What is the most effective laser treatment for melasma?

Dr. Irwin, What is the most effective laser treatment for melasma? I have melasma resulting from oral contaceptives. Through 3 pregnancies, I never experienced any hyperpigmentation. Unfortunately, months after starting BCP's, I developed large patches of melasma on my forehead and upper lip. I discontinued the pills and have used chemical peels and otc hydroquinone to no avail. (I have always used sunscreen as I am very fair in coastal Texas.) There are so many lasers, such little guidance, and tech moves so fast the options are very different from just a few years ago. I'm desperate to improve these patches but I am also afraid of making them worse with the wrong treatment. Many thanks for your time!

I really, really wish I could be more positive here! The truth is that there IS no great laser treatment for melasma, YET. Here’s the latest from the conference in Paris (more of my reviews from the conference here).

There is still no true “cure” for melasma. There is just good control.

While this may not really be what you want to hear (I have melasma too) there is power in accepting this because you CAN get really, really good control of it with time.

Here are some positive steps to take if you have Melasma:

  • Your sunscreen must contain 18% zinc or higher and be used at least once a day. Twice is better.
  • Double sunscreen – use two layers – if outside at all. A base sunscreen with high zinc like this one by DermaQuest is one I recommend. Try a powder like the Colorscience or Jane Iredale mineral makeup on top of that.
  • You must used a brimmed hat whenever outside
  • Use hydroquinones or plant based lightening agents every day for 3-6 months of the year. Some cautions when looking into these here. Consult with your dermatologist.
  • Any melasma treatment, if not timed correctly and with good pretreatment topicals, can make melasma worse. This includes peels
  • Some people have a low level allergy to hydroquinones that is difficult to diagnose but will make the melasma worse.
  • Avoid treatments for 2-3 months on either side of the soltice (June 21) because this is when UVA is the highest in the northern hemisphere.
  • Here are some non-hydroquinone products and my skincare regimen suggestion in AM and PM for pigmentation and Melasma.

Reviewing laser options for melasma:

  • IPLs –  generally will make it worse –  some very light skin types do ok with it, especially in the winter
  • Fraxels –  often cause initial improvement followed by recurrence or even worsening
  • CO2 –  the jury is still out on these but make be the same as the Fraxel.  Not enough data
  • Vbeam –  interestingly –  can be helpful in some cases if there is a vascular (increased blood vessels) component to the melasma.  Talk to your doctor.
  • Clear & Brilliant (a very light Fraxel basically) –  made by Fraxel company –  may be helpful if done in a series of 3-4 at the right intervals and careful sun avoidance.   Some studies in the past few years on this are hopeful.
  • Nd:Yags –  may have a good but usually temporary effect – used often in India and on darker skin types.   Only try this if the center is very experienced.  There are different “Yags” and different protocols.   It’s not one size fits all.

Hope this help,  Dr. I

Dr. Brandith Irwin, MD

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

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