Face pigmentation and melasma treatments

Melasma is a form of facial pigmentation affecting the forehead, cheeks and commonly the upper lip areas. It tends to affect darker skin types, but is commonly seen in Australian women.

Essentially three factors contribute to melasma:

1. Genetic- not everyone will have a family history of melasma, however some people are pre-disposed to this condition. Melasma is more common in females of darker skin races, such as Asian, Mediterranean or Middle Eastern extraction.
2. Hormornal– oestrogen from the pill, or pregnancy stimulates the pigment producing cells in the skin, resulting in excessive pigmentation. In many situations, despite having no history of pregnancy or the pill, some people have melanocytes that are sensitive to normal amounts of hormones. In others it may occur in pregnancy.
3. UV exposure (sunlight) - Even brief exposure to UV light can stimulate pigmentation. The use of sunscreen is the cornerstone of treating melasma.

Queenslanders have extraordinary doses of UV exposure compared to the Southern states, and the use of sunscreen, even on cloudy days is important.

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Facial pigmentation and melasma can be difficult to treat.  It is important to carefully assess the patient skin to determine the depth of pigmentation, address factors which may contribute to the facial pigmentation and educating the patient in regards to their skin care regime including photoprotection and sunscreen use.

If treated incorrectly melasma can often be made worse.  As everyone’s skin is unique, the most appropriate treatment individualize treatments for every melasma  case. This in turn ensures that the best results are seen.

Westside Dermatology’s four step guide to melasma treatment and facial pigmentation will result in clinically significant improvement in over 80% of patients.

Step 1 - Identification of causative factors, patient education

Product review and advise. Sunscreen and photoprotection recommendations.

If patients are on the oral contraceptive pill, if possible we recommend another form of contraception. Note that contraception measures such as Implanon and the Nuvaring have been documented to worsen Melasma. Depo Provera contraception worsens Melasma in 1% of patients. Discuss with your General Practitioner non- hormonal methods of contraception.

Step 2 - Melanocyte inactivation

This step inactivates the overactive pigment producing cells (melanocytes), which results in pigmentation.

Several prescription creams are available. Unlike over the counter creams, each prescription is individualized for every patient.  A custom prescription of a compounded cream containing variable concentrations of Vitamin C, Vitamin A,  Alfa Hydroxy Acids and Hydroquinone is recommended. The concentration of each ingredient will depend on the depth of pigmentation, the ethnic skin type, the individual skin sensitivity and your current product use. Even with a strong concentration of compounded creams, it still takes up to 4 weeks to notice fading of the pigmentation.

Step 3 - Removal of excess pigmentation

This step clears the excess pigmentation from the layer of the skin. This can be done withChemical peels or with Fraxel/ ProFractional lasers.

Chemical peelscan help speed up the process of clearing up melasma by gentle exfoliation of the excess pigment from the deeper layers of the skin. An excellent starting point is 20% Glycolic Peels or AHA peels. Chemical Peels are performed every 2 to 3 weeks and are well tolerated. Unlike more aggressive chemical peels Glycolic acid (AHA peels) gently exfoliates the pigment. There is no downtime with this type of peeling.

More on chemical peels.

Fraxel or Fractionated laser can give excellent results in resistant cases of melsama. Usually 2-4 treatments are needed. Laser treatment is NEVER the first line treatment of melasma, and should be reserved for cases where other treatments have failed. Fractional laser treatments can improve all types of melasma including dermal melasma, and is safe in darker skin types.

More on Fractional laser

Step 4 - Prevention of melasma

The last step of melasma treatment is the use of a maintenance regime by the patient. Westside Dermatologist usually prescribe a Vitamin A cream or AHA/ Glycolic preparation to be used several nights a week. For continued long lasting affects patients must continue to be vigilant about the need for ongoing photoprotection. Sun protection cannot be overlooked or more emphasized.

Intense Pulse Light or IPL is a good treatment for other causes of facial pigmentation ,however in the majority of cases, it may worsen melasma. This is due to the excessive heat generated by IPL which causes inflammation (Post Inflammatory Hyperpigmentation ) which leads to the formation of extra pigmentation.  As a rule we do NOT use IPL as initial treatment of Melasma.

