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What can a doctor do for melasma?

Dr. Ellen Marmur, MD
Dermatology

There are various types of melasma, depending on how deep they are in the skin. When it is diagnosed, the dermatologist will use a Wood's lamp to enhance the pigment. If the hyperpigmentation looks even darker under the light, it's probably deeper in the skin and will be harder to treat.

Most melasma is superficial, and the best treatment (in addition to prescription lightening creams) is a 20% to 30% TCA or Jessner's chemical peel. I do a 30% peel on myself twice a year to keep my melasma at bay. A glycolic acid peel can be done on people with darker or more sensitive skin, since it's gentler than trichloroacetic acid (TCA). Both are melanotoxic and can decrease the number of melanocytes in the area for good. Usually one to three peels (followed by microdermabrasion seven to ten days after the peel) gets rid of the hyperpigmentation, although the success rate varies from person to person.

For deeper melasma, my best prescription is two chemical peels a year and two to four Fraxel laser resurfacing treatments per year to get rid of both the superficial and the deeper pigment. Fraxel essentially removes pigment through intense exfoliation (in the same way it's used for stretch marks). The laser heat basically drills microscopic pinholes through the skin and vaporizes whatever is in its path. This creates a controlled wound that in turn causes a fast reconstruction of the skin, so the healing process is fairly quick (usually about thirty-six hours). It's important to remember that melasma is a maintenance issue, and people go through years of the discoloration coming and going. This is a case where upkeep and prevention (in the form of sun protection) is key.

Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

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Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

What if a leading dermatologist just happened to be your best friend and you could ask her anything? DR. ELLEN MARMUR, a world-renowned New York City dermatologist, answers all your questions with...

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.