Melasma
Melasma is a peculiar condition of the female sex that consists of the appearance of dark spots badly delimited in the area of the face, especially the forehead, mustache and cheeks. It is usually associated with a genetic predisposition factor, with the taking of oral contraceptives, with pregnancies and usually appears after intense exposure to the sun.
The treatments are effective, but they are slow and often relapse after to have achieved to “clean or bleach” the woman’s skin. This leads to significant discouragement. It is for this reason that it is very important that the dermatologist explains to the patient that any treatment to combat and completely reduce melasma is long, that obliges to cover the area with high photoprotectors and thick makeup. And that with a proper maintenance, the non-reappearance of the same is achieved.
It should also be known that if the woman continues to take contraceptives during treatment, the expected results will be very poor and with great resistance for improvement. Occasionally, the woman can’t leave them for some medical reason and has to assume the difficulty of getting a complete disappearance of melasma stains.
In the most favorable scenario, with the absence of contraceptives and without forecast of pregnancy immediately, the treatment project is based on the combination of non-ablative fractionated laser (3-4 sessions / year) with topical depigmenting products in the form of creams or lotions. It should be clearly explained that combined use is the key to success in this condition. If we treat melasma with laser only we will obtain few results. If we apply only depigmenting creams we will get a partial clarification or no result.
About the laser it should be known that alone the type of laser discussed above that is, non-ablative fractionation, preferably of Erbium, is suitable. The other lasers used as the Q switched of Neodymium or Alexandrite or IPL, not only do not solve the melasma but can make it worse.
About the depigmenting products, the ideal is to use the Hydroquinone 2-5% in a discontinuous way, that is, to rest from time to time. It is the most effective whitening product, although it can’t be applied to pregnant women or when the woman wants to become pregnant, and in certain women it can produce irritations and redness that can force her to leave her.
Similar products such as Arbutine which is a precursor to Hydroquinone is used for the purpose of bleaching in women who do not tolerate Hydroquinone but does not have the efficacy of it.
Together with Hydroquinone is used kojic Acid which has a beneficial effect and increases the results of the Hydroquinone. Adding Retinoic Acid or Glycolic Acid increases the penetration effect of the Hydroquinone. It can have the inconvenience, according to the skins in which it is used, of increasing also the irritation. If the skin tolerates these combinations of Hydroquinone + Kojic Acid + Retinoic Acid or Glycolic Acid, satisfactory results come before. A corticoid or other anti-inflammatory is usually introduced to minimize predictable skin irritation.