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?

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?

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?

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.

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.

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?

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

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.

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.

How does this peel compare to cosmelan treatment?

Is there any coverage from insurance for the Melanage treatment due to it being under “medical dermatology”

Hi Dr. Ringpfeil, I’ve been suffering from “Paradoxical darkening of the treated area” from IPL/Fraxel laser treatments. Is there any treament for this? I’ve tried many different options with few different drs, but pigmentation seems to be getting darker. Almost ready to give up, but it is quite depressing when even makeup can’t even hide the spots and look worse with grey tone showing. Thank you

I used a cream given to me by the dermatologist for melasma and it made my skin above my eyebrows hypopigmented. the skin no longer browns when the rest of my face gets a tan. The patches are lighter in color than the rest of the color on my face. Is there a treatment for this
thank you

Hello!
I’ve been dealing with melasma since the birth of my first child who is now eight. I’ve tried citric acid peels, glycolic acid, Obagi skincare, hydroquione and nothing seemed to work. I use skin skinceuticals sunscreen with titanium dioxide and zinc oxide and currently use the rodan and fields reverse regimen. just recently I received two laser treatments in my dr office using the clear and brilliant laser. I actually feel like my skin got worse. Could that possibly happen?
Thank you

Hi Dr. Ringfeil, I started using Retin A for my dark marks in September, but have only been able to apply it about once a week due to excessive peeling and dryness. I feel like this should have gone away by now. Am I using it too infrequently for my skin to adjust? Thank you!

According to the table above, there are 3 types of Skin layer affected by melasma, Superficial, intermediate and deep. Is there a way I can check which type I most likely having? Late 40s
Ethnic (Chinese)
Moderate spots, more on the left side (driver side)
Had them for over 4 – 5 years
No birth control pills

Also, if you use a brightening mask on your face, will it brighten the dark and light areas, or mostly affect the darker areas? Should you not use brightening masks on your entire face? Thanks.

Hello. Is it okay to apply topicals on your entire face if you have darker patches/spots on many different areas of your face? Thanks.

I have moderate melasma and have tried the Obagi system and other topical products with minimal results. I am vigilant about sunscreen however I have found even with a hat, sunscreen 50+ and little exposure outside if it is a very hot day my melasma will get worse – is it possible for melasma to get darker just from being in the heat?
Also, I have heard some people have had promising results from the Palomar Icon Aesthetic System. What is your opinion of this system?

Do you think an oral or injectable medication to suppress the hyperactive pigment cells which would essentially control the melasma from the inside out is forthcoming or is this like the treatment of acne, which is a multi-billion dollar industry for drug companies and doctors alike? It seems like nothing is “cured” anymore – we only have access to endless super-expensive treatments for conditions that aren’t “life threatening”. These issues aren’t merely cosmetic to the sufferer – they can be devastating to your existence. And if you don’t have the financial ability to spend thousands of dollars on masks, and lasers and dermabrasions, you just have to suffer with it. OTC treatments DO NOT work, and prescriptions only marginally. It’s really a shame medical care is all about money anymore.

Hi Dr. Ringpfeil, Are there certain birth control pills that are less linked to melasma than others? I am on Yaz and a year ago developed a small patch of melasma. Sunscreen has helped manage it, but I did notice going off Yaz for a few months also dramatically helped my melasma.
However, going off birth control caused my acne to return, so I opted to go back on Yaz. Are there any birth control pills out there that are less likely to induce melasma? Thank you.

Hi, I was wondering what are the “botanical fading agents” that are referred to in the above section about post- melasma care? Thanks

I have got melasma on my face for 7 years and I have tried almost all treatments available, from laser, hydroquinone and many other skin lightening products. The only product that worked was Triluma, very expensive though. But after 3 months, my skin became very red, sore, dry and very very thin, I had no idea about this thinning until one day I did face waxing and my skin peeled off with the wax cloth. Just imagine the pain I went through, I have stopped using everything now and my melasma just gets worse by the day. I dont even go out anymore, my self esteem is zero. I just hope that someone will discover a permanent cure soon.

