Anyone with melasma knows how frustrating the skin condition can be. Dark, spotchy patches settle in on your face, sometimes even resembling dirt, and they can be tough to treat. They can also be tough to hide with makeup. When skin-care products and concealer tricks aren’t cutting it, you may think in-office treatments are the answer. However, despite many advancements in aesthetics space, more treatments pose a risk to melasma than a benefit. Here, leading dermatologists weigh in on which in-office treatments to avoid if you have melasma.
Featured Experts
- Ava Shamban, MD, a board-certified dermatologist based in Beverly Hills, CA
- Heidi Waldorf, MD, a board-certified dermatologist based in Nanuet, NY
- Rebecca Marcus, MD, a board-certified dermatologist based in Dallas
What Is Melasma?
“Melasma is a type of discoloration on the skin that shows up in patches,” says Beverly Hills, CA dermatologist Ava Shamban, MD. It usually appears on the forehead, nose, cheeks or above the upper lip (you may have heard of the “melasma mustache” before), but it can crop up anywhere on the face. “Melasma is more common in women and difficult to control,” Dr. Shamban adds. “It is most often attributed to hormone fluctuations, especially during pregnancy, but it can also be caused by infrared heat, and ultraviolet or other forms of radiant light. It is often exacerbated with flare-ups due to sun exposure or stress and the elevation of stress hormones.”
Treatments to Avoid With Melasma
Ask any dermatologist, and they will confirm melasma is one of the toughest skin conditions to treat. And to make matters worse, some of the most popular and effective aesthetic procedures can make it worse. Here’s how to navigate your options and be on your way to brighter, more even skin.
Radio-Frequency (Heat-Based) Treatments
“Anything involving heat should be used with extreme caution by those who have melasma,” says Dallas dermatologist Rebecca Marcus, MD. “Heat stimulates melanocytes to produce melanin. 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 then, we’d follow with 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.”
Most Nonablative and Ablative Lasers (and IPL)
“Most lasers and IPL are based on the idea of elective photothermolysis. This means destroying the pigmented cells where dendrites contain more melanocytes cells,” Dr. Shamban explains. “However, in response, an adverse basal layer damage inflammation can follow. This can result in repigmentation recurrence, mottled depigmentation or post-inflammatory hyperpigmentation (PIH). Therefore, dermatologists do not recommend most nonablative or ablative fractional lasers, IPL and Q-switched laser treatments for most melasma patients.”
Some fractional 1550/1540 nm nonablative laser therapies show promising results and are approved by the FDA for treating melasma, Dr. Shamban says. “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. This is particularly true for patients with skin of color, or those with a history of PIH, to see the individual response.”
Nanuet, NY dermatologist Heidi Waldorf, MD says, “Fraxel and other lasers have been used successfully to reduce melasma, yes. However, 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, they need to be vigilant about using sun protection.”
One option derms can safely recommend is the PicoSure Pro laser, which is FDA-cleared to treat melasma. According to Cynosure, the company that makes the laser, the delivery is so quick that it spares the skin from high thermal damage. It’s able to target the unwanted pigment—it also improves wrinkles, acne scars and large pores—without making it worse.
Microneedling (Without Radio Frequency)
“Although microneedling is touted as being safe for melasma, nothing is 100-percent,” Dr. Waldorf says.” I have seen post-inflammatory hyperpigmentation, as well as a darkening of the melasma after microneedling.” 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.
