Chloasma/melasma – are lasers safe especially on darker skin types?

Hello Dr Irwin, I have very lage dark brown spots on each cheek which appeared in 1999. They have been diagnosed as chloasma. I consulted three dermatologists between 2000 and 2005, two of whom advised me that laser or peeling techniques were not recommended for Asian skin types , I have Indo-European origins. Therefore I have only used depigmenting creams which had no effect and in fact the spots have increased in size in recent years. My question is: have laser techniques advanced since 2005 and are there any now which would provide a good result on my skin type? Thank you

So first, I’m assuming you’ve had these spots looked at in the past year by a dermatologist to make sure they are not skin cancer!

Then, this is a tough question and not all dermatologists are in agreement about it, even experts in the field.   In my opinion, using an IPL on your skin type is not effective and runs a significant risk of making your worse.   Using a Fraxel laser is safer but the early data that looked promising on melasma has really not stood up to the test of time.  That is probably because the follow up periods in the studies were not long enough and so, while there was a temporary benefit, the melasma recurred eventually.  That’s a lot of money to spend for a temporary benefit since multiple treatments are needed.

As for newer fractionated CO2 lasers, in my opinion, there is not enough data to tell if they will be effective yet.  They are promising in some ways and are fairly safe on darker skin types.  I really think it’s too early to say and we certainly haven’t worked out the best settings or protocols if it does turn out to helpful.  If it were me, I’d wait but keep a close eye on this.

Peels, if done correctly, DO help!   See the work of Dr. Pearl Grimes, who is on the faculty at UCLA who has published extensively in this area.   Dr. I

Dr. Brandith Irwin, MD

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