Hi – I have moderate melasma and I am currently using a cream with 20% azelaic Acid, Retin A, Asorbic Acid, Fluocinolone, and Diclofenac. Its pretty irritating to my skin. Is that normal and will it go away? What are the advantages of Azelaic Acid over Hydroquinone? Also, what sunscreen do you suggest? How often should I reapply it if I am outside? What if I am just running errands, etc? Do I need to put it on several times a day? Thanks!

hi, i would like to know what type of treatment is good for melasma on african american skin, i have gotten this horrible dark mask on my face that feels like sand paper, once i wash my face, i try not to use soap, so i,ve been using an olay foaming soap, which seems to still completely dry my skin out, and i don’t know what type of moisturizer to use. i started getting this pigmentation about 4/5 months ago and i thought i had a reaction to something because it gradually got dark and it was itchy, on my face and neck,but then it grew into a full mask on my face and it is very devastating and depressing and as taken my self esteem away to the point where i don’t want to be seen and i have to wear make up everyday, where i never have worn makeup on my face before. i’m looking for a treatment that will help me get rid of this mask.

I know you recommend a sunscreen with zinc oxide or titanium oxide, is there a brand that contains these ingredients within a daily moisturizer or do I need to buy a separate sunscreen and moisturizer and apply both? Also, what SPF should I apply and is there a specific brand I can pick up at a local drug store that you would recommend? Thanks!

I have melasma and am currently trying some OTC lighting creams my question is when using sunscreen does it have to contain zinc oxide and titanium oxide or is zinc oxide 7.5% alone good enough? The reason I ask is it is very hard to find sunscreen with both zinc and titanium oxide and the one I did find with both is so greasy my make-up cakes on my face.

Hi,
I am 37 year old asian female – have been using obagi hydroquinone and tretinoin products for about 3-4 years, have tried kojic acid, chemical peels and fraxel once for consistent melasma/freckle problems. I inherently do not have thick skin, but I feel like my skin may be getting thinner and more susceptible to sun exposure… I am considering melanage next but is there anything that could be done about the thinning skin to help make it thicker?

After a melanage peel, can one wear makeup to hide the redness?

Question for the doctor… My Melasma began when I started the pill 2 years ago. I am a 37 year old women. If I stopped the pill would the melasma evidentually go away 100%, if I did topical therapy for the current brown spots?

I am getting married in 6 weeks. I started with melasma last year on my forehead and chin, but it’s more pronounced on my forehead. My dermatologist gave me Hydroquinone, etc., to lighten it, but it hasn’t worked at all. I wear a #50 sunscreen with titanium and zinc and a sun visor. I’m wondering if I can possibly get rid of the melasma at least on my forehead before the wedding, and what is the best, quickest treatment? My assumption is microdermabrasion is out, and I should opt for a Melanage Peel, but I’m wondering, will that cause more damage to my face before the wedding??? Thank you, Gina

I am a 41 year old male with what appears to be melasma on my forehead and cheeks. I’ve had the condition for two years and it worsens in the sun. Since it first appeared, I regularly wear sun protection but I am curious if this will go away on its own or if i need to do something about it. I’ve read this predominantly effects women so how did I come down with it?

I have a red face all day long. i don’t know what to do any more. i’ve done my research and think it may be rosacea, but since i am not a doctor i am not sure. What are your recommendations for reducing redness on my dry face. Also,do you accept Keystone health plan east?

