How to treat melasma pigmentation

Melasma is a special form of pigmentation that is also called the mask of pregnancy or chloasma. This form of facial pigmentation usually affects the upper lip, around the eyes and forehead areas. Most patients come to see me because their melasma worsens after pregnancy, the pill or by a beautician who accidentally performed IPL. In fact IPL is the biggest flare factor for melasma in my patients. The most common complain is 'upper lip discoloration'!

Here is my recipe for treating melasma/hormonal pigmentation-

1. Sunscreen – pick a factor 30+, use at least twice a day. Also wear hats, and tint your car! Best sunscreen? I like La Roche Posay or Neutrogena. Cheapest sunscreen that is good- SunSence or Ego sunscreen.

2. Bleaching – I like Hydroquinone 5-8%, mixed in my favourite OBAJI moisturiser. Triluma is also a good product. I sometime add a prescription vitamin A, such as tretinoin if one can tolerate this cream. I also like Lytera in patients who can have sensitive skin with facial pigmentation.

3. Peels- I like AHA or glycolic acid peels, as these are gentle, and can be very effective for epidermal melasma. I also use Vitamin A peels called VITA peels as well as weak TCA 8% peels every 2 weeks.

4. Lasers are great for some forms of melasma. Laser is never used as first line treatment, but as adjunctive treatment. In my hands the Picosure Focus laser is by far the safest, and best. I did use the Revlite 1064 with a 6mm spot in the past. Other lasers that can help fade skin/ facial pigmentation and melasma include Fraxel. Fraxel comes in 3 wavelengths, - it’s the Fraxal Dual at 1927 that can help. IPL will make melasma worse- never use IPL to treat this form of skin pigmentation. IPL will worsen melasma if you are not on anti-pigment creams.

Melasma may also fade after pregnancy, so with strict sun protection, you may not need any treatment. Hormones such as the pill can contribute to melasma, so if you are on the pill, considers changing to another form of contraception.

Once melasma has cleared, a melasma management plan needs to be in place as this form of facial pigmentation can recur. I usually get my patients to come in for monthly chemical peels, or maintain with Picosure laser every few weeks to months.

Thanks for viewing this video on melasma. Let me know if you would like to see any other treatments regarding cosmetic dermatology. I place one video a week, covering subjects ranging from acne scar treatments, Botox, Fillers, face lifts, PRP, skin rejuvenation, anti-ageing and many other cosmetic solutions.

All the best

Dr Dr Davin Lim
Laser and aesthetic dermatologist
Lasers and Lifts
BRISBANE, Australia.



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