Skincare, makeup, and medspa procedures tend to become the primary focus when someone is first dealing with melasma. Of course, this makes perfect sense; people are used to treating blemishes topically with conventionally available products or processes. Unfortunately, this usually means turning to harsh and abrasive chemicals and procedures. While these may help some people some of the time, 9 out of 10 times they end up making things worse.
As we know from my Defining Melasma article, melasma is a highly inflammatory sensitive condition. Making matters worse can be very easy to do with topical treatments.
Melasma is an inflammatory skin condition, it is very sensitive to heat both internal and external. We don’t want to treat inflammation with more inflammation, we want to calm the skin and nourish it.
The bottom line is your routine and products won't cure your melasma but depending on your choices they can certainly make it worse. Knowing what is in your products and how to identify a good product is the key to a successful routine.
Medspa procedures.
Laser both ablative/non-ablative.
It is possible for laser treatment to help with melasma, but in my experience this is quite rare. Usually lasers exacerbate the condition. Let’s take a look at the different options available.
Lasers cause heat to penetrate the surface of the skin, inducing inflammation. There isn’t a single laser that won’t make your face red directly after treatment, and redness indicates inflammation.
Ablative lasers are likely to aggravate melasma and should be avoided at all costs.
Non-ablative lasers are generally considered less invasive and are often touted as melasma-approved treatments. Don’t believe this. We have seen lasers work for some people but I would estimate about 10% of the people who try it end up with good results. It is generally expensive and you will need yearly treatment to keep up with any beneficial results.
Making lasers work
Lasers will only work if you regularly use a topical between sessions. You will generally need somewhere between 6-10 sessions along with corresponding topicals to see positive results. This process must usually be repeated yearly to maintain said results. It can become quite cost prohibitive depending on treatment.
There is one laser that has recently come to my attention called LaseMD. This laser is non-ablative and is used with 4 serums after treatment. The serums included are vitamin C, A, tranexamic acid and resveratrol. Personally I would skip the vitamin C, but the other serums are ok. I’ll talk more about vitamin C in the next article.
The treatment costs around $600-$1200/session, though I have heard of $200 sessions I believe in Arizona. This laser creates microchannels in the skin so that the corresponding products can penetrate within the deeper layers of the skin. If your melasma is already breaking up or in a passive phase it might be a good option.
LaseMD still causes inflammation and it will likely make your face peel. As with any other laser treatment it should not be used if you have active melasma. The duration of LaseMD’s benefits depend on your internal imbalances and inflammation levels.
Lasers are a risky game and often not worth the expense and risk considering the low likelihood of a desired outcome. The best thing to do is find a skincare routine you feel good about until you can get your melasma to fade/reverse. Once you are able to do that you can reassess how comfortable you are with lasers.
Remember to patch test before going into a full treatment. If you can arrange to see the effects of the laser on a smaller patch of skin you can see the expected results with much less risk before deciding if the full treatment will be worth it
Microdermabrasion removes the stratum corneum and is best suited for mild skin conditions.
Melasma commonly exhibits a thinning of the stratum corneum as a result of sun exposure. We don't want to continue to agitate the stratum corneum; we want to support it so it can be replenished and healed.
Microdermabrasion can make melasma worse by heating up the skin which causes inflammation. Some patients will experience sunburn-like symptoms after treatment, and we all know how terrible sunburns are for melasma.
Microneedling is often recommended for hyperpigmentation. The procedure is meant to help topical products get into the deeper layers of the skin. Microneedling is done with tiny needles that poke wounds into the skin, stimulating collagen and elastin. This is great for acne, scarring, hair loss, large pores, stretch marks, wrinkles and hyperpigmentation. Microneedling does cause inflammation to the skin and if your melasma is active it may likely make it worse. It can also cause bruising, bleeding, scarring and it can sometimes take days to weeks to heal if you have a bad reaction. These side effects are not common but can be especially damaging for those with melasma.
Microchanneling is said to be less invasive than microneedling, however it seems to be very similar. Microchanneling is used with a round paddle-like device. The head contains less needles that are more spread out. It uses the same basic action as microneedling and causes tiny wounds to stimulate collagen and elastin for healing. Though it claims to cause less inflammation than microneedling it will cause inflammation nonetheless. If your melasma is active this won’t be an ideal option, if your melasma is passive or fading it may be a better choice than microneedling.
