IN-OFFICE PROCEDURES FOR MELASMA TREATMENT: PROS AND CONS
Melasma is a recurring skin problem that many of us deal with, especially in women with darker skin tones. Traditionally, topical treatments and chemical peels are commonly used to treat melasma, but due to the recurring nature of this issue, many seek alternative treatments, such as chemical peels, lasers, microneedling, and more recently, platelet-rich plasma (PRP) procedure. So what are the pros and cons to these procedures? How can we maintain the result from in-office procedures to prevent melasma from returning?
1. Chemical Peels
There are currently various categories of peels for treating melasma. The main categories are AHA, BHA, and tretinoin peels. Among various peels, high concentrations of glycolic acid (30-70%) have been mostly used for in-office procedures. Peels are effective in treating melasma as they increase epidermal remodelling and increase skin cell turnover. Various studies with skin of colour have shown that glycolic acid peel is effective at treating melasma. Indeed, superior results have been reported with up to 50% of glycolic acid, especially when used in conjunction with other at-home skincare products, i.e. 10% Glycolic Acid, Vitamin C, azelaic acid, or adapalene. However, note that the recovery time may take a while and a very strict sun protection regime needs to be in place, in order to minimize neomelanogenesis and prevent post-inflammatory hyperpigmentation
PROS: Scientifically proven to be effective for skin of colour (more prone to hyperpigmentation), suitable even for sensitive skin (using a gel-based peel).
CONS: Can only yield a good result for epidermal melasma that is <1 year old (not effective for long-term, dermal melasma), medium or deep chemical peels may require 2-3 weeks of recovery time.
There are currently various laser treatments for melasma, but it is generally agreed that non-ablative lasers are preferred over ablative lasers, due to their tendency to cause less inflammation and subsequently post-inflammatory hyperpigmentation. Examples of lasers used to treat melasma include Q-switched, intensed pulsed light (IPL), ablative CO2, and non-ablative fractional lasers. Current data show that lasers are not effective as a monotherapy approach for treating melasma and in some cases, melasma recurs 3-6 months post-procedure, despite a strict post-procedural care. Check out Dr. Davin Lim's Youtube video (He is a Board-Certified Laser Dermatologist) to learn more
PROS: Improve both epidermal and dermal melasma, more suitable for light-coloured skin types (less risk of post-inflammatory hyperpigmentation)
CONS: Not advisable as a monotherapy, response can be unpredictable, melasma frequently recurs 3-6 months post procedure, lasers are NOT considered cures for melasma (they do not directly target melanin production), increased risk for post inflammatory hyperpigmentation, long recovery time (~2 weeks)
Microneedle technology creates micro-sized pores through the epidermis allowing the penetration of hydrophilic molecules. By disrupting skin cell architecture, microneedling also induces elastin and collagen expression and storage. A small study has reported its efficacy in treating melasma. Microneedling treatment in conjunction with topical treatment (tretinoin, hydroquinone, and fluocinolone) for 30 days improved the appearance of melasma in 22 subjects to varying degrees.
PROS: Great for increasing the efficacy of the topical treatment, minimal recovery time
CONS: Lack of data in the literature, not as effective as lasers or chemical peels.
4. Platelet-Rich Plasma (PRP) Skin Rejuvenation Therapy
PRP is a blood-derived product that contains higher concentration of platelets suspended in plasma. It contains various growth factors, plasma proteins, chemokines and cytokines, all of which contribute to skin healing, tissue growth, and generation of hyaluronic acid. So, this is a great anti aging treatment you can get at your dermatologist's office. Recently, scientists have begun conducting pilot studies to assess the efficacy of PRP in treating melasma. Studies with skin of colour reported promising results by far, but bear in mind that data remain limited compared to more conventional approaches, such as chemical peels and lasers. Also, note that PRP can be delivered with microneedling or microinjection technology.
PROS: positive data from pilot studies, suitable for skin of colour, minimal risk of post-inflammatory hyperpigmentation (given the delivery method), minimal recovery time
CONS: Lack of data in the literature, long-term efficacy unknown.
Note that depending on the severity of the melasma, combined treatments i.e. topical, oral, and/or procedural, may be required. Post-procedural care, such as strict sun protection regime, maintenance with a good skincare routine, and hormonal therapy must be in place to prevent melasma from recurring. It is very important to understand that melasma can return even after in-office procedures. Please consult with your dermatologist for a treatment that is most suitable for your skin.
Also, don't forget to check my blog post on skincare ingredients and products that can help reduce melanin production here
The Skin Press
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Sirithanabadeekul et al. (2019). DOI: 10.1111/jocd.13157
Sarkar et al. (2017). DOI: 10.4103/ijd.IJD_490_17
Trivedi et al. (2017). DOI: 10.1016/j.ijwd.2017.01.004