Melasma - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about Melasma or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Melasma - Hyperpigmetation
Melasma, often called the mask of pregnancy, is induced by hormones found in pregnancy and certain birth control pills paired with UVA exposure.
Melasma responds to topical fading agents. The chance of recurrence can be reduced only by meticulous use of a broad spectrum UVA filtering sunscreen.
Melanage - A new revolutionary solution for Melasma
Melanage peel can significantly reduce the pigmentation after only one treatment. Traditionally, microdermabrasion in conjunction with topical fading agents has also been very successful in the treatment of melasma. Peels such as glycolic acid or even Trichloracetic Acid can help but as solo treatments are inferior to the previously mentioned treatments.
Melasma Types
| Superficial (type 1) |
Intermediate (type 2) |
Deep (type 3) |
|
|---|---|---|---|
| Skin layer affected | epidermis (upper most) | epidermis and upper dermis | Epidermis and Medium and deep dermis |
| Ease of treatment | +++ | ++ | + |
| Ease of maintenance | Extreme discipline | Extreme discipline | Extreme discipline |
| Frequency | most common | less common | rare |
| Ethnic distribution | Mediterranean, Latino, Middle and Far Easten | Predominantly Far Easterns | |
| Gender distribution | 90% women | 90% women | 90% women |
Related treatments
Melasma Treatment Options
| Melanage peel + kit | PicoSure® Focus Array | Microderma- brasion + topicals | Micro- derma- brasion | Q-switched Nd:YAG | FRAXEL | Topicals | |
|---|---|---|---|---|---|---|---|
| Works on melasma types | 1,2 | 1,2,3 | 1,2 | 1,2 | 2,3 | 2,3 | 1,2 |
| Efficacy | +++ | ++ | ++(+) | + | + | + | ++ |
| Downtime | 2-10 days | none | none | none | 1 day | 2-3 days | none |
| Number treatments | 1 | 3-5 | 6 | 6-10 | 2-4 | 4 | daily |
| Time to results (months) | 1 | 1-2 | 4 | 4-8 | 4 | 4 | 6-12 |
| Preparation | none | none | 1 month of fading agents before 1st treatment | none | none | topical numbing medicine | none |
| Risks | none | none | none | none | none | Paradoxical darkening of the treated area | None if used as instructed |
| Total Cost | Call for price | $2000 | $850-$1200 | $600-$1150 | $800-$1600 | $2400-$4000 | $500-$1500 |
The key for sustainable results
The key in maintaining these results over time is to meticulously follow a post procedure skin care regimen for life.
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Post Melasma Treatment
Post melasma treatment always includes the use of a sunscreen. It must be applied daily, regardless of sun, cloud, rain or snow because UVA rays travel through anything including your car windows. It cannot just be any sunscreen but must be able to block or filter the entire UVA spectrum. If ever in doubt or you cannot find your usual sunscreen, use sunscreens that contain zinc or titanium dioxide.
If you are committed to a lifetime without melasma. Call us today to schedule a free melasma treatment consultation to learn which melasma treatment fits you best.
Post Melasma Care (topical)
| Pigment suppression/ dispersion | Limitation of use | Source | Use during pregnancy | |
|---|---|---|---|---|
| Sunscreen with UVA filter | +++ | none | drugstore | yes |
| Hydroquinone 2-5% | +++ | 6-9 months, can be restarted after hiatus | drugstore (2%), prescription (4% and 5%) | no |
| Botanical fading agents | +++ | none | physician dispensed | yes |
| Glycolic acid | + | none | physician dispensed | yes |
| Kojic acid | + | none | physician dispensed | yes |
| Mandeleic acid | + | none | physician dispensed | yes |
| Vitamin C | + | none | drugstore | yes |
| Azelaic acid | + | none | prescription | yes |
| Retinoids | ++ | pregnancy/nursing | prescription | no |
I am a 35 year old caucasian women. I started getting melasma on my face several years ago. I have a lot of scarring from Acne and want to improve my skin. I had ipl laser consultation where they tested a patch of my skin but it made my melasma worse. What would you reccomend?
Melasma is triggered by UV rays, visible light in the lower frequencies, heat, and inflammation in the upper layer of the skin. Lasers that do not emit heat, such as picosecond lasers are helpful for ice pick scars. Box car scars can toke longer to respond to picosecond lasers. Rolling scars can be treated by subcision. Microdermabrasion and microneedling can achieve transient improvement in the appearance of acne scars. Caution must be exercise when using microneedling because it can inflame the skin when aggressively used.
I suspect that you have post-inflammatory hyperpigmentation (PIH) rather than acne scars, based on trying IPL which might correct this type of pigment in some people.
PIH resolves on its own after 12 months in most people as long as acne is fully controlled and sunscreen is diligently applied and reapplied every 2 hours when outdoors. The process can be hastened with picosecond lasers of the 1064 nm wavelength (Enlighten and others).The picosecond laser also helps with melasma although it is not as powerful as a Melanage / Cosmelan peel. The latter treats melasma and PIH.
