Finally, a More Effective Treatment for Melasma

Melasma can be frustratingly difficult to treat for all the reasons I highlighted in my last blog post. But there’s growing optimism that that might not always be the case.

New research indicates that energy-free microneedling, typically in conjunction with potent fade creams and strict sun avoidance, can be an effective treatment for melasma across all skin tones. Let’s get into how it works and why.

How it works

Lasers are generally great for eviscerating excess melanin. But the heat they generate can make melasma worse, triggering the formation of even more discoloration in the weeks following treatment. By contrast, mechanical microneedling generates no such heat.

Through a series of clean, controlled punctures, microneedling is able to reach the deeper dermis that’s often affected by melasma. There, via its healing mechanisms, we’re essentially forcing the surrounding skin to make brand-new skin that hasn’t yet been agitated by hormones or the sun.

Exactly how deep the punctures are will depend on a few factors: the location of the pigment, the patient’s susceptibility to creating more melanin as a result of inflammation (also known as post-inflammatory hyperpigmentation, or PIH), the overall sensitivity of the skin, and the amount of downtime a patient’s willing to endure.

That said, the greatest improvement generally results from varying the depth of the punctures across the face, based on the depth of the pigment that’s being targeted and the thickness of the skin (the cheeks can tolerate a deeper puncture than the nose or around the eyes).

In a new study – a review of 459 melasma patients from seven different countries – researchers found that “topical therapy with microneedling improved melasma severity with a large effect,” with the best results seen at 12 weeks. The key phrase is “topical therapy with melasma.” On its own, said one of the study’s coauthors, microneedling doesn’t help.

The other part of the equation

Lighteners enter the equation at different phases. First, dermatologists will usually have patients “pretreat” their skin for two weeks prior to microneedling with a bleaching cream – either a prescription-strength hydroquinone or a formula that contains hydroquinone plus a retinoid and low-dose corticosteroid.

Then, during the microneedling, active ingredients are inserted into the punctures as soon as they’re made or slathered on the treated skin right after. Every dermatologist has their own preferred formulation, but most include some combination of tranexamic acid, glutathione, vitamin C, and niacinamide, most of which are traditionally administered intravenously. Platelet-rich plasma is also popular.

Most patients will undergo several sessions, spaced four to six weeks apart. For the first few days after each treatment, it’s a good idea to use only gentle cleansers, healing ointments, and mineral sunscreens. 

As with most medical procedures – and this should certainly be considered one – there is the potential for complications, which makes it all the more important to seek out a board-certified dermatologist with extensive experience administering topical therapy with microneedling.