Increased pigmentation has multiple causes, ranging from hormonal issues to sun exposure and the use of some medications. Any treatment must address the cause where possible.
The bane of most women is melasma, also known as chloasma or the "mask of pregnancy"— a dark skin discoloration found on sun-exposed areas of the face. It is often associated with the female hormones estrogen and progesterone, i.e. pregnant women, women who are taking oral contraceptives, and women who are taking hormone-replacement therapy during menopause. However, it is also seen in women who are not pregnant or on the pill. Rarely, it is seen in men.
Most patients want a quick fix (which, unfortunately, does not exist) and are thus vulnerable to those who will prey on their insecurities. Not uncommonly, I see patients who have paid upwards of RM5000 for a series of laser treatments & promised a miraculous cure - only to have the melasma rebound with a vengeance several weeks later.
Although my clinic has a fractional laser & a double frequency Ndyag laser, I do not treat melasma with laser that can cost thousands. Instead, I always start with Triluma cream - a compound of hydroquinone, tretinoin, and a topical steroid - costing RM250. In more than half the cases, they see lightening of the melasma within 2-3 months.
Unfortunately, not all patients with melasma have this kind of positive response. For example, some patients will not see improvement if they continue to take oral contraceptives or hormone replacement therapy.
For patients with stubborn melasma, I might add some chemical peeling or microdermabrasion (+/- transdermal electroporation - a device that enables 100% penetration of topicals applied). As a last resort, I might try laser-based or intense pulsed light (IPL) treatment.
Each new laser that hits the marketplace seems to make claim of how well it can treat melasma. Usually, the results do not live up to the hype. The latest laser to make this claim is copper bromide laser (brand name Dual Yellow laser). This laser hasn't arrived in Malaysia yet so I can't make further comment about it's effectiveness. Results from lasers or IPL have been mixed, with some patients showing significant improvement and others showing darkening.
Other types of hyperpigmentation, such as that caused by chronic sun damage, is more of a static process that tends to be easier to treat. These are termed lentigines or "liver spots". These are easily treated with a double-frequency Nd:YAG laser. Most patients will see a 70% to 80% improvement with one treatment.
For patients who have many, many spots or who cannot tolerate downtime, IPL would be a better choice. Some lucky patients will see some improvement in fine lines, but more often not. IPL is not good treatment for fine lines.
Fractional CO2 resurfacing has become one of the newest, more exciting advances in laser technology. Compared to traditional laser resurfacing, which treats the entire skin surface, fractional lasers target small microscopic treatment zones, sparing the surrounding skin. During 1 treatment session, only 20% of the skin surface is lasered, preserving the healthy skin between, resulting in rapid healing following treatment. Result is an improvement in color and texture of skin. There is minimal downtime—most patients are back to work within 2 days with some mineral makeup cover. Most patients require 4-6 treatments spaced about a month apart.
There is a confusing array of treatments offered for pigmentation removal out there. It is always best to seek good medical advice firstly to diagnose the type of pigmentation & secondly to get sound medical advice as to what is the most appropriate & cost-effective treatment.
