5 Ways to Treat Melasma
Melasma is a very common skin pigmentation problem which is seen in Brisbane. This is due to Brisbane’s high UV index which gives rise to unwanted facial pigmentation. Melsama is a very unique form of facial pigmentation that is more commonly seen in women. Melasma pigmentation is frequently seen due to hormonal changes including the pill and pregnancy. Melasma often improves in Winter, and worsens in Spring- especially in Brisbane with the Ultraviolet index.
What does melasma look like? Melasma is a unique form of pigmentation. It presents as ragged edged areas of pigmentation that occur on the face, especially around the upper lip and just below the eyes. Melasma also commonly presents as pigmentation on the forehead area.
What is the cause of melasma?
The cause of melasma is due to genetic factors but also can be induced with hormones and UV exposure. Another form of melasma is known as rebound melasma which is commonly seen after IPL treatment for facial pigmentation. This form of melasma is notoriously difficult to treat and is frequently caused by beautician who are untrained in the recognition of this skin condition.
What is one of the most unpredictable methods to treat melasma?
By far the IPL laser used by many beauty salons can worsen this condition. In Brisbane dozens of patients have their pigmentation worsened by IPL treatments by cosmetic clinics. The lax laser laws and licensing means many ‘chain’ clinics offer great discounts on IPL and skin rejuvenation. Does IPL work? Absolutely, but in the correct setting. IPL works best for sun damaged skin, pigmentation due to age, and freckles. It often worsens melasma, especially if melasma is active. This includes post partum melasma- that is hormone induced pigmentation associated with childbirth.
So here are my five favourite melasma treatments:
1. The 3C laser program combined with tyrosinase inhibitors. The 3C program stands for improving collagen, clarity and skin colour. I use a particular low-dose laser every fortnight over a 10-week program. This coupled with our especially formulated creams can markedly improve melasma. Realistically, patients will achieve between 50% to 80% improvement. There is no chance of melasma worsening with the 3C program as our laser is extremely gentle. Each treatment takes approximately 5 to 10 minutes to perform, the patients can wear makeup straight afterwards. As with all our melasma treatment programs, I always reinforce the use of sunscreen twice a day as the foundation of treatment.
2. HQ, Lytera and Clear and Brilliant Fraxel. This combination works very well for epidermal melasma or light melasma. The Clear and Brilliant system by Fraxel is a fractionated laser resurfacing procedure which is very light. This is best for epidermal melasma and sun damage. The key is to decrease skin pigmentation on the upper layers of the skin, but to also infuse the deeper layers with certain vitamins such as antioxidants including vitamin C/ascorbic acid together with copper peptides. I also use a special cream which inhibits pigment production after laser treatment. The Clear and Brilliant program unlike the 3C program has some downtime. The areas of melasma may look red to brown for several days post Clear and Brilliant. Melasma starts to improve at week two. In the majority of cases I use Clear and Brilliant for the management of melasma prevention once I have treated patients with the 3C program.
3. The use of hydroquinone, Lytera and other bleaching agents coupled with glycolic acid peels can help epidermal melasma. My peel of choice is either a lactic acid or a glycolic acid starting at 10%. With melasma patients we can work up to 50% to 70% as tolerated. However, the peels will have to be graduated as we do not want rebound pigmentation after chemical peels.
4. Low-strength TCA peels. I like the use of low-strength chemical peels such as trichloroacetic or TCA peels for the treatment of skin pigmentation including melasma. Patients typically undergo five to six treatments, peels are spaced between two to three weeks apart. With lower strength TCA peels, skin peeling is not an issue. What I do expect is that patients are slightly red and sunburnt for a period of 12 to 36 hours post chemical peels. The use of sunscreen is essential to help reduce or prevent rebound facial pigmentation. I also use a mixture of hydroquinone usually in the 5% to 8% concentration in Obagi. TCA peels are useful for patients who are resistant to the 3C laser program. 5. High-strength TCA and Jessner peels combined with hydroquinone.
This is my old fashioned method of treating recalcitrant dermal melasma. Before the invention of lasers, melasma was treated with trichloroacetic acid chemical peels. In fact, did you know that Medicare provides a rebate for patients who exhibit severe melasma as defined by pigmentation affecting greater than 75% of the face with medium strength chemical peels? This treatment, however, in my opinion is out dated and old fashioned. It can certainly work as a last line resort for dermal melasma or rebound melasma following lasers. It can also be used to treat face pigmentation secondary to postinflammatory hyperpigmentation. This form of chemical peel requires partial sedation as the strength of TCA in Jessner’s are in the region of 30% to 35%. The procedure itself takes 10 minutes to perform and I treat all areas including the eyelids. This is an excellent peel to stimulate collagen production, it is more useful for the treatment of wrinkles, sun damage, age spots, sunspots and precancerous areas. Does it work for melasma? Yes, it can, however, in this day and age of lasers, such as the Clear and Brilliant Fraxel together with the 3C program, I do believe that this treatment is out dated.
This summarizes my preferred method for treatment of melasma. The absolute foundation of treatment, however, is that patients do need to avoid the sun wherever possible. Hats must be used whenever patients are outside and remember that UVA goes through the glass in your car. Having tinted windows will help; however, absolute sun avoidance together with the use of sunscreen at least twice a day forms the basis of reducing facial pigmentation and melasma.
Explore the website as I have written numerous articles on methods to treat melasma both on this website and external websites, including the Australasian College of Dermatologists website.
Dr. Davin Lim