsMonths to years
  • AnaestheticNil Required
  • Back to WorkImmediately
  • Cost$-$$

Melasma Treatments

Melasma is a unique form of hormonal pigmentation that is mostly seen in women. Melasma can be improved by up to 80% with a combination of prescription creams, sunblock, gentle chemical peels & special lasers.

FactsFacts on melasma treatment

  • The cause of melasma is a mix of genetics, UV exposure & hormones
  • This is a special form of pigmentation that presents on the upper lip, around the eyes, & forehead area
  • Melasma is often patchy, & motley in appearance
  • Lasers can improve melasma
  • The degree of improvement will depend on the depth of pigmentation
  • IPL should not be used to treat melasma
  • Microneedling often makes melasma worse
  • The majority of melasma can be improved with a combination of SPF, tablets, creams & laser

What is melasma?

Melasma is also known as hormonal pigmentation or cholasma. It presents as patchy pigmentation on the forehead, under the eyes & upper lip.

Melasma is caused by a combination of genes, UV rays, and hormones. It is more common in pregnancy & may occur after taking the birth control pill.

Why is melama vital to diagnose? It is because melasma is a unique form of pigmentation. Unlike other types of pigmentation, melasma has to be treated in a special way or treatments can worsen pigmentation.

Patchy pigmentation and upper lip darkening are signs of melasma. Never undertake IPL for this form of pigmentation.

What is the best treatment for melasma?

The optimal treatment will depend on the type of melasma you have. The majority of patients will have mixed melasma– this means your pigmentation lies on the surface as well as deeper in the dermal layers of your skin. The best method of treating this form of melasma is with a combination of creams, tablets & laser.

  • Sun protection and sunscreen forms the basis of treatment. If you are sun exposed for 20 minutes without sun block, all the work you may have accomplished to fade your melasma will be undone.
  • Creams- we use a mixture of fading creams, including bleaching agents, Vitamin A, as well as Vitamin C creams.
  • Peels- our favourite peels include AHA or glycolic, VITA peels, or lactic acid peels. TCA at very low concentration can also be used.
  • Lasers- I employ both nano, pico & thulium lasers. Never undertake IPL, as this often makes melasma worse.

Why is sun protection essential in the management of melasma?

Without good sun protection, even the best lasers & creams will have no chance of improving melasma. This is because the pigment cells are super sensitive to UV, visible light & infrared light sources.

A high factor SPF 50+ sunscreen is best. As a daily sunscreen I like La Roche Posay 50+ Anthelios or Invisible Zinc. For outdoor activity, Sunsense or Cancer Council makes great sunscreen.

Sunscreens only form one part of sun protection- sun avoidance and a broad brimmed hat is essential.

The correct way to use sunscreen in melasma patients is as follows-

  • Two types of sunscreen. Daily & activity.
  • Use twice a day.
  • Use 2 finger lengths.

What can I try at home before seeing a dermatologist?

Sun protection will give you the biggest improvement by far. Once you get this right you can try the following before seeing a dermatologist.

Fading creams: Try this combination- Azelaic acid 10-20% in the am. Superfade 2% Hydroquinone in the evening. You do not require a prescription of these creams.

The combination of correct sunscreen use & bleaching creams can reduce pigment by up to 30-50%. For further improvement, book a consult with my team of therapists & nurses @cliniccutis.

Davin’s View on Melasma Management

This is one of the hardest skin condition to treat.  Despite continue education to the cosmetic industry, including beautician and cosmetic GPs, hundreds of cases of IPL & Pico lasers are performed for melasma pigment. The vast majority of cases will worsen. Melasma MUST be treated medically, with lasers as adjunctive therapy.

Treating this condition is a marathon & not a sprint. The most successful treatments are gentle, over a period of weeks to months.

Not all melasma can be treated or improved. Deep melasma or dermal melasma will not improve with creams or peels. Fortunately the majority of cases are ‘mixed’, namely superficial and deep, and hence the majority of cases can be improved. The key to treating this condition is with a mixture of tablets to reduce vascular input, appropriate lasers in the correct settings, & also creams that ‘turns off’ the pigment producing cells.

If laser is performed, it has to be gentle and not agitate melanocytes, or melasma will worsen- the laser of choice is Q switch laser. I tend not to use Fraxel for this condition because of the fact that some cases can worsen with this treatment. In some cases I use the LaseMD Thulium 1927 laser with topical therapy such as t.acid.

New lasers such as Picoway & Picosure has shown great promise in the treatment of resistant melasma & sun induced pigmentation.

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