I've been told that Melasma is very common amongst the Asian population. But in my 3 years of Aesthetic practice, I've hardly seen a single case! So although I was always intrigued by how to treat this very common condition, I've never had much opportunity to try it out.
Melasma, also known as Chloasma and "mask of pregnancy" is a hereditary condition that causes the deposition of pigmentation in the face. The brown discolouration has indistinct edges and predominantly affects both cheeks, athough the forehead ad chin can be affected too. It is predominantly seen in women, worsened by hormonal stimulation (pregnancy, oral contraceptive pill) and sun exposure. The pigmentation can be at various leves, from superficial to relatively deep.
The treatment options have been relatively limited, with creams containing Hydroquinone (such as Triluma) being first line. Although it is known that lasers do not improve the condition, it seems people continue to persist trying!
When we obtained the Nano Perfector last year, the treatment of Measma was one of the draws. Apparently, relatively recent onset Melasma could be reversed quite quickly with this device. We have yet to try this. Upon discussion with Dr Xanya Weiss recently, she now says that it can cause a lightening, but it didn't sound hugely dramatic. Perhaps it's as well we've not had any patients to treat in this way?
I'd also been hearing about the success our Thai friends have been havng with soft plasma peeling for Melasma. So when the opportunity came about for me to tag along with our local distributor for training, I jumped on it!
The treatment protocol for plasma peeling Melasma came about because the doctors were treating Melasma with lasers. What started off as superficial Melasma was recurring as deep Melasma. So from a light brown, it was turning very dark. Naturally patients and doctors were distressed, so they started to look for alternative options.
The protocol now involves rather aggressive plasma peeling with iontophoresis and the occasional glycolic peel. The skincare regime has also been documented, including exact quantities for best results. Downtime is minimal.
I met one lady who has been treated for the past year. She started off wth significant melasma over both cheeks. Now it is barely visible and her skin glows. There is still a light hit of the underlying condition, but she is happily continuing treatments in hope that it will one day be gone.
We are also bringing in Estelan, a program that is modified from Cosmelan. This starts off wth the application of a cream in clinic. This is left on for 4 hours, so washed off at home. Then twice daily application of Estelan 2 continues the treatment for the next few months. There is some peeing and redness after the initial peel, but by all accounts the results are pretty decent and provides rejuvenation & lifting as well as de-pigmentation. This is perfect for the person who is able to tolerate a few days of downtime and doesn't want the inconvenience of regular trips to the clinic for pasma peeling.
With the introduction of these two services, it's interesting that I am starting to see some patients with Melasma now. So I'm really looking forward to assessing for mysef which of these is more superior in the long term.