Intense Pulse Light Therapy or IPL aka photo facial.
IPL releases light at many different wavelengths. This light is diffused so it isn’t direct and focused like a laser. Melasma spot pigmentation absorbs this light and turns into heat. This is the main issue with IPL, it heats up the pigmentation which we know can cause melasma to spread or darken.
TCA & Jessner peels are dermatology-grade peels often used to treat melasma.
The TCA peel is used with trichloroacetic acid, ranging in concentrations from 10%-50%. The most common side effect of a TCA peel is post-inflammatory hyperpigmentation.
The Jessner peel is a solution of 14% made of lactic acid, salicylic acid, and resorcinol. Although lactic acid and salicylic acid are both very safe, in high doses resorcinol can be toxic to the central nervous system and respiratory system. Resorcinol is also an endocrine disruptor, particularly thyroid.
These peels are not ideal for melasma, acid’s at 10% or above are too strong and may well aggravate or worsen melasma.
Though dermatologists conventionally say these are great options for melasma, they most definitely are not and should not be advised for melasma treatment.
Medical-grade topicals & medication.
Hydroquinone has a long history of stigma attached to it but has become quite popular recently with new companies like Musley making prescription grade topicals more accessible. It has 40 years of safety studies behind it and is one of the most studied compounds in the cosmetic industry. Nonetheless it is banned in countries like the EU and Japan.
Though touted as a very safe product if results don’t occur within 3 months discontinuing treatment is usually suggested. Side effects include irritation, burning, stinging, cracking, bleeding, dryness, blisters, oozing and black-brown pigmentation (in dark skin individuals). These are signs of inflammation that will worsen melasma in some cases. It is best to transition off hydroquinone once results have been achieved. Hydroquinone is not ideal for darker skin individuals.
Tretinoin is a prescription-grade synthetic vitamin A used to treat acne. The benefits of tretinoin are that it turns over skin cells faster. It can get rid of some pigmentation but it will take time to work and might not remove all of the pigmentation. Though generally considered safe to use it can still cause a burning sensation, irritation, chapped skin, or peeling. Common reactions such as these can definitely exacerbate melasma when applied too frequently. Also, Tretinoin doesn’t interact well with AHA’s, BHA's, PHA's, and other chemical peels. In my studies it seems many who use this treatment experience a worsening of their skin condition before seeing positive results. So far I have not heard of Tretinoin worsening melasma for the long term.
My primary concern with Tretinoin is that because it is a prescription form of vitamin A (synthetic), it is usually combined with other toxic ingredients. The newer companies like Musley, Hers and Apostrophe seem to have better additional ingredients (combining it with with niacinamide and azaelic acid for example). However, the inactive ingredients are not readily available or easy to find, and these are the ingredients that are often hazardous.
I would like to see a tretinoin product that is on the clean beauty side, meaning that it has less harmful ingredients and more antioxidants. There are retinol’s and retinaldehydes with better ingredients, this is what I use.
Tranexamic acid (oral medication) is a synthetic version of the amino acid lysine and is an antifibrotic medication often used to treat heavy bleeding in menstruating women.
This medicine is often touted as an amazing treatment, and while it does seem to give amazing results they tend to be temporary. Most people see the melasma return when treatment is done and oftentimes it has spread or become worse than before. Tranexamic acid doesn’t treat the root of the problem and requires continuous use to keep whatever results are attained.
Cosmelan is a 4 phase depigmentation system that starts off with a peel and is followed by a series of topical treatments throughout phases 2-4. The active ingredients are azelaic acid, kojic acid, arbutin, phytic acid and ascorbic acid. Cosmelan is a very strong peel and lots of women have had great results with this peel. The downfall is that it is quite expensive, with an average cost of $750 for the entire treatment.
In addition to the steep price tag, Cosmelan can definitely worsen melasma.
If you have active melasma this is not the best option. If you have passive melasma or your melasma is fading or reversing it may be safer to use.
OTC products & at-home treatments.
Dermaroller is the at-home version of microneedling. In my opinion microneedling is a safer option because the likelihood of damaging your skin during self treatment is greater than when being cared for by a trained professional. For the same reasons microneedling is usually more sterile than a dermaroller. I tried dermarolling and it caused more broken capillaries for me. On the other hand, microneedling can actually heal broken capillaries. I prefer microneedling to dermaroller, though of course results will vary from person to person.
