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Peeling Melasma

Treating melasma is one of the most challenging indications in aesthetic dermatology.

In my hands and over the years, chemical peels in combination with bleaching agents still work the best. Most recently, very interesting and promising new bleaching cosmeceuticals are coming up, matching both, efficacy and safety compared to the gold standard substances such as low dose hydroquinone and or kojic acid.

Anyhow, I do strongly believe in the fact, that -for a therapeutic effect- we still need highly efficacious treatments to resolve and manage these hyperpigmentation conditions: Chemical Peels in combination with bleaching substances are a very potent way to treat melasma. It`s either about raising the concentration of the working agents or about performing multiple treatments.

Overall, the physician has to have a broad experience in combining those agents and secondly, the patient needs to be educated on following a life-long "skin-diet"-program.

Reader Comments (27)

According to a medical journal, oral administration of Tranexamic Acid is also an effective and safe therapy for the treatment of melasma. Has anyone tried this?

06.13 | Unregistered Commenterjoy anne

Have you tried an erbium laser peel?

Before treating melasma, I always check my patient's thyroid function as 25% of paients with Melasma have thyroid disorders.

06.14 | Unregistered Commentermp

I tried tranexamic acid intradermally with so-so effect...

no. use the q-switch for deep, tx-resistent melasma

Before treating melasma, I always check my patient's thyroid function as 25% of paients with Melasma have thyroid disorders: right!

Dr. Zinker is correct. I find that after r/o medical etiologies the q switch yag works well. It requires 7-10 tx about 2 weeks apart and agressive avoidance of sun exposure. I normally use a 2-4% Hydroq. plus spf 35.

The bigger issue resides in the fact that despite all this therapy the first time a patient gets unprotectes sun exposure the melasma returns.

Its often a simple situation such as "running to the store" where the exposure occurs.

06.14 | Unregistered Commentergm

Jessner's peels is on the top of my list for treating this.

I've been seeing claims that Fraxel works for melasma. Your thoughts on this please? Can anyone attest to this?

I have used fractional resurfacing (Palomar and Reliant) for melasma. Both work ok. The best thing that I have used laser wise is Q switched Yag. Roughly 6-8 sessions, 1-2 times per week with daily Hydroquinine 4% during sessions.

I have been using Fraxel for several years...I won't recommend this for treating melasma. In my clinic, Fraxel is more effective in treating sun damage.

We recommend the Cosmelan without hydroquinone, which works quickly and effectively. We ensure that we keep clients on the Cosmelan 2 home care cream for an absolute minimum of 3 months, but most of our clients remain on the home care program for 1 year, as recommended.

Tashia, is the Cosmelan Mask a single treatment? How about the recurrence? How often do they need to repeat the treatment? I would never use Laser on Melasma. I had a client who had IPL done on Melasma and it was not a pretty site.

Brightnex is an amazing non HQ option available through Zein Obagi skin Health. The risk with lasers and other procedures is the risk for PIH

11.6 | Unregistered CommenterM.O.

Skin type needs to be considered. Laskin Medical has has 4%, 6%, and 8% hydroquinone. Also, 1% tretinion along with a complete product line including Spectra peels which are TCA based.

11.20 | Unregistered CommenterKendall,M

I use Easy-TCA from Skin Tech, depending on the depth of the pigmentation, 2-4 treatments. For home use SPF50 sunscreen, Blending Bleaching cr (from Skin Tech, contains Kojic acid) 2-3 times per day plus tretinoin cream every night. Works very well in most cases and can be used for all skin types.

12.4 | Unregistered CommenterH.rai

I advise pts to take Vitamin C during the day. Retin A 2-3 x per week at night. Series of Palomar 1540, or Sciton pro fractional lasers to manage melasma.

01.19 | Unregistered CommenterD.A. RPA-C

Have you ever tried azelaic acid instead of hq? I found it works well and is better accepted by patients as it causes less irritation, doesn't smell like some hq preparations and doesn't stain fabrics. Used in conjunction with retinoic acid I've found it quite effective. Of course a high SPF daily is also essential.

01.22 | Unregistered CommenterPeter G.

We use an 8% liquid hydroquinone without the retin A component. It is applied with a cotton pad and has an excellent absorption rate. We have found that the Retin A in most HQ formulations is what irritates patients skin. Because this form of HQ does not use Retin A (because it's liquid and penetrates easily) it is very well accepted by patients. Because nothing greater than 4% has been used in long term trials, we take patients off it one month out of every 4.

01.25 | Unregistered CommenterKenneth S

Fraxel works, but is obviously more expensive and time consuming because it takes a few treatments for the patients to see visible results. The main problem with melasma is that even if it responds to a treatment, it tends to come back that is why sunscreen is very important in their skin care routine.

01.31 | Unregistered CommenterS.Wong

We have had very good rapid results using a Melanage Peel from Young Pharmaceuticals. It is expensive, but it works.

For not such deep pockets, we compound a 10% Hydroquinone solution that also has 5 other skin lighteners. It is applied with pads BID for 30 days and a spray on dry powder 50 SPF sunblock. The combination is much less expensive, takes about 30 days and has very little side effects. In fact, some patients with Melasma and Acne state that this combination works well for their acne too...I have no idea why, but we have heard it that a lot from patients.

Hydroquinone is still by far the best bang for your buck.Very efficient for melasma.

02.19 | Unregistered CommenterVCrutcher

I have used hydroquinone and equal parts Vitamin C cream starting at 5% -8%. Microdermabrasion does wonders as well.

03.7 | Unregistered Commenterfannie

have you checked Laser Toning and soft peel protocols promoted by Spectra system of Lutronic Corp.? It works on both epidermal and dermal melasma. we have tried this system in the Middle East and Gulf regions and its gaining popularity because of good results and low cost treatment.

04.2 | Unregistered Commenteridella

I have literally hundreds of success stories using the VI Peel w/ Precision Plus for Melasma - it's what it was specifically designed to address. It's truly amazing. And it's sulfate and paraben free unlike many of the others out there. The Precision Plus booster has Hydroquinone and Kojic Acid which really add value to the peel.

04.27 | Unregistered CommenterTJ

Are you not aware that Hydroquinone can cause melasma to return worse than before? And so it goes with lasers too. Your skin looks great for a couple of weeks and them melasma reruns more aggressive than before, despite slathering on sunblock!

11.3 | Unregistered Commenterval

Melasma is an internal condition. Unless you are planning to permanently destroy your melanocytes, I would avoid HQ (like what val said) and aggressive therapies because they do not treat the problem, they only improve it temporarily while aging your skin in the process. We can treat melasma by using Osmosis SkinCare. The process takes 6 months but a majority of our clients see significant change in their melasma in 3-4 months. We are repairing liver damage caused by hormones. For pregnant women, it appears elevated hormones are more likely to cause it if you are over 30.

11.4 | Unregistered Commenterben, md

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