Laser treatment of melasma

Melasma are dark hyper-pigmented patches located on the forehead, chin and upper lip, caused by the increased production of the pigment melanin in the skin. They can appear after intense exposure to UV rays, during pregnancy, when taking contraceptives and due to hormonal imbalances.

Depending on the skin depth at which the pigment is produced and accumulated, melasma can be:

  • epidermal melasma – light brown in color, the pigment is located in the top layers of the skin
  • dermal melasma – grayish and bluish in color, the pigment is located in the deeper third layer of the skin
  • mixed melasma – dark brown in color, the pigment is present in both the superficial and deeper layers of the skin

Melasma are often a chronic skin condition, certain types are hard to remove and they have a tendency of recurrence. Newer and superficial patches respond well to the application of creams and to chemical peels. Older and more deeply engrained melasma, especially of the mixed type, does not respond well to standard therapy, so that laser therapy is the only efficient method of removal.

Which lasers are efficient and safe for melasma removal?

It is known that in some persons lasers can cause an increased pigment production and lead to a worsening of the melasma. By using the Q-switch laser which emits short impulses during the treatment, the pigment located at a certain skin depth is selectively destroyed, without causing damage to the surrounding tissue. It is recommended that the Q-switch laser is used at lower energy levels during the treatment of melasma, which does not lead to irritation and inflammation. Potential undesired effects and unwanted hyperpigmentation are thus reduced to a minimum. In persons prone to scars and staining it is possible to test a smaller skin surface before the laser treatment. Laser treatment of melasma will not be effective if the melasma are related to hormonal imbalances and increased levels of the estrogen hormone. Removal of melasma from sun exposed skin is counter-indicated.

What does the laser treatment for melasma look like?

In our clinic, melasma are removed by a Q-switch Candela laser, the Alex TriVantage model, which was shown to be very successful in melasma removal treatment around the world. During the laser treatment, the entire skin surface is treated with laser rays which are absorbed by the pigments in the skin.

Occurrence of redness on the treated areas is possible following treatment and it normally recedes after 1-2 days. The treated surface is dry and flaky. Skin re-epithelization creams are used for 10 days following treatment. Sun protection with SPF 50+ sun screen cream is advised along with the use of skin lightning creams, which gives the best results in melasma removal.

How many laser treatments are needed?

Depending on whether the type of melasma is epidermal, dermal or mixed, it usually takes between 2 to 4 treatments. Some melasma have the tendency to recur, but recurrence is reduced following laser treatment. In such cases, maintenance treatments are advised once a year, so that melasma are removed and their recurrence is prevented.

Spec. Dr. Sladjana Cvejic, dermatologist
Dermatological clinic DERMATIM, Belgrade