LED masks are similar to IPL but since they are home devices they are much safer and have less heat coming from the mask. Would this be ok for melasma? If your melasma is active no, if it’s passive or going away, maybe.
I used an LED mask for a month and I didn’t notice any change in the pigmentation, I did feel unsure about the heat so I discontinued.
Dermaplane is the safest option for getting products deeper into the skin. It does remove the stratum corneum, so if you have melasma from sun damage I would certainly be cautious. You can dermaplane at home, carefully, with the right technique. It lightly exfoliates and removes vellus hair. It also makes it easier for your skin to absorb products. I do this once or twice a month.
A few at-home dermaplaning tips are:
-Use a dermaplane razor/facial razor. I use a reusable one and it has 3 replacement blades, it beats using the plastic disposable blades.
-Hold the blade at an angle, hold the skin taut, and use short strokes.
-Don't go over an area more than once.
-Shave in the same direction as the hair growth.
-Moisturize immediately after with something gentle, preferably with lightweight oil. I use watermelon seed oil here. It absorbs quickly, prevents acne, removes impurities and my skin seems to feel calm after. Sometimes products can cause a stinging sensation if it’s not something with minimal ingredients. Keep it simple.
-Only do it once a week at most.
-Avoid dermaplaning with acne, eczema, cold sores, dermatitis, and rosacea.
-Don't use chemical exfoliants on the same day. Wait for 24/48hrs before use.
Here's my favorite tool:
(Please purchase through my affiliate link. There's no extra cost to you, and it helps keep this project going so I can support more women on their healing journey)
Eucerin Anti-pigment system has 3 products: A dual serum, an SPF and a night cream. The active ingredient is thiamidol, which is the alternative to hydroquinone. Though it does work it takes weeks to show improvement and will have to become part of a regular routine. Results do not last without continual application.
I tried it for a few weeks and didn’t like how it felt on my skin. I found the silicones in it oily and hard to wash off. It left a thin film on my face and I didn’t like the scent. Despite these complaints it is fairly safe to use and has been effective for many women with melasma. It is not likely to make melasma worse. There has been some speculation about the German product being better than the US product but I haven’t done the research here. An easy cross reference on the ingredient list should let you know if there is a difference.
Many women love the results with Eucerine but many still get tired of the need for continual application and desire a more permanent, systemic cure. The goal of Mind Body Beauty is to heal from the inside out. Topical treatments can help externally but permanent results require attention to internal conditions.
At the end of the day.
Nobody wants to be ultimately dependent on a product to look and feel healthy. The low probabilities of positive long-term term outcomes with topical treatments can end up being a depressing reality even if they come with short-term term relief.
You have to decide for yourself what your skin health goals are. Are you willing to experiment with your skin? Are you willing to possibly make it worse? Are you willing to compromise long-term skin health to get rid of melasma spots?
For me, the answer to all these questions ended up being a resounding no. Because of the complexity of treatment and the process of discovery, I ended up using my melasma as inspiration to heal myself from the inside out
I would rather work on the internal healing process than the topical process, and I suspect if you’re still reading my material you feel the same. In my opinion it may be safer to use some of the treatments mentioned above only after seeing progress with other reversal modalities. Though it may then be safer to work with intense topicals one must remain diligently attentive to the internal process. As they say, beauty is more than skin deep. I’m sure sufferers of melasma can relate as much as anyone to this aphorism
Don’t get me wrong, I do think it is possible to help the skin topically without compromising overall skin health- because treating external inflammation is also important. I’ve tried a lot of different skin procedures but the only outcome for me was the feeling of desperation and hopelessness. I would build up the excitement of trying something new and then be let down, time and time again. Anxiety, depression, and desperation are emotions that became all too familiar as I chased the next ‘shiny object’ treatment.
Ultimately Mind Body Beauty was born out of my need to change my mindset around the healing process, remember to visit my article Mind over melasma.
Let’s talk more about what healthy things you can do topically in Part 2.
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Tell me if you had success with any of these products or procedures or if there is a product you are interested in.
I’m interested to learn more abt internal stuff
Hi Christy, I’m working to get that information out. Thanks for being here & your comment.