Can melasma be cured?

You might have begun to notice it as a faint brownish shadow on your cheeks, forehead or upper lip that you had dismissed as ‘nothing’.Over time, you got more worried as the marks grew darker and bigger.

After a carefree day in the sun, the patches too, multiplied with wild  abandon. Before you knew it, even packing on layers of make-up couldn’t conceal the obvious patches.

Sounds familiar?

I’ve heard this story countless times.

Melasma affects up to a third of women. It is one of the most common medical aesthetics conditions that I have treated over the years.

Melasma can be very distressing. It can get very tiring for patients to constant camouflage the brown plaques. Sometimes, the pigmentation bothers patients so much that they choose to stay home rather than go out to social occasions.

Patients are often desperate to cure their melasma but many lack knowledge on how melasma should be treated.

Such patients are vulnerable and are often taken advantage of.

They often waste thousands of dollars on dubious treatments after being convinced by flashy advertising, celebrity endorsements or aggressive sales tactics.

At the end of the day, they may end up worse off.

How can you avoid getting scammed? Here are some red flags you should watch out for.

1. Impressive Before And Afters - Are They Legit?

Many advertisements feature impressive before and after pictures. Examples can be seen in TV commercials or banner ads splashed across the MRT cabin. Typically, these are from beauty salons and show severe pigmentation totally gone after ‘just a few’ treatment sessions.

There’s a reason why Singapore’s Ministry of Health has prohibited medical clinics from putting up before and after pictures.

At best, these before and after pictures may not be representative of the effects of the proposed treatment.

At worst, they could be the results of creative make-up and editing.

Many of the ‘before’ pictures look suspicious.

For example, the distribution of the pigmentation or appearance may not be consistent based on my experience seeing many patients with melasma over the years.

And it goes without saying that make-up + Photoshop does wonders.

Don’t take impressive before and after pictures at face value!

A responsible doctor would only share these as part of his experience and stress that they may not be representative.

2. Can Instant Whitening Really Be Achieved?

Melasma is a chronic condition, often slow to respond to treatment.

At the same time, it is a particularly sensitive to inflammation and irritation.

Aggressive treatment of melasma may actually result in melasma rebound or post inflammatory hyperpigmentation. In other words, trying to quickly lighten melasma and get a quick result may actually cause melasma to worsen.

For example, intense pulsed light treatments, aggressive chemical peels or overly strong lasers can sometimes initially clear melasma, only to be followed by visibly worsening days later as more melanin is produced.

That ‘laser’ that your beautician uses to burn off moles and pigmentation often turns out to be a electrocautery pen instead of a real laser. These do not specifically target pigmentation, produce lots of collateral heat damage and are almost guaranteed to cause a flare.

Melasma treatments that promise instant or quick results after just a few sessions are best viewed with a healthy dose of scepticism.

3. Are Beauty Salons Safer Because They Don't Use Lasers?

After years of research, a beauty salon develops a proprietary miracle formula made with milk and flowers that cures melasma effectively with no lasers, invasive procedures and light machines involved.

Sounds too good to be true?

It probably is.

In medicine, heavy emphasis is placed on evidence based medicine. Research data guides treatment decisions. Qualified medical specialists scrutinize and review clinical studies prior to acceptance for publishing by reputable medical journals.

If said beauty salon formula is indeed so effective and research proven:

1. Wouldn’t it be to their advantage to publish the research to bolster their claims? It would certainly help them get more customers.
2. A properly conducted clinical study would prove their claims allowing them to charge even more but you don’t see them doing this
3. Multi-billion dollar pharma companies would have thrown a ton of cash at them to license or buy the formula outright for worldwide distribution and profit

Singapore’s Ministry of Health strictly regulates medical practice.

In contrast, there is minimal to no regulation of the beauty industry, leaving the door open to wild, baseless claims.

4. Bargain Laser Treatments - Worth Your While?

A few years ago, a chain of medical clinics selling very cheap laser packages sprung up and grew very rapidly. These clinics generally only equipped one type of laser (q-switched nanosecond laser).

The laser sessions were sold in bulk. The one and only type of laser machine available was touted to fix all sorts of problems from pimples, pores to pigmentation. Each session was very short and patients were encouraged to get many frequent laser treatments.  The doctors doing the lasers tended to be relatively inexperienced and changed from session to session.

What happened?

Since melasma is a recurring problem, patients kept going back frequently for laser treatment, encouraged by sales consultants. Monitoring of their condition was difficult as the patients saw different doctors each time.

Eventually, many of these patients developed permanent white spots alongside the melasma. Not only was the melasma not cured, but their skin tone ended up looking even more patchy and unsightly.

I have seen and treated many of these victims.

The chain of clinics eventually died out as they were selling laser packages at unsustainable prices and were unable to deliver.

