“Melasma is difficult to control and most often attributed to infrared heat, ultraviolet or other forms of radiant light and hormones,” says Beverly Hills, CA dermatologist Ava Shamban, MD. “It is often exacerbated with flare-ups due to sun exposure or stress and elevation of stress hormones.”
Like Dr. Shamban said, ask any dermatologist and they’ll tell you it’s one of the toughest skin conditions to treat, but it shouldn’t keep you from enjoying all the benefits of aesthetic procedures, if you know which ones won’t make the discoloration worse. These are the treatments experts say to avoid (or proceed with caution) if you have melasma.
Radio-Frequency (Heat-Based) Treatments
“Anything involving heat should be used with extreme caution by those who have melasma, as heat stimulates melanocytes to produce melanin,” says Dallas dermatologist Rebecca Marcus, MD. “While lasers can potentially be used to reduce or eliminate pigment in melasma, recurrence frequently occurs a few months later. Risk of recurrence can be reduced by pre-treating the skin with a tyrosinase inhibitor such as hydroquinone, and by following an aggressive post-care anti-pigment regimen.”
“If radio-frequency microneedling is used, the operator must make sure to use the correct settings to avoid heating the upper layers of the skin,” says So, the bottom line is that all treatments in melasma must be done very carefully by an experienced operator and accompanied by the right pre and post care regimens.
Most Nonablative and Ablative Lasers (and IPL)
“These treatments are based on the idea of elective photothermolysis, which is destroying the pigmented cells where dendrites contain more melanocytes cells,” Dr. Shamban explains. “However, in response, an adverse basal layer damage inflammation can follow and result in repigmentation recurrence, mottled depigmentation or post-inflammatory hyperpigmentation (PIH). Therefore, most nonablative or ablative fractional lasers, IPL and Q-switched laser treatments are those we do not recommend for most of the melasma patient population.”.
There are some fractional 1550/1540 nm nonablative laser therapies that show promising results and are approved by the FDA for treating melasma. “But, for the reasons stated above, it is with careful consideration and engaged at lower fluences and a range of only the shortest variable pulses. It may also be recommended to pre-treat the skin with topicals like Cyspera Intensive System or a hydroquinone [four to six weeks] and laser testing prior to full treatment, particularly in patients with skin of color, or those with a history of PIH, to see the individual response.”
Nanuet, NY dermatologist Heidi Waldorf, MD says, “Although Fraxel and other lasers have been used successfully to reduce melasma, in my experience, I’ve seen them worsen it more times than improve it. I will use a gentle, low-heat laser like Clear + Brilliant, but only if the patient is already on a topical regimen to reduce hyperpigmentation and is using vigilant sun protection.”
Microneedling (Without Radio Frequency)
“Although microneedling is touted as being safe for melasma, nothing is 100-percent, and I have seen post-inflammatory hyperpigmentation, as well as a darkening of the melasma after microneedling,” Dr. Waldorf says. With microneedling, and any of the treatments mentioned above, it’s always best to do you research to find a qualified provider, and make sure you have a consultation before booking your appointment so your specific case of melasma can be examined.