Is it possible to have filler injections into the cheeks (Radiesse) and the Melanage peel done in the same visit? I am hoping to get them both done at the same time.. Thank you

I was recently given a bottle of Clinique’s Even Better Clinical Dark Spot Corrector to use before I try microdermabrasion, but I have a couple of concerns. I have been on the same brand of birth control for about 10 years and over the last 2 years, I began seeing melasma develop. I am concerned that if I try this topical treatment and it fades the darker melasma spots, when I discontinue taking birth control, will those same areas look bleached? I would rather have the melasma spots for a few more years than have several bleached spots on my face forever. Secondly, if I use this topical treatment, will it make those areas where my melasma is worst, even more sensitive to sun from that point forward? I do understand, however, that sunscreen is vital to reducing the appearance of melasma. Thank you in advance for your time!

I met with Jill regarding my melasma and she recommended microdermabrasion. I am planning on starting a series of six this coming autumn, and would like to schedule appointments in advance. I forgot to ask her how many weeks should you have in between sessions? Thanks so much! PS– Jill is a great asset to your practice!

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.

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.

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.

Absolutely!

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.

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.

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.

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.

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.

The principles and ingredients are very similar. The difference is that the in-office mask for the Melanage peel is freshly prepared and mixed just before application leading to reproducible results at all times. There is no degradation of ingredients.

Melanage treatment is unfortunately not covered by insurance.

Last resort is Melanage peel. And meticulous sun protection is a must regardless.

I wonder what fading agent your dermatologist might have used but I am unaware of a way to allow the skin to repigment, in general. I am surprised to hear that you are allowing your facial skin to tan. Melasma is highly stimulated by UV rays and our patients are advised to not get a tan on their face if they want to keep their melasma under control. In your case, avoiding a tan above the forehead should make for less color contrast.

The Clear and Brilliant laser has demonstrated efficacy in melasma treatment in several studies. It usually achieves about a 50% reduction of melasma after 3-4 treatments. Paradoxical hyperpigmentation with this technology is not common. However, if you notice darkening of your skin that persists for more than 3 weeks after each treatment, this laser might not be suitable for you. You might want to consider Melanage Peel, which removes 80% of melasma in a single treatment. Please note that treatment of melasma with any technology does not remove the need to prevent pigment from recurring. You will always have to use your sunscreen, reapply every 1-2 hours, and use non-hydroquione pigment suppressing agents (e.g. kojic acid, vitamin C, glycolic acid, licorice extract, azelaic acid etc) year round.

Most people with melasma have pigment in one or two layers. A dermatoscope (polarized light) can help with determine the layer that is predominantly affected and treatment can be designed accordingly. The exact layers can only be determined with a skin biopsy. A biopsy leaves a small scar. It is usually avoided unless overuse of hydroquinone is suspected to have caused the dark pigmentation.

Weekly retinoid use is indeed too little to let the skin adjust to it and your skin starts the process over and over, hence you are scaling and peeling. You may try to apply moisturizer before the retinoid and then use half a green pea size to spread over your face except upper and lower eyelids and red lips three times a week. If you still continue to peel after 14 days, you may have to go to retinol instead.

It is difficult to answer this very specific question without the name of the product. The previous answer will give you some guidelines.

Topicals such as plain moisturizers, moisturizers with sunscreen or sunscreen products are safe to use all over the face. Topicals intended for fading of dark spots that can safely be applied to the entire face even when you have dark patches are kojic acid, arbutase, azelaic acid, vitamin C, as well as facilitators such as lactic and glycolic acid and tretinoin. In case of presvcription products, please ask your precsriber if they can be applied safely.

Melasma is very sensitive to UVA rays and perhaps even to some of the rays in the visible light that are near the UVA spectrum Therefore, a densely covering UVA sunscreen such as a mineral screen, Anthelios sunscreen or Neutrogena with Helioplex are needed to block these unwanted rays. Heat does not worsen melasma directly but heat causes little gaps in the sunscreen film on your skin. This happens even with the best mineral sunscreen. The best protection is therefore sunscreen and a wide brimmed hat or over sized visor. While Melanage peel is the single best treatment for melasma no treatment cures it and prevention or maintenance are needed. IPL (intense pulsed light) such as delivered by Palomar Icon might achieve results in some but but can paradoxically worsen melasma. The only laser that has not worsened melasma to date is the Picosure laser. It is not as effective as the Melanage peel but is very suitable for people who cannot afford downtime. Four to five treatments will achieve about 60-70 % reduction of melasma.

