Worsening melasma and also have rosacea – what can I do?

I developed rosacea and melasma (both dermal and epidermal) in the last three years. Not on meds or bc and am very cautious with sun exposure (hats, zinc and chem sunscreen, tinted windows in home and car) but I have had a gradual increase in dermal (blue/gray) pigment that is distressing. My question is two-fold: 1) can dermal melasma fade if I don't stimulate the melanocytes via direct or incidental UV exposure? I know treatment options for dermal melasma are quite limited and given the fact that I have rosacea too, even more so. 2) I own a red and infrared light therapy unit that I used for a sports injury and it was quite effective at bringing down inflammation and pain. I know there are reports of success with regular use for rosacea and pigmentation but I'm worried about other light sources worsening my melasma. What are your thoughts on the role infrared light plays is melanin production in melasma skin, if any? Thank you

You bring up a really great point.  And recently at the Paris IMCAS conference there were several speakers from the mid east and asia who made the point that, in their opinion, we do not biopsy enough in the west for pigment problems.  

 There are many diseases that can cause an increase in pigment on the face including reactions to certain medications.  I always vote for an accurate diagnosis before treatment (as much as humanly possible) because otherwise treatment is just a very  educated guess.  What if your pigment is not melasma?  Doctors and patients tend to shy away from biopsies on the face due to fears about scars.  But, many times a biopsy can be done leaving a tiny (2-4 mm) scar that is virtually invisible.   You may want to talk your board certified dermatologist about a biopsy.   Melasma can usually be differentiated from a medication reaction or an adrenal problem or sun damage, etc. with a biopsy.  It’s worth thinking about. 

 I know of no data on the sports home device red, infrared issue and would hestitate to offer an opinion on this.  Dr. I

Dr. Brandith Irwin, MD

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