Melasma prevention is an ongoing project and requires meticolous and unrelentless effort.
Thank you for this page. It is the most informative I’ve found! I would use your clinic if I lived nearby. But since i live in south Mississippi… I will locate a clinic closer to me. Thanks Again. 🙂
Could you possibly recommend a Top Dermatologist for melasma and ethnic skin in Tampa, Florida?
Please check the dermatologist locator at http://www.aad.org. Our office is in Pennsylvania and, unfortunately, I have no personal recommendations for the Tampa area.
I am a dark skinned male. I got many sun spot and PIH. Recently, I developed a lot of inflammed acne on my forehead and very big PIH afterwards. Is melanage peel good option for me?
Absolutely!
Aloha,
I have been suffering from a melasma mustache for about 3 yrs. I am a 55 y/o Asian. I’ve tried Tri-Luma- No change,x6 microdermabrasion treatments which made it worst. X8 Pico laser treatments which I believe made it worst. I was told by one dermatologist that there is no cure for melasma. Is this true? It is also very difficult to cover. Please advise.
It is correct that there is no cure yet for melasma and all efforts are directed at treatment and prevention. I am sorry to hear that standard treatments made it worse.
Strict sun protection with a zinc oxide or titanium dioxide based sunscreen that is reapplied every 1.5 to 2 hours, fading agents and peels, microdermabrasion, treatment for any underlying redness with specific vascular lasers (PDL and thullium lasers), oral treatment with tranexamic acid, and picosecond laser treatments are usually effective. Not all picosecond treatments are the same and one sub-type (the Pico Focus Lens treatment) does not work for everyone with melasma. Many of our patients respond well to Melanage peel, which clears 85% of the melasma on average. Ultimately, a combination of treatments and a customized treatment plan to the depth of your melasma will get you to your goal of reducing the showy pigment.
Prevention includes the same type of sun protection as outlined above, daily fading agents and periodic touch up treatments.
I developed melasma on my face several years after menopause ( no hormonal replacement therapy). Does treatment differ in my case compared to younger women (estrogen related)? I am asian with medium skin tone.
Treatment of melasma is similar whether it occurs with pregnancy, hormone replacement, or after menopause. It is always customized to the depth of melasma and the amount of downtime one can afford with treatment.
Hi , I’m 46 years old . Asian I have what it call malasma .what can I do? I been treated with a mini melanage Peel . And seems like getting worse.. I need to see a doctor? And who can I see? Best special in malasma treat?
I agree that you should see a dermatologist to get help with your melasma. All dermatologists in our practice is highly qualified to treat you. Please keep the appointment you have scheduled.
Hi, my Dr gave me Obagi, it worked for a while and made my dark spots lighter but now it is not working any more and make my dark spots darker, why is that
Unless you used the Obagi system for many years in a row and have developed paradoxical darkening of skin, you might have a hypersensitity to hydroquinone, the main ingredient in the Obagi system. Please see your doctor for evaluation.
Hi, I am 50 years old (Asian) developed a small patch of what appears to be melasma on my left cheek bone near the eye. I have tried treating with Obaji#3 with a small pointed applicator like a toothpick just on the pigmented part however, I have not had much lightening results and it makes the adjacent skin red after 1 time use so I have not used it on a regular basis. Most dermatologists near me fear rebound pigmentation after laser use on Asian skin it seems. What is a safe laser to use on Asian skin ? and also, what would be the advantage of going with melanage vs “Asian”safe laser? And lastly, I am afraid that some non laser melasma treatments will thin my skin and cause more fine lines when I make facial expressions, so is there a non laser treatment that minimizes that thinning of skin effect afterwards? Or would laser be better ? Thank you so much in advance.
Picosecond lasers are the only lasers for melasma not associated with rebound pigmentation. The laser fires so fast that it does not cause heat, hence avoiding all known side effects of laser treatment. They leave the skin pink for a few hours but otherwise cause no downtime. Clearing is less than 50% after 5 treatments 4 weeks apart. Melanage peel is color safe. It will not thin your skin. Reduction of melasma is about 80-90% with a single peel and significant downtime of 10 days of redness and peeling. Our practice performs all of these treatments, and it really comes down to expectations and the ability to afford downtime.
hi. i am 40 years from Bangladesh, Asian country. i have been suffering from melasma last 3 years, did laser treatment , that didn’t work and later under consultation of dermatologist. he advice few cream like DRONE_TM and melalumin for pigmented skin and also skin whitening tablet for 3 months. but last 7 months i am under his consultation but my skin condition extremely deteriorated, darkened and skin spots are immensely visible after dropped Drone-TM cream after 3 months using. sopts come back and i am so upset. i am looking for your advice if possible.
Melasma is generally difficult to treat. Oral tranexamic acid has changed the way we can treat melasma sustainably without having to take this medicine beyond three months. Dietary changes that balance hormones might be helpful in others.