Question for the group:

What have folks found to be most effective for treatment of melasma, particularly in skin types IV or darker? Is there a particular product, treatment or combination that you have found to work best?

Also, the same question about post-inflammatory hyperpigmentation from acne and hyperpigmentation from laser treatments? What works best?

Thanks in advance.

Topicals. Obagi NuDerm.

Fraxel is an option but be careful.

We have been getting results that are satisfying to the patient (proper positioning of expectations is key!) with a combination of IPL - Cutera LP560, topical hydroquinone and steroid used judiciously, and Prevage MD. We start very low on the power for the IPL in an area of the body that won't be a problem if it gets a bit darker, let them heal completely and assess the result before even considering a full treatment.

being in south texas we treat a lot of fitz. IV and V types, look into EpiQuin Micro, I have seen great results when used correctly and had great pt feedback. PIH really just takes time, I suggest a product for sensitive skin with kojic and azelaic acids. you could also use 2% hq if there is no sensitivity. you just need to becareful no cause more hp. I would prep my pt with HQ before tx if I were concerned about PIH

Thanks for the advice everyone. Has anyone tried Cosmelan Depigmentation system by Mesoestetic?

Seems to be fairly costly. It would be good to know if it really does better than other products.

I heard some great things about cosmelan on other websites and so I tried it on a family member with PIH. The physician tx didn't do anything for the pigmentation and the daily cream feels tacky on the skin and caused her to breakout and made her mineral makeup look cakey. She refused to continue using it when her skin texture felt worse 3 wks into the program. It's also very difficult to get answers from their phone reps unless it's part of the script they are obviously reading from.

JMD,

Thank you for the feedback. I have been getting a lot of calls from them ever since I requested their catalog. I have wondered if their claims were too good to be true.

Kikuchi: from my experience a series of Modified Jessners peels is very good for "epidermal melasma' . Dermal Melasma will require a Q-switched laser to improve. You can tell the difference between epidermal and dermal by using a woods lamp.

hi dermarogue:
how does epidermal vs dermal melasma appear different with a wood's lamp? Is dermal melasma a deeper brown?

Never mind. I got the info out of a derm text.

Triluma works the best for most patients with type 4 and 5skin type and melasma.

I second Tri-Luma for melasma, can be used in all skin types.

We have been using the Fraxel 1500 in practice in the treatment of Melasma very successfully. Melasma responds very well to the right settings, the complications typically occur in too many treatments. There is no protocol so a lot of practitioners get good results after 2-3 and push the envelope trying to achieve 100% clearance and this can actually aggravate the problem. Treat Melasma in skin types 1-4 at 8mz level 6. Pre treat for 3 weeks with HQ 6% and the results are amazing.
More is not better when it comes to Melasma.

Has anyone heard or or used MSM Sulfur to treat melasma???? Does it work? Does it help?

Methyl-Sulphonyl-Methane Sulfur

There is a book called Melasma . . . is this the clear solution? by Vaness Wild that claims the MSM Sulfur works.

can anyone suggest a protocol using quantum IPL for treatment of melasma?

See my post on "Melasma Users Group"

We have recently purchased the new Cosmelan formula for treatment of melasma. It contains 8% HQ and many active ingredients known to be tyrosinase inhibitors. Our experience has been it does a very effective job removing melasma on skin types I-IV. In fact we have reduced the number of laser procedures and now have been moving toward the Cosmelan treatment on a routine basis. We buy the kit from Mesoestetic in Encino, CA for $300. We charge the patient $1,000. It's a very profitable procedure and my aestheticians manage the skin side of my practice.

I have incorporated adding Cosmelan 2 into my treatment protocol by having the patient apply the product 30 days prior to the first laser treatment. This will alleviate any PIH issues you may encounter.

We have recently purchased the new Cosmelan formula for treatment of melasma. It contains 8% HQ and many active ingredients known to be tyrosinase inhibitors. Our experience has been it does a very effective job removing melasma on skin types I-IV. In fact we have reduced the number of laser procedures and now have been moving toward the Cosmelan treatment on a routine basis. We buy the kit from Mesoestetic in Encino, CA for $300. We charge the patient $1,000. It's a very profitable procedure and my aestheticians manage the skin side of my practice.

I have incorporated adding Cosmelan 2 into my treatment protocol by having the patient apply the product 30 days prior to the first laser treatment. This will alleviate any PIH issues you may encounter.

