Are skincare products and lasers not helping? What to do when you’re feeling frustrated and stuck!

Hi, Dr I, I really need some serious help on my melasma/brown spots/broken capillaries! I’ve suddenly developed these problems out of nowhere, I had zero discolorations all my life and now all of a sudden they have appeared. I’ve seen several dermatologists and they all tell me that all of these (IPL, Excel-V, Pico laser, Resurfx laser) will help me... I’ve had a combination of these (at least 10 in total) since and there’s been zero improvements?!!! I’ve also been using Lytera at night, Vit C and D’s Sheer Zinc in the morning (reapplying once in the afternoon even though I’m indoors at the office), I’ve also just started using hydroquinone 4% and I am totally crazy about staying out of the sun at all times but no improvements yet! Please let me know what actually works? I know you can’t get rid of it completely... I’ve read all your articles/answers on melasma and it seems lasers in general don’t help? But you’ve got rid of yours? How please? Can you let me know exactly what treatments you had over the years to get rid of them. Or recommend any lasers that might help. I’m in my mid-30s btw. Thanks in advance for your valuable advice.

Wow – I hear you on this. It can feel like an intractable problem sometimes.  Here are some thoughts for help moving past this problem.

Is your diagnosis correct?

I can’t tell you how many patients we’ve seen over the years who come in with a diagnosis of melasma (or something else) who really don’t have melasma.  It’s something else or….a combination of melasma, sun damage, skincare product irritation, rosacea, or other skin diseases.

Some things to consider:

  • Any skin irritation and often hormones can make melasma worse!
  • Are you taking hormones of any kind, especially oral contraceptives, or have some hormonal imbalances?  A good gynecologist or endocrinologist may be able to help, if your primary care doctor doesn’t know much about this.
  • Lasers can make this worse.  Is it possible that all these laser treatments are aggravating it?  Have you tried just a period of skin rest, meaning no lasers or peels for 6 months?  Just great skincare products, double sunscreening and hats?
  • Do you have undiagnosed rosacea?  Melasma is sometimes worst in areas of dilated capillaries.  If the rosacea is better controlled, that may help. After good control of rosacea, a VBeam may be helpful to reduce the capillaries.
  • Is one of your skincare products irritating you?  You can try for several weeks just using a very bland cleanser, moisturizer (like CeraVe) and the sunscreens. When you start your products back add one every week so you can tell if one is a problem.
  • Look up some of Dr. Pearl Grimes research out of UCLA.  She has been and is a pioneer in treating this problem.
  • Talk to you dermatologist about tranexamic acid preparations.

Optimizing Skincare products:  Visit Our Shop

You’re doing a great job already, but here are some more things to try.

  • Watch the hydroquinone 4% carefully.  About 10% of patients develop irritation from it that’s subtle, and the melasma just slowly gets worse.  The “triple” creams are better because they contain a little tretinoin (retin A) and a low strength (safe) steroid that helps with this irritation factor.
  • Double sunscreen.  You’re using 18% zinc which is the best, but that still won’t block everything.  Try using a mineral powder over that like the Colorscience or even Jane Iredale mineral powder makeup.
  • If you’re sure the Lytera isn’t irritating you, can you use it twice a day.
  • If you’re in an office, be aware that windows do NOT block UVA which is key for melasma.
Hope this helps,
Dr. Brandith Irwin
Founder, SkinTour
Director, Madison Skin & Laser Center
Follow my skin tips and travels on Instagram!
Dr. Brandith Irwin, MD

Ask me your skincare question!

Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

  • All our content is written and researched by myself.
  • My medical office in Seattle has treated thousands of patients for 15+ years.
  • This site is not affiliated or financially tied to any product, treatment or device.
Ask Me Something
SkinTour Skincare
One of the best investments in your skin is your daily skincare. Why? Because you can prevent many problems with blotchy skin color, lack of glow, texture, some types of acne, and fine lines with good skincare products. You can also correct some of these problems with effective skincare products. Great skincare is often more expensive because quality ingredients are expensive. Some companies spend on research/development which benefits all of us and adds to the cost. Are they worth it? In general - yes! I have handpicked some of what I consider to be the best skin care products, and offer them for sale on SkinTour's shop. This is based on my team and I's testing and research at our clinic. Many of the products are in my own regimen. What could be better than using skin care products a dermatologist uses?!