I sympathize with your frustration about melasma. Unlike acne where cure can be achieved with isotretinoin (Accutane) when indicated and photodynamic therapy, we really are far from a cure in melasma. Most people with melasma are frustrated and often devastated. Thus far, the mechanism of hormonal interplay with sun exposure in melasma is not fully understood. Therefore it is not surprising that there are not yet oral or injectable medications to cure this condition. There is pretty effective treatment to dramatically reduce melasma and in almost all the results can be maintained with very diligent sun protection.

Melasma is triggered by an increase in estrogen from a combination oral contraceptive or pregnancy or premenopausal hormonal variations. Oral contraceptives that are based solely on progesterone would not trigger melasma. However, they are not as effective in prevention of pregnancy and do not typically control acne. I recommend that you explore other treatment options for your acne.

The most important are Arbutin (bearberry plant extract), Glycyrrhiza Glabra (licorice root extract), Morus nigra (mulberry root extract), Emblica (Indian gooseberry extract). Technically, alpha hydroxy/glycolic acids are also botanical agents while kojic acid is derived from mushrooms. Various products contain combinations of these. Amongst these botanical agents Pigment Regulator by Skinceuticals and Vivite Vibrance by Allergan are very reliable. Botanical agents acne be irritating to some and use should be discontinued if redness occurs.

I suspect that the retinoid in Triluma (tretinoin) has rendered your skin sensitive during the time of your treatment. When using a retinoid it is prudent not to apply it the night before waxing, peel, microdermabrasion and other facial procedure. Some people may need a couple of days without a retinoid. However, skin usually recovers from this reaction after a period of time. Prevention of pigment formation for life is crucial because no cure for melasma is available yet. A hat and sunscreen must be worn daily and when outdoors must be reapplied as frequently as every 1-2 hours. Sunscree should block the entire UVA spectrum and several sunscreens fulfill this property (all Anthelios sunscreens, all Johnson and Johnson sunscreens that carry the Helioplex sign, all titanium and zinc oxide containing sunscreens over 5%).
Preventions also includes the use of pigment suppressing topicals such as vitamin C, kojic acid, glycolic acid and other herbal fading creams, non-herbal fading creams like Perle and hydroquinone. The combination of several of these agenets works best. Treatment for most types of melasma is possible and depends on ability to tolerate downtime and on financial means. Treatment does not eliminate the need for life long prevention. Melasma quickly returns or appears difficult to treat when prevention is not carried out diligently. Any unopposed sun exposure sets you back by 2 steps.

Sun protection is key to treatment and prevention of melasma. You should wear a hat or umbrella when outdoors and reapply sunscreen as frequently as every 2 hours. If there is any chance you have sweated or rubbed of your sunscreen, it is better reapplied. I am unaware of advantages of any single ingredient of your compound over another. Melasma is best treated with various substances that work synergistically to suppress pigment production.
Hydroquinone is approved by the FDA. However, it should not be used continuously for years and in my practice, it is replaced with a non-hydroquinone containing regimen after 6 months. (It can be used at a later time if needed.) Azelaic acid, Retin A, ascorbic acid at high concentrations and diclofenac (especially when sun damage is present) can be irritating and a mild topical steroid (fluocinolone) was probably added to counter any irritating effects. You should use this compound as directed by your dermatologist. If irritation does not resolve after 1-2 weeks of sparing use, speak to him or her about it.

Your description is not that of melasma. Please see a dermatologist for evaluation.

