Melasma

Melasma: multifactorial hyperpigmentation as a therapeutic challenge

Melasma is a chronic, recurring form of hyperpigmentation characterised by symmetrically distributed pigment patches, mainly on the face. Its causes are rarely singular: UV exposure, hormonal fluctuations such as pregnancy or contraceptive use, and genetic predisposition often play a role at the same time. On top of that, the pigmentation may sit epidermally, dermally or in both layers, which makes treatment considerably more complex than with other forms of hyperpigmentation.

The biggest therapeutic pitfall is the risk of post-inflammatory hyperpigmentation in response to overly aggressive treatment. Fluences that are too high, the wrong wavelength or insufficient cooling can actually worsen the pigmentation. Caution and a well-founded choice of protocol are not a luxury here but a necessity.

Choosing the technology based on melasma type and skin profile

For melasma, low-energy Q-switched Nd:YAG (1064 nm), as on the Hollywood Spectra, is the most studied laser treatment. Picosecond systems such as the PicoPlus and the handPICO handpiece on the Etherea MX give comparable results, and patients may find them less painful. The ultra-short pulse duration minimises thermal damage to the surrounding skin while still fragmenting melanin clusters effectively. Low energy densities and multiple sessions are the norm here, not the exception.

In darker skin types, the risk of pigment shift is higher. Long-pulse lasers work mainly through heat, and heat can worsen melasma. For melasma, 1064 nm is therefore used mainly in Q-switched or picosecond mode, at low energy.

IPL can be used in melasma only with great caution, and is suitable exclusively for lighter skin types with superficial, epidermal melasma. The wrong setting can produce the opposite effect.

Topical maintenance with hydroquinone, azelaic acid or retinoids remains an essential part of any melasma protocol. Energy-based treatments are most effective as part of a combined approach, not as a standalone solution.

A practice perspective

Melasma is an indication with high patient demand and complex treatment dynamics. That very complexity also makes it an indication where expertise and the right technology make the difference. Clinics that can offer a safe, well-founded melasma protocol build strong, long-term treatment relationships with a loyal patient population.

Medi-Invest supports you in building a melasma protocol tailored to your patient profile, from the choice of technology to treatment frequency and combination with topical therapy.