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Melasma: Treatment Options

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Melasma is one of the most frustrating skin conditions for so many of my patients. Characterized by patches of irregularly shaped, but well defined blotches of light to dark brown hyper-pigmentation, it usually appears on those areas of the face that see the most sun: the forehead, cheeks, nose upper lip and chin.

The exact causes of melasma are not completely clear. Hormones definitely play a significant role. This explains why 90% of melasma sufferers are women, many of whom experience their first bout during pregnancy, although oral contraceptives and hormone replacement therapy can also trigger outbreaks. Sun exposure is another huge risk factor. I have seen many patients over the years who, out of the blue, have developed a dark and persistent shadow over their upper lip while they were on their vacation in the Caribbean. Ethnicity also seems to play a role; women with darker olive complexions such as those of Hispanic, Asian and Middle Eastern descent are definitely more prone to developing melasma than those with lighter skin. Finally, any irritants to the skin such as waxing, electrolysis or laser hair removal can trigger long lasting melasma.

Treating melasma takes both patience and persistence. Since it is a chronic skin condition, it is never completely cured. It may disappear for a while, but any effective treatment plan is going to require consistent attention and constant re-evaluation. When you first come to see me at my Ottawa Cosmetic clinic, I will do a thorough evaluation to confirm that you do indeed suffer from melasma as opposed to another skin condition. From there, I recommend the most appropriate treatment plan for you. Most plans involve one or more of the following options:

  • My first recommendation to all of my melasma patients is: WEAR SUNSCREEN. The daily, consistent application of a good UVA/UVB sunscreen is one of your most crucial tools in preventing and controlling your melasma outbreaks.
  • Nuderm Obagi System offers an 18 week skin care program that is specifically designed to reduce melasma’s hyper-pigmentation. For the right patient, I have seen terrific results with this program. It comes with Hydroquinone (HQ) or with Arbutin (HQ free) for those with more sensitive skin.
  • Vitalize Peels are great for patients who have a mild case of melasma and are generally gentle enough to not irritate the skin.
  • Acid and chemical peels are good on their own, but I mostly use these to help maintain a patient’s even complexion once we have gained control over the initial presenting melasma.
  • IPL (FotoFacial) treatments are specifically designed for eliminating brown discoloration, and can be an extremely effective tool in battling melasma.
  • In expert and experienced hands, Lasers can significantly reduce melasma.

Important Note: It is imperative that you do not allow anyone but an expert to use lasers on your face. Although this should be the rule regardless of why you receive a laser treatment on your face, this is even more crucial when it comes to treating melasma. The reason for this is that if the laser settings are not set properly or if the skin is not prepared adequately with the appropriate products in the weeks preceding the laser treatment, or even if too many treatments are performed, laser treatments can actually make melasma worse. The Fraxel Dual 1927 is a fractional non ablative laser and it is considered the gold standard in treating melasma. I have been using it for several years with my clients and I have delivered very positive results in reducing melasma for the right candidates.

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