What’s New in Melasma Treatment?
Melasma is hard to treat. For those of you struggling with it, that is not news. Both the definitive cause and the definitive cure of this chronic pigmentary disorder remain elusive after years of study. So is there any reason to get excited about reading another article on the topic? Yes. In fact, there is. In recent years, some new studies and treatment refinements have emerged that point to progress. But just to set your expectations, we’re letting you know up front, a wide-brimmed hat is still one of your best defenses.
The goal of melasma treatment is to limit the catalysts for melanin production and increase the exit pathways so that there is a net loss of pigment. The problem is, the catalysts for pigment production are more extensive than the pathways for pigment elimination, so melanin accumulates in the epidermis and the deeper layers of the skin. The longer the discoloration remains untreated, the more deeply rooted it becomes. And just when you think you’re making progress, a flare-up can occur. Especially during the summer months when the sun is at its peak. So is there anything new under the sun in terms of treatment? Here’s a look at what we know and what’s new.
Standard Treatments
Topical Agents
These have been the first-line of treatments for decades, and they are still your mainstay. Two major groups: those that disrupt the process of the pigment production within melanocytes, and those that accelerate cell turnover. The pigment disruptors include hydroquinone, kojic acid, mandelic acid, vitamin C, and niacinamide. The turnover accelerators include vitamin A, lactic acid, mandelic acid, and glycolic acid.
Chemical Peels
In conjunction with topical treatments, chemical peels help accelerate the process of removing pigment through cell turnover. Deep peels aren’t recommended as they can exacerbate pigment problems by irritating and inflaming the skin. It’s best to stick to lighter peels like glycolic acid, mandelic acid, or enzymatic peels.
Laser and Light Therapy
While these treatments have been used with some success, many people see a recurrence within a few months, while many others experience post-inflammatory hyperpigmentation due to thermal damage. According to a report published in the International Women’s Journal of Dermatology, about 50% of people will have a recurrence to some degree within three to six months of a laser- or light-based procedure regardless of the type of device used. Nonablative fractional laser treatments seem to accrue the longest delay in recurrence. IPL has a mid-range recurrence rate. Q-switched lasers have the fastest rate of recurrence. Of the laser options, nonablative fractional laser treatments offer the best results, but still kind of a lesser-of-evils choice.
Sunscreen
Whatever the underlying cause of melasma, sun is the major exacerbating factor. Melasma can be caused or worsened by not only the sun's rays but also heat and visible light. That means sunscreen is a must, but also avoiding sun exposure as much as possible. Wear a hat or sit under an umbrella.
What’s New
Fractional Radiofrequency (FRF)
Radiofrequency ablation uses an oscillating current of electricity to charge molecules and ions, causing them to collide and generate energy in the form of heat, which stimulates collagen production and disperses melanin. It’s preferable to traditional laser therapy because the RF heating profile can be controlled with greater precision than with the laser. Fractional RF is a new development that adds pins of varying depth and density, which are inserted into the skin, allowing still more control of the thermal range, which reduces the risk for hyperpigmentation. The process has minimal post-treatment recovery time and has been shown to be safe for all skin types.
Picosecond Laser Therapy
This advancement in laser technology uses pressure instead of heat to scatter pigment, which then gets flushed from the body. The process delivers energy faster than a nanosecond to convert the energy to pressure. Because it doesn’t use heat, it doesn’t induce post-inflammatory hyperpigmentation. The technology has been studied for tattoo pigment and birthmark removal. Its use for melasma is still new but looks promising. In one small study, pigment reduction was significant, and none of the subjects developed hyper-pigmentation on the rebound. The researchers concluded that picosecond technology has a distinct advantage over traditional laser therapy.
Microneedling
Microneedling is an alternative to laser and light treatments that’s been gaining traction (literally) over the last few years. Instead of light or heat, microneedling uses a roller device with hundreds of tiny needles that penetrate the skin creating micron transport pathways for therapeutic brightening agents to reach deeper into the skin. Microneedling also stimulates elastin and collagen production.
Whatever method you use, one constant remains. A topical regimen to inhibit melanin and accelerate cell turnover is a must. Chemical peels, laser and light therapies, microneedling, radiofrequency, will not work alone. All of these treatments require pre-conditioning of the skin and a consistent post-treatment regimen that includes antioxidants, brighteners, exfoliating ingredients, and SPF.
Use hydroquinone along with other antioxidants and brighteners, but stop using the hydroquinone every four months or so before resuming another cycle. During the off-time, continue to use vitamin A therapies to promote cell turnover, and brighteners like kojic acid, vitamin C, niacinamide, mandelic acid, and glycolic acid. Hydroquinone and vitamin A products should not be used during pregnancy and nursing, but mandelic acid is pregnancy-safe.
Vivant recommends:
Triple-action, targeted corrector serum that gently exfoliates, lightens, and brightens for a smoother, more consistent tone and texture.
Advanced exfoliating and brightening serum targets more severe hyperpigmentation and melasma to correct and prevent discoloration. Formulated to be potent but non-irritating.
Vitamin A, lactic acid, kojic acid, niacinamide, and peptides make this a potent brightening and rejuvenating cocktail. This is an excellent starter serum for skin not acclimated to vitamin A. Move up to the vitamin A chain as skin acclimates to push your results farther.
For skin that’s sensitive or prone to hyperpigmentation, this gentle exfoliating and brightening serum is the perfect choice to boost cell turnover and inhibit melanin production. Move up to the 15% formula when skin is acclimated to the 8%.
Sun protection is non-negotiable. Apply this featherweight, non-greasy SPF daily under makeup or mix with a little mineral powder to make your own light foundation.
Professional Peels
Ask your aesthetician about Vivant’s 20% Glycolic Solution, 30% Mandelic Acid Solution, or our Prozyme series enzymatic peels. Find a skin care professional.
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