What is melasma?
These diffuse brown spots can take the form of a mask and appear on the cheekbones, temples and forehead, sometimes without sun exposure. But UV rays accentuate them. Often of hormonal origin, they occur following pregnancy, taking oral contraceptives, hormone replacement therapy for menopause or even certain medications. This type of stain is particularly sensitive. The treatment should not be too aggressive, because if there is inflammation under the thermal effect of the laser, the hyperpigmentation may worsen.
Treatment with a medical cream
This is a prescription depigmenting treatment based on cortisone, hydroquinone and tretinoin, called Kligman’s Trio. This is the first-line treatment to be applied for three months (cost around € 30 per tube).
A medium peel
In case of failure of the previous treatment, an average peel can be decided.
Based on 20% glycolic acid and kojic acid or TCA (trichloroacetic acid), it exfoliates the surface of the epidermis in order to stimulate cell renewal and to create a new skin. If this remains ineffective, then the laser can be considered as a last intention. Cost of a session, from 125 to 150 €.
Fractional lasers
Non-ablative fractional lasers are used on melasma with varying degrees of success, but without the risk of worsening the spots. In 3 to 4 sessions, a low power Q-Switched laser can also improve the appearance of melasma. This progresses like a chronic disease, so recurrences are frequent.
Thanks to Dr Jean-Michel Mazer, dermatologist.
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