What can I do about melasma? It just doesn’t go away with products.

Hi Dr. Irwin: I have medium color skin (latin), with some melasma spots on forehead. A Dermatologist and a Cosmetic surgeon had recommended to stay away from deep laser. I used many products, hydroquinone, BHA, AHA. Renova, and plenty of sun block with 17% zinc oxide. I don't see any changes. What else can I do? Thanks for your help. Myrna

If I could have one dermatology wish granted by a good fairy, I would wish for a true cure for melasma!!!   It is such a painful problem for many women (and some men)!  And, in some situations, it really, really undermines self confidence. 

The problem is that all the treatments you mentioned above help with the superficial part of melasma but not the deeper component.  So even if it improves temporarily with all the creams listed above, it often recurs with even minimal sun exposure.  It’s so frustrating I know!!

No laser (yet) has been proven to make a permanent improvement in melasma.  Fraxel was thought to be helpful several years ago but it has not been proven to last.  I’m hoping perhaps the fractionated CO2, perhaps with particular settings, will be proven to help.  I agree with your doctors that it is is not worth what you would spend on lasers and could make you worse.

Two things to think about.  Of the hydroquinones, I do think Triluma works the best.  Have you tried that one?  Also, some patients get worse on BHA, AHA or Renova even because they get irritated and that causes more pigment.  Are you sure that all these things you are doing aren’t making you worse?  You might want to try stopping everything except the sunscreen for 2-3 months and see what happens.   Also, if you are on birth control pills, you must find an alternative!!!!!  Dr. I

PS – Also please wear a hat.   

Dr. Brandith Irwin, MD

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