What can I do about melasma?

Dr. Irwin, I was diagnosed by a dermatologist a few years ago with melasma. I have also had slight acne and with my pregnancy 2 years ago my melasma was really dark. I am 35 years old and the melasma and acne started in my late late 20\'s. I have had numerous laser treatments (ip-Fraxel) and they helped some and broke up some spots but I still have really dark spots all over my face. It is uneven all over and very oily. I'm searching for a good glycolic peel but have not decided on anything. Do you have any recommendations on what to try now or what type of peel to use. I used the Obagi for months and still use some of the products but the hydroquinone didn't seem to make a difference. Help DWebb

I still think that melasma is the toughest problem to treat because there is no cure for it – just good control. You will absolutely need the help of a dermatologist who’s interested in this problem.  You should see him/her at least twice a year.

First, You MUST NOT be on any type or oral birth control or estrogen creams, patches or tablets if you want to make progress.  See your OB/GYN for other options if you are. Second, you MUST double sunscreen every day with both sunscreens containing UVA blockers as well as UVB.  For example, use a mexoryl based sunscreen as a base with a powder sunscreen with a high percentage zinc (like ColoreScience), titanium or other minerals  –  or a mineral makeup (like Jane Iredale) over that.  These are the basics.

Then, what has been proven to help most is a combination of intermittent (not continuous) use of products containing hydroquinone (like Triluma), light to medium peels, and retinoids like Renova.  You need help from a dermalogist because sometimes these products can make you worse IF you become irritated by the product – even very subtle irritation.  No laser that I know of is proven to make melasma permanently better at this time.  And, because they are expensive, I don’t usually recommend them because improvement is temporary.

Have your aesthetician look at the Illuminize and Vitalize peels systems.  In knowledgeable hands, these are usually quite safe for melasma patients.     Dr. I



Dr. Brandith Irwin, MD

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