Procedural options in melasma management

Dr Raj Thethi, MBChB BSc (Hons) MRCSEd, Founder, Yorkshire Skin Centre, UK, shares an international perspective on the procedural options for melasma.

Melasma is marked with uneven vertical distribution of melanin, which affects not just the epidermal layer of the skin but also the dermal layer.

Treatments for pigmentation include:

● Prevention

● HQ

● Retinoids

● Topical agents

● Lasers and light energy (IPL)

● Nano/picosure therapy

● Cosmeceutical organic acids

● Chemical peels

● Microneedling

Dr Thethi points out that PRP as a procedure to treat melasma is gaining ground as patients have reported improvements at four sessions. However, he also sees a progress towards Platelet-rich fibrin (PRF) especially in the UK. “I am still hesitant about PRP for treating melasma,” he confesses. It is important to do the right thing for the right patient at the right time. In laser treatments, there are a number of options available, and a combination of these lasers will give optimum results.

Lasers for melasma management

● Q-switched laser

● Nd YAG

● Picosure

● Nanosure

● Erbium Fractional

IPL treatment

The Intense Pulse Light Treatment (IPL) or photofacial shows promising results. Here are the following findings about IPL treatment: 1. Meta-analysis of eight studies (215 patients across the studies)

2. Melasma area and severity index (MASI) score was significantly low (P < 0.0001) 3. Suitable skin types 1-3 (4) 4. High satisfaction but potential for AEs

“In the UK, given the risk-averse attitude of practitioners, they do not have as much experience in treating type 4 skin with IPL,” states Dr Thethi.

Two combination treatments that Dr Thethi has successfully used on a patient are the trichloroacetic acid (TCA) 35% peel and radiofrequency assisted microneedling, and a course of glycolic peel with oral glutathione.

“It all comes down to the kind of consultation you have with the patient. It is important to have an in-depth consultation and set the patient’s expectations appropriately. It is also necessary to tell them that it is going to be a long road. For practitioners, especially junior practitioners, it is better to under-promise and over-deliver while treating melasma,”

Dr Thethi concludes.