Laser melasma treatment is effective to fade unwanted hyperpigmentation. However, melasma removal often requires a combination of approaches, including melasma cream, laser and sun protection. Though considered a tricky pigmentation, recent advances in laser technology and picosecond lasers have revolutionised treatment over the past years. Lasers have become a cornerstone of the melasma treatment plan. Not only do they help break down the pigment, but they reset the melanin-producing cells in the skin to reduce recurrence. Laser treatment of melasma can be combined with peel and skincare such as Cosmelan to go a more thorough treatment approach.
Chloasma is a pregnancy pigmentation that develops by the same mechanism. It is also called the pregnancy mask. In contrast, it is best to adopt a wait and see approach for chloasma.
Melasma Treatment – 3 Step Process
- Prescription hydroquinone or other ‘bleaching’ topical creams
- Laser Melasma Removal
- Sunscreen & sun protection
Multi-stream approach to Melasma Treatment.
Hyperpigmentation not only impacts the aesthetic appearance but also has a significant psychological impact on esteem. It is a challenging condition to treat and requires a combination of treatment steps. Melasma treatment must always consider ongoing care to prevent recurrence and often intermittent treatment to keep it under control.
Step 1 – Melasma Cream to Inhibit Pigmentation Formation.
The first step is to apply a cream that inhibits the formation of new and exfoliates existing pigmentation. There are ideal combinations such as Kligman’s formula and Triluma. Both of these are prescription hydroquinone, vitamin A and a mild steroid mixture. It remains the first go to step except in individuals who have a sensitivity to hydroquinone. Three months is the maximum recommended course of hydroquinone. However, it provides the most consistent suppression of new melasma formation.
- Useful for most superficial (epidermal) pigment, limited effect on deep (dermal) pigment.
- Suitable skin type 1 – 6
Step 2 Laser Melasma Treatment with Fast, Low Energy lasers.
The introduction of picosecond and other ultrafast lasers was a game-changer for the treatment of melasma. It has moved firmly into centre stage instead of peels. The reason is that low power lasers that act primarily on breaking down the skin pigment also reset melanocyte (the pigment-producing cell) activity. The first of these ultrafast lasers was the Picosure laser. However, there are now several 2nd generation pico-lasers available, including PicoCare & PicoPlus.
Picosecond lasers are safer for melasma treatment as they break down the pigment by photoacoustic shattering. The mode of action makes them ideal for tattoo removal, unlike old lasers, which relied on thermal heating to breakdown pigmentation. Q switched lasers of either nanosecond or picosecond duration both affect not only breaking down pigmentation but also resetting the melanocytes to help prevent the recurrence.
Note: Though safer, q switched and picosecond laser can have side effects such as Post-Inflammatory hyperpigmentation, so preparing the skin with hydroquinone cream and sun protection are essential, as well as appropriate aftercare.
Some people are sensitive or cannot?do not want to use hydroquinone. Alternative treatments to hydroquinone include antioxidants, various acids and even plant-derived botanicals. The list of known agents to help remove melasma include licorice root, vitamin A, Vitamin B (niacinamide), Vitamin C (ascorbic acid), kojic acid, arbutin, azelaic acid and Symwhite. Creams such as Meladerm, Lytera, Cosmelan and Dermalan contain combinations of the active ingredients.
Step 3 – Sunscreen and Sun protection.
With melasma and chloasma, the last and crucial piece of the puzzle is SPF protection 365 days per year. As though the above treatments settle and reset the melanocytes, hyperpigmentation recurs immediately with sun exposure or other skin irritation. Protection should include broad-brimmed hats, umbrellas and repeated application of SPF 50+
- The oestrogen changes the way skin pigment responds to sun exposure.
- Adequate sun protection is essential to prevent a recurrence
- in Brisbane; our summer sun is relentless. Even with vigilant Spf protection, additional melasma cream used over the hottest summer months may be required.
Chemical Peels to Remove Melasma
Ten years ago, chemical peels were recommended above laser for settling melasma. Laser treatment was reserved for deep and resistant hyperpigmentation. The reason was old laser technology ofter caused a rebound in the hyperpigmentation due to inflammation caused by dermal heating. Treatment protocols were revolutionised when ultrafast picosecond lasers were introduced.
Chemical peels in combination with bleaching creams remain an excellent treatment to settle stable pigmentation. They can reduce pigmentation and still has a place where cost is a consideration. However, as most melasma is unstable, treatment with the laser has become the cornerstone with sun protection and hydroquinone cream. Chemical peels, with good effect, include jessner, TCA, vitamin A, superficial glycolic or BHA.
Cosmelan Peel & Creams for Melasma
Cosmelan is a specialised treatment peel and creams developed for the treatment of Melasma. It is highly effective when used in combination with laser melasma treatments. Cosmelan can be initiated immediately to start treatment and suppress melanin production before laser treatment.
- More common in women with darker skin types
- High-risk populations have an incidence of 9 – 50%
- In the general population, the risk is 1%
- Causes of melasma are sun exposure, hormones and genetics.
- The pigmentation most commonly in the centre face, map-like patches.
- The pigment appears on the upper lip, forehead & cheeks but can occur on the neck, décolletage and even on lower arms and legs.
What is Melasma?
It is caused by hyper-functional pigment-producing cells (melanocytes). This causes excessive deposits of melanin (brown pigmentation) in the epidermis (superficial) or and or dermis (deep) skin. The excess melanin is commonly accompanied by increased blood vessels and signs of sun damage or inflammation.
Free Assessment with our Laser Therapists
No referral is required; you will be booked in for a free initial with our laser therapists. The initial consultation is to provide diagnosis and education, as you will also need to see our doctor for a prescription of the treatment plan. There is a cost to see the Doctor, which is redeemable on any treatments you have.
Book online or call 3350 5447 for a free Consultation