As frustratingly persistent as melasma is, it can be managed with an appropriate treatment. Not as well known is that the wrong treatments can trigger post-inflammatory hyperpigmentation and exacerbate existing melasma. That’s why it’s crucial to be diagnosed and treated by a board-certified dermatologist.
Melasma can vary significantly from one person to another. In some, the discoloration of the skin only goes as deep as the epidermis, or the more superficial layer. In others, it goes deeper, to the dermis. And some can experience a combination of both. Your treatment should be based on the distribution of your pigment. That said, there are a few in-office procedures that everyone with melasma should avoid.
Intense pulsed light (IPL)
IPL is a common go-to for correcting hyperpigmentation. And it can be a worthwhile treatment for moderate to severe melasma when it’s coupled with an aggressive topical maintenance regimen. However, in dark skin types, there’s an increased risk that IPL will target normal endogenous skin pigment, which can lead to post-inflammatory hyperpigmentation.
Non-ablative fractional resurfacing lasers (NAFRLs)
NAFRLs, like Fraxel, are lauded for their ability to reduce the appearance of fine lines and wrinkles, improve skin tones and texture, and correct hyperpigmentation. But where melasma is concerned, they tend to do more harm than good. While the 1550 nm and 1927 nm NAFRL have been shown to be effective in treating melasma, they also appear to pose a greater risk of worsening the condition and causing post-inflammatory hyperpigmentation than some of the other available technologies, including Clear and Brilliant and picosecond lasers.
Ablative fractionated resurfacing lasers (AFRLs)
AFRLs like CO2 and erbium:YAG decrease the amount of epidermal injury, which diminishes the adverse effects of melasma. But, again, they carry a higher potential to cause post-inflammatory hyperpigmentation and worsen melasma than less aggressive lasers.
Q-switched lasers are often used to remove tattoos, freckles, and other dark spots. But they’re not a good option for treating melasma because they fire a longer pulse duration. That matters because it can lead to thermal damage in the surrounding tissue, increasing the likelihood of post-inflammatory hyperpigmentation developing.
Some chemical peels
Chemical peels have shown the ability to correct hyperpigmentation without the side effects or downtime of most laser treatments. But there is a higher risk of post-inflammatory hyperpigmentation with some chemical peels and even the potential for the melasma to worsen. Superficial peels, such as glycolic acid and retinoic acid, generally pose less of a risk of complications because they tend to be less irritating and inflammatory than stronger peels.