A safer option is the use of Fractional lasers.

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A safer and much more effective way of treating melasma is the use of Fraxel or Profractional laser. 

Fractionated laser treatment (Fraxel, ProFractional ) produces hundreds of tiny but deep micocolumns of treatment into your areas of pigmentation. Each column is the diameter of your hair shaft.  Laser vaporizes both superficial and deep pigmentation, but also leaves areas of your skin untouched forming the basis of fractional laser treatments. For every micro column the laser treats, it leaves the surrounding tissue unaffected and intact. This fractional treatment allows your skin to heal much quicker than if the entire surface was treated at once as the untreated area heals the wound by removing the treated skin and replacing it with new tissue.

The advantage of treating skin this way is that there is less downtime and side effects while obtaining a significant clinical improvement. This type of laser treatment is also safe in darker skin types such as in Asian skin.

Fraxel / Profractional lasers generate less heat compared to IPL and hence treatment for melasma is much safer and more comfortable compared to IPL. The risks of post treatment hyperpigmentaion (darkening) is still present with Fraxel/ Profractional. To further minimize the risk of worsening melasma,

We use the ProFractional system over the Fraxel as it produces less heat, resulting in a safer and less painful treatment profile for our patients.

• Do use a high factor sunscreen on a daily basis
• Do avoid sun light exposure
• Do use prescription creams as first line treatment
• Do consider changing contraception if you are on the pill
• Do consult a specialist for further treatment before changing your products
• Do NOT attempt IPL as first line treatment
• Do NOT attempt microdermabrasion as first line treatment

Pregnancy is a common time to develop melasma, and this condition can get better after childbirth- this may take 6-9 months. The same rules apply to treatment, namely avoiding sun exposure, and if possible, avoiding the pill. Specialist can tailor a safe and effective melasma treatment program suitable if you are breastfeeding.

Melasma is more common in darker skin races and can be harder to treat. The same rules apply to treatment, namely avoiding the sun, and hormone pills. Bleaching creams and chemical peels can improve melasma in 50-60% of cases in dark races.  Fractional laser treatments can be successful in resistant cases, however lower settings and multiple treatments are needed. (4-6 treatments)

More on skin therapies in Asian, Mediterranean and darker skin types

Treatment of facial pigmentation including melasma can be difficult and if undertaken incorrectly, pigmentation can actually worsen. A dermatologist can carefully asses your skin type, the depth of pigmentation and customize a prescription treatment suited to you.

We can also utilize state of the art treatments such as fractionated lasers and chemical peels to speed up the process.

As we are a specialist group of doctors, a referral from your GP is advised. Call Westside Dermatology on (07) 3871 3437 to make a booking or to enquire about the referral process.

*Treatments for melasma are NOT Medicare reimbursed nor are they covered under private health insurance. Treatments are deemed cosmetic in nature.

Westside’s Radiant skin program was developed by our laser expert to provide a solution for gentle, but effective Fractional Treatments - ideal for Melasma patients.

More on Westside’s Radiant Skin Program

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Dr Davin S. Lim

The vast majority of malesma, a form of facial pigmentation can be treated with sunscreen, a customized lightening cream and a series of gentle AHA peels.

In some situations Fraxel laser or fractionated resurfacing can give good results, however this should be reserved for melasma where other treatments have failed.

IPL is NOT indicated as first line treatment in malesma however maybe considered down the line. If IPL is used to treat melasma when the melanocytes (pigment producing cells) are still active, then darkening of the pigmentation can be seen. Strict and absolute sun protection forms the foundation of melasma management. The choice of sunscreen is important, as this will ensure adequate use and protection from UV radiation.

"Extremely happy with my dermatologist. He set the expectations from the beginning- a simple prescription of creams, peels and sunscreen, and I could see results within 2 weeks!" Caroline R, Highgate Hill

"My melasma is much improved without the need for laser or high strength peels. A simple cream 3 nites a week keeps the pigmentation away!" Fiona K, Paddington.