A physical sunscreen combined with moisturizer that contains a minimla ingredient list is difficult to find. The Anthelios mineral sunscreen with or without tint is a light weight sunscreen that contains only titanium dioxide but does not moisturize. Vanicream makes fantastic free of everything moisturizers but they do not produce a sunscreen product that also contains a moisturizer. A product by Physicians Formula contains titanium dioxide and works as a moisturizer but its ingredient list is endless, which makes me uncomfortable.
The best is to use a light weight hydrating product with glycolic acid first and follow with a physical sunscreen in the morning, or use a potent moisturizer at night.

In fact, zinc oxide 7.5% is sufficient. There are some sunscreens that contain much less than 7.5% zinc oxide and then augmentation with titanium dioxide is crucial. Titanium dioxide by itself at concentrations above 10% is also fine.

It is very unusual to develop thinned skin from retinoids (tretinoin), hydroquinone or any of the other fading agents, when thinning refers to a state that is thinner than nature provides. Retinoids can bring your skin to the level it was when you were young and had no sun exposure yet but they do not thin your skin beyond its physiological state. When we are exposed to the sun over our lifetime, skin thickens to protect itself from the sun.
This process is described by some as “leathering” and in a cosmetically conscious person, this is not a desired state. Therefore, the glow of skin that has the same smooth and even texture and color as skin that has never seen the sun comes at a price. The skin must be protected from sunlight as it does not have any natural sun protection to UVA light, the light that drives melasma and leathers and ages us. Sun protection can be carried out with physical sunscreens including sun protective clothing and hats with very wide brims or topically applied zinc oxide and titanium dioxide or by chemical sunscreens and or by any combination thereof. When you have melasma, life-long UVA protection is essential or the melasma could come back immediately. A number of different treatment options including Melanage peel reduce melasma. If you feel you have abnormally thin skin, you should be evaluated. Rare medical conditions should be excluded before you receive any further treatment.

In the first 3 days, make up is very difficult due to the scaling that starts. Afterwards it is possible.

Most melasma can be treated with topical creams or a combination of topicals and in-office procedures. Keeping melasma away is typically a much bigger project than removing it from the skin. Sun screen should be truly broad spectrum. Therefore, the physical sunscreens containing zinc oxide and titanium dioxide are most commonly recommended. Few other sunscreens that are truly broad spectrum contain molecules that stabilize their UVA filters.
In addition to sunscreens, pigment production can be regulated with herbal fading creams, topical hydroquinone, glycolic acid, vitamin C and others. In order to reduce your skin’s ability to produce melasma, it is recommended that you avoid increased estrogen levels that occur with many birth control pills and during pregnancy.

Melanage peel would probably be the best yet the redness and scaling after Melanage can last up to 4 weeks which would increase your nervousness factor and is therefore undesirable. I would do a few microdermabrasion treatments every 10-14 days and continue hydroquinone. You should see some improvement until your wedding.

Melasma is indeed far more common in women than in men. Occasionally, it resolves once you wear sunscreen diligently. Most of the time, however, it needs treatment to fade away. After treatment, meticulous sun protection is essential, too, as with any lapse in sun protection, it comes back.
In general, the treatment is regarded easier than the prevention of relapse after treatment.

You can have both treatments on the same day. Make sure when you book the appointment that the front desk is aware that you are interested in both treatments so enough time will be allocated for your appointment.

Melasma occurs often because of a combination of sunscreen and an increased estrogen level such as with oral contraceptives or during pregnancy. Melasma is not known to fade by itself when you discontinue birth control or after giving birth. Those who do not like the darker areas typically work hard to remove them and work even harder to make them stay away. Once you have developed mealsma it easily come back after treatment if do not practice immensely diligent sun protection against UV rays.
Fading creams that helps with melasma are not known to make the treated areas lighter than your normal surrounding skin. It also does not render these areas more sun sensitive.

The intervals between microdermabrasion treatment are only 2 weeks. Go ahead and schedule accordingly.