We have recently purchased the new Cosmelan formula for treatment of melasma. It contains 8% HQ and many active ingredients known to be tyrosinase inhibitors. Our experience has been it does a very effective job removing melasma on skin types I-IV. In fact we have reduced the number of laser procedures and now have been moving toward the Cosmelan treatment on a routine basis. We buy the kit from Mesoestetic in Encino, CA for $300. We charge the patient $1,000. It's a very profitable procedure and my aestheticians manage the skin side of my practice.

I have incorporated adding Cosmelan 2 into my treatment protocol by having the patient apply the product 30 days prior to the first laser treatment. This will alleviate any PIH issues you may encounter.

We have recently purchased the new Cosmelan formula for treatment of melasma. It contains 8% HQ and many active ingredients known to be tyrosinase inhibitors. Our experience has been it does a very effective job removing melasma on skin types I-IV. In fact we have reduced the number of laser procedures and now have been moving toward the Cosmelan treatment on a routine basis. We buy the kit from Mesoestetic in Encino, CA for $300. We charge the patient $1,000. It's a very profitable procedure and my aestheticians manage the skin side of my practice.

I have incorporated adding Cosmelan 2 into my treatment protocol by having the patient apply the product 30 days prior to the first laser treatment. This will alleviate any PIH issues you may encounter.

We have recently purchased the new Cosmelan formula for treatment of melasma. It contains 8% HQ and many active ingredients known to be tyrosinase inhibitors. Our experience has been it does a very effective job removing melasma on skin types I-IV. In fact we have reduced the number of laser procedures and now have been moving toward the Cosmelan treatment on a routine basis. We buy the kit from Mesoestetic in Encino, CA for $300. We charge the patient $1,000. It's a very profitable procedure and my aestheticians manage the skin side of my practice.

I have incorporated adding Cosmelan 2 into my treatment protocol by having the patient apply the product 30 days prior to the first laser treatment. This will alleviate any PIH issues you may encounter.

people use this website to hurt other peoples business, jealous, childish, mean and self centered - you know who you are - get a life

We have recently purchased the new Cosmelan formula for treatment of melasma. It contains 8% HQ and many active ingredients known to be tyrosinase inhibitors. Our experience has been it does a very effective job removing melasma on skin types I-IV. In fact we have reduced the number of laser procedures and now have been moving toward the Cosmelan treatment on a routine basis. We buy the kit from Mesoestetic in Encino, CA for $300. We charge the patient $1,000. It's a very profitable procedure and my aestheticians manage the skin side of my practice.

I have incorporated adding Cosmelan 2 into my treatment protocol by having the patient apply the product 30 days prior to the first laser treatment. This will alleviate any PIH issues you may encounter.

I have been using Cosmelan for over a year ( you can't stop for few years ) and i have great results. my skin looks better than ever. i highly recommend to anyone with dark spots.

Kikuchi, melasma and postinflammatory hyperpigmentation can be TEMPORARILY IMPROVED, BUT NOT CURED with lasers.

Sun protection. Or you can just prescribe tretinoin and hydroquinone separately.

Don't forget sunscreen too! The next best option would be chemical peels/fractional C02.

I completely agree with chris b. Comply with your sunscreen regimen!

I have been applying 8% hydroquinone with tretinoin and dexa daily. Works really well for me. I'm just used to the redness. But I also avoid the sun and religiously apply my sunscreen.

Have you tried Q-switched Nd:yag laser? Multiple treatments helps in improving hyperpigmentation.

I have a 45 yrs old female client that's had Melasma for the past 20yrs, it's very bad on the forehead and low face and jaw areas. Over the yrs she has tried many treatment but with no success. Does anyone know of a cream or lotion to help on the skin? many have been suggested but it would be nice to hear from someone that has had some results with this skin problem.

Q-switch Yag lasers can be very helpful, but expect to do many treatments (8 or more). I've also seen Melanage peels from Young pharmaceutical's make a noticeable difference for some people as well. Q-switch Yag will likely be more helpful for the dermal component of the melasma

In the past I have tried Dermaceutic spot peels for some patients with very resistant melasma and saw improvement. Fraxel re:store 1927 treatments have helped our darker skinned patients with melasma, however we prep their skin for 2- 4 weeks with hydroquinone prior to each treatment and in between treatments. Patients do have to understand though that we cannot guarantee that it will work, but we have seen quite good results from a series of treatments.

In the past i have tried Tri-luma but i prepared extempore before use .I do not guarantee but it is working !