Melasma appears in the form of brown, hyperpigmented spots, symmetrically on parts of the skin exposed to the sun: forehead, cheeks, above the upper lip, and chin. The cause of melasma has not been fully explained, but it is provoked by sun exposure, pregnancy, taking oral contraceptives and hormonal imbalance. Darker-skinned women are more likely to be affected by melasma.
Melasma involves increased synthesis of melanosomes (pigment) by melanocytes and their increased transport to neighbouring skin cells.
There are three types of melasma, depending on the level of skin in which the pigment is produced and accumulated:
–Epidermal melasma – pigmentation is in the superficial layers, lighter colour, easier to remove
– Dermal melasma –pigmentation is in the deeper layer, darker, ashy colour
–Mixed melasma– a combination of epidermal and dermal melasma, darker brown colour
What are the therapeutic options for treating melasma?
Strict sun protection is necessary in case of melasma. The use of protection containing physical filters such as zinc oxide and titanium dioxide is recommended. Topical use of hydroquinone, vitamin C, azelaic acid, kojic acid is most common for melasma.
Chemical peels and PRP treatments often produce good results. However, melasma is a chronic skin condition. Some types are difficult to remove and tend to recur.
If the response to local therapy is poor,laser melasma removal is the only effective method.
Which lasers are effective for removing melasma?
Q-switch lasersare non-ablative, highly effective lasers for the treatment of melasma and other pigmented lesions on the skin.
Designed to remove tattoos, they can very effectively break down the pigment from melasma and allow the lymphocytes to carry it away.
The advantage over chemical peels lies in the ability to extract pigment from the third layer of the skin without damaging the skin.
Some lasers can cause reactive hyperpigmentation, which is when the changes get even worse.
Q-switch lasersemit short pulses, lasting a billionth of a second, selectively destroying pigment located in the deeper layers of the skin, without damaging the surrounding tissue. During the treatment, lower laser energies are used which will not lead to irritation and inflammation. Laser treatments should not be performed on sunburned skin. The treatment is not effective in the case of excess estrogen and hormonal imbalance.
What does laser melasma treatment look like?
In our clinic, we use the Candela Q-switch laser– Alex TriVantage laser, which is a non-invasive, highly efficient laser. The entire patch is treated using the laser. A slight tingling sensation is felt during the treatment. Redness appears after the treatment, and in the following days the skin is dry, darker and slightly flaky.
Recovery is expected in 10 to 14 days, and regenerating creams should be applied topically. After the treatment, it is mandatory to use SPF 50+ creams for sun protection as well as whitening creams, which helps to achieve maximum results.
How many treatments are necessary?
Depending on the depth, colour and size, it usually takes two to four treatments to remove melasma. The procedure may be repeated after one month. In types of melasma that tend to recur frequently, their frequency decreases after laser treatments.
If the dermatologist deems it necessary, a chemical peel is applied immediately after the laser removal of melasma. The selected acid should stop the new pigment synthesis.
In order to achieve maximum results, other mentioned methods are combined immediately after the laser treatment.
Various inflammatory processes can provoke spots on the face which are called post-inflammatory hyperpigmentation.
Their treatment combines all the above methods, but in addition to the Q-switch laser, the Pulsed dye laser is also used.
In the case of post inflammatory hyperpigmentation, inflammatory process and neovascularization are the background of the problem.
Sometimes it is difficult to distinguish melasma from post inflammatory hyperpigmentation.
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