Lasers, Melasma, and Brown Spots… What Lasers Might Be Best
This issue comes up a lot! More than you would think. It’s because women, and also some LBGTQIA+ members, have female hormones. Those hormones + light can cause excess hormone stimulated brown pigment to form which is excess melanin. Melasma is the broad term for this kind of pigment. It’s more stubborn because it’s not just an increase in pigment itself. An increase in the number of cells making the pigment is also part of the problem. Typical scenarios are oral contraceptives, pregnancy, some medications, and just too much sun at the time of the month when your estrogen peaks which is just before you ovulate at mid cycle. There’s really no true cure, just time and good control.
This is different from brown pigment that occurs just from sun damage. That’s serious too because it’s an indicator of how much skin cancer risk you may have. But in some ways, it’s easier to reverse because it’s not made worse by our hormones. This is a little tough to explain, but you all are smart.
And sometimes we have both melasma and sun damage, or melasma and capillaries, or melasma and eczema, etc. It’s why you need a good cosmetic dermatologist to help you.
Things to consider with lasers and melasma:
- How much time you spend outdoors is key! If you spend time outdoors, plan any lasers with your derm for the winter season when the days are short. If you have a more outside lifestyle, and are not wearing a burka, then you are getting UVA and some UVB through your sunscreen and around your hat.
- BBLs/IPLs seem to cause the most problems, in our experience, because people consistently underestimate their potential for worsening melasma.
- Computers, visible and blue light. It’s turning out that visible light (not UV) and even blue light from screens can activate melasma in some people. You’ll want to use sunscreen for sure. Iron oxides in tinted sunscreens block visible and blue light better.
- If you are really prone to melasma, a good clinic will be able to do a test spot before doing the entire face.
- You won’t make progress with melasma usually unless you find an alternative birth control method with your Gyn and go off the oral contraceptives, or go very lo-estrogen.
- Generally, longer wavelengths are less likely to activate pigment, so for broken capillaries, a Nd:YAG long pulsed (not Q switched) will be safer.
Hope this helps,
Brandith Irwin, MD, FAAD