“Melasma continues to be a challenge for treatment. Topical treatment remains the cornerstone for the management of melasma. Melasma usually does not respond completely to any single treatment. Avoidance of aggravating factors (e.g. sun, UVL and hormones (oral contraceptive pills/hormone replacement therapy) are important in the management of melasma. Melasma should be managed as a chronic relapsing disorder akin to psoriasis where induction and maintenance phases of treatment should be considered. Lasers and light devices play little role in the primary treatment of melasma. However they can be used as an adjunct to topical treatment and may help improve the pigmentation in some recalcitrant cases of melasma. However the risk of post-inflammatory hyperpigmentation (PIH) from laser and light devices in patients with melasma is high and should be used with extreme care and after counselling the patients. Occasionally, lasers and light devices may aggravate melasma. Ablative lasers and QS pigment lasers are generally not effective and are likely to be associated with severe PIH. IPL has been reported to alleviate melasma in some patients, but the improvement is mild (up to 30%) and unpredictable. Recently fractional photothermolysis has been reported to produce good results but other report especially those from Asia failed to confirm their efficacy. Recurrence is the norm. “Skin toning” with the QS Nd:YAG laser using low fluence and large spot size applied frequently at weekly to fortnightly intervals has been reported to improve melasma but the pigmentation recurs shortly after treatment (temporary effect) and guttate hypomelanotic macules is a frequent complication.”
Source: GOH Chee Leok. Melasma – Beyond Creams, Lotions and Potions
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