Dr. Angela Hwee: Are lasers worsening your melasma?
When I see patients for pigmentation-related conditions like melasma, often I’m asked,
“Doc, so which lasers should I use?”
“Is it the pico laser?”
“How expensive will my laser treatment be?”
Now, since when was melasma treatment associated with lasers? Yes, lasers are often used to treat this notoriously stubborn condition – but they’re not the be-all-end-all. In fact, if used inappropriately at the wrong time, lasers can worsen your melasma.
If your doctor has been selling you package after package, guaranteeing you that your melasma can be cured, I urge you to reconsider. That’s because melasma cannot be cured.
In this article, allow me to answer some of your biggest questions about melasma, including how your laser treatments might be worsening your melasma, why your melasma isn’t getting better despite choosing the correct treatment, and whether this condition will ever get better.
What is melasma in a nutshell?
Melasma involves relapsing and chronic hyperpigmentation that is characterised by symmetric patches on the face, neck, chest, and forearms. Melasma can also start as darker patches on both sides of the mouth.
The condition is often called chloasma or “the mask of pregnancy”; patients commonly notice dark patches in their 30s, or whilst they’re expecting. And while melasma can be psychosocially detrimental, it is asymptomatic, and is not clearly associated with any systemic illnesses.
In Singapore, melasma most commonly affects Chinese, Korean, Japanese, Hispanic, African-American females1.
Can melasma be cured or can it only be controlled, and to what extent?
Melasma cannot be cured. However, it can be lightened to such a significant extent that the hyperpigmentation is no longer visible. To see long-lasting improvements, regular maintenance is needed even after a course of laser treatments – you can imagine how draining and not pocket-friendly this could be; hence why many patients express disappointment and give up entirely after a while.
Unlike conditions like acne scars where treatment does not always have to be prolonged, the nature of melasma unfortunately does not allow transient treatments.
But treating melasma is like treating ageing – anti-ageing treatments cannot reverse ageing, but they can slow down this inevitable process coupled with the help of lifestyle factors.
What is the best way to treat melasma?
Educate, educate, educate. When patients know enough about their condition, they better understand why certain things need to be avoided or done, and will be more aware and compliant with advice given.
Successful treatment is a two-way street, and requires teamwork from both the doctor and patient. In terms of optimal treatment, I prefer to use a combination therapy approach, especially for difficult cases, comprising:
- Both prescriptional and skincare topical applications
- Oral medications, for patients who are willing and well-suited for it
- Lasers and fractional microneedling, which prevent treatment results from stagnating
Our clinic avoids aggressive lasers, as we have often seen melasma darken after aggressive laser treatments at other clinics. Often, melasma rebounds shortly after such treatments despite seeming success initially.
So do lasers really worsen melasma?
It depends. For the most part, lasers play a huge role in treating melasma. But it could go south if:
Your doctor is not making keen decisions about what type of laser to use
For example, they might be using too aggressive or too weak a laser, or even the wrong laser for your specific condition. It is paramount that your doctor makes good judgement calls when choosing which laser to use on you. This deep understanding only comes with the experience of having treated countless cases of melasma.
You require a change of laser upon entering another stage of your treatment
It is not uncommon that a single patient might need a few different lasers at various stages of their melasma treatment.
You are a darker skinned individual who is getting treatment meant for lighter skin
Doctors treating individuals with richer skin must be able to use laser settings that are strong enough to treat the melasma effectively, yet not too strong that it burns their patients.
You are not getting laser treatment at optimal intervals or quantities
Laser treatments with longer intervals (4-6 weeks) are very useful when it comes to maintaining results and helping to prevent melasma from recurring.
What are some common mistakes people make when they seek treatment for melasma?
Many wrongly think they have freckles and that they can be easily treated with a single laser treatment session. This cannot be further away from the truth, as melasma requires long-term topical applications as well as a course of laser treatments.
But make no mistake – not all topical applications are helpful for everyone.
For example, I once had a patient who was using topical Hydroquinone 4% as prescribed by another doctor for her melasma. She came for a second opinion after her melasma worsened with treatment.
When I saw her, her skin was red from the medication! Simply by stopping the HQ application and using a simple soap-free cleanser and moisturiser, the patient’s melasma lightened within 2 weeks.
While Hydroquinone 4% is commonly used by doctors to treat melasma, many patients are actually sensitive to HQ and do not respond well to it. Melasma can be so unique that various topical medications used to treat it can negatively affect patients with sensitive skin.
Rule of thumb: Avoid or stop any product that causes even the tiniest bit of red or causes dryness, as slight inflammation of the skin can worsen melasma.
What does regular maintenance for melasma look like?
- Regular maintenance can be in the form of topical applications, such as serums that contain lightening ingredients like Vit C or Resorcinol2.
- Apply sunscreen during the daytime, even when indoors.
- Use topical applications that do not cause skin sensitivity, redness or other reactions.
- Regularly check in with your doctor or read more about your condition from credible sources – knowledge is power!
How realistic should local patients be when it comes to treatment outcomes?
While heat and the sun in Singapore are huge melasma triggers, it really depends on the patient’s lifestyle. If they spend a lot of time outdoors during the day, they must be extremely diligent with wearing sunscreen and protective headgear for their treatment to be effective. Naturally, their course of treatment may also be longer compared to those who mostly exist indoors.
Any questions? Feel free to drop me a message or arrange a consultation with me to personally assess your condition.
- Sarkar, R., Ailawadi, P., & Garg, S. (2018). Melasma in Men: A Review of Clinical, Etiological, and Management Issues. The Journal of clinical and aesthetic dermatology, 11(2), 53–59.
- Grimes, P. E., Ijaz, S., Nashawati, R., & Kwak, D. (2018). New oral and topical approaches for the treatment of melasma. International journal of women’s dermatology, 5(1), 30–36. https://doi.org/10.1016/j.ijwd.2018.09.004