What Are You Paying For?

Melasma is a difficult condition to treat.

Newer lasers, such as fractional ruby, picosecond lasers or thulium lasers, have been developed to treat melasma more safely and effectively. The more advanced the laser, the more expensive it tends to be. Some lasers can cost more than a quarter of a million dollars to purchase, not to mention the running and maintenance costs.

Experienced, highly skilled professionals probably won't find it worth their time and effort to offer bargain basement treatment prices.

As the saying goes, you get what you paid for.

And if you paid peanuts, you might just get a monkey.

Try not to fixate on getting the cheapest, best laser deal.

Pay more attention to the the doctor’s skills and knowledge, as well as safety and effectiveness of the treatment.

5. Does A True Melasma Cure Exist?

If you are being told that melasma can be cured if you just signed this package of laser treatments or facials, please turn around and walk out the door.

To cut a long story short, there is NO cure for melasma.

To date, the disease process that causes melasma is still unclear.

Vascular lasers (such as Dual Yellow, Pro Yellow or Pulsed Dye lasers) are sometimes touted to target the blood vessels feeding the melasma, but they have not been shown to cure the condition.

New developments such as fractional thulium laser, microneedle fractional radiofrequency seem to produce longer lasting results. Progress has also been made in utilizing oral and topical medications to control melasma.

However, no treatment has ever been consistently proven to be able to cure melasma.

How Can You Beat Melasma?

Fret not!

While there is no cure per se, melasma can be treated effectively with the right approach.

The Most Important Factor in Melasma Treatment

It is important to consult a doctor to get a thorough examination.

I would not trust a beautician to have the proper medical knowledge and specialized tools to make a proper diagnosis.

Sometimes, melasma can coexist with other pigmentary conditions. Other times, it may turn out not to be melasma at all.

Needless to say, different conditions are treated differently, so this is very important.

Is There One Laser That Can Treat All Melasma Cases?

Many new lasers and devices have been developed to treat melasma in recent years.

After treating many cases of melasma, it is clear that melasma has a spectrum of activity.

Some patients respond quickly with fast pigment clearance, whereas others require more sessions. In some patients, the pigmentation comes back very slow after laser, while others require more frequent maintenance. Patients may have very different responses to various treatments.

Hence, it is important to have a range of treatment options such as:

• Picosecond laser: Better than traditional nanosecond q-switched laser toning at breaking up melanin while less likely to cause white spots
• Fractional Ruby Laser: More pigment specific than traditional Nd:YAG wavelength used for laser toning and unlikely to cause white spots
• Fractional Thulium Laser: Results last longer than traditional laser toning, added skin rejuvenation benefits and unlikely to cause white spots
• Vascular Laser: Results may last longer than traditional laser toning.
• Microneedle Fractional Radiofrequency: An adjunct to prolong the results of other laser treatments

Should You Rely On Laser To Control Melasma?

Melasma is a long-term condition in which the balance of pigment production and elimination is upset. Excess pigment is constantly being produced and deposited in the skin.

The goal of melasma therapy is to limit the pigment production and remove the built up pigmentation. A maintenance regimen is required to keep pigment production and elimination in equilibrium once the desired amount of lightening is achieved.

Purely relying on laser treatments is inadequate. It is necessary to control melasma activity and hence pigment production This may involve control of risk factors (such as sun protection), topical and oral medications and supplements. Sporadic procedural treatments may also be required for maintenance, depending on how well the melasma can be controlled .

Conclusion

Melasma can be frustrating to deal with but it can be treated and managed.

Many patients have good results and clearer skin with proper medical treatment.

You can read more about how I personally treat melasma here.

It does take effort to control the risk factors, use medications and supplements to suppress the melasma, and come for laser sessions to clear the pigmentation.

A close partnership between you and your doctor is necessary for great outcomes.

You might be considering melasma treatment but harbour uncertainties about its effectiveness . Or perhaps, you might have questions about other aspects of melasma treatment.

Please feel free to drop me a message. I’ll try my best to help!

References

1. P.E. Grimes, MD, S. Ijaz, BA, MPH, R. Nashawati, BS, MSGM, and D. Kwaka. New oral and topical approaches for the treatment of melasma. Int J Womens Dermatol. 2019 Feb; 5(1): 30–36.
2. Sharmishtha Shailesh Deshpande, Swapna S. Khatu, Geeta S. Pardeshi, and Neeta R. Gokhale. Cross-sectional study of psychiatric morbidity in patients with melasma. Indian J Psychiatry. 2018 Jul-Sep; 60(3): 324–328.
3. M.K. Trivedi, BS, BA, F.C. Yang, MD, and B.K. Cho, MD, PhD. A review of laser and light therapy in melasma. Int J Womens Dermatol. 2017 Mar; 3(1): 11–20.