{"id":4195,"date":"2021-12-16T12:10:59","date_gmt":"2021-12-16T04:10:59","guid":{"rendered":"https:\/\/ozheanzoey.com\/?p=4195"},"modified":"2024-01-24T08:08:07","modified_gmt":"2024-01-24T08:08:07","slug":"dr-sam-pradeep-why-current-melasma-treatments-dont-work-and-might-make-your-condition-worse","status":"publish","type":"post","link":"https:\/\/ozheanzoey.com\/dr-sam-pradeep-why-current-melasma-treatments-dont-work-and-might-make-your-condition-worse\/","title":{"rendered":"Why Current Melasma Treatments Don\u2019t Work and Might Make Your Condition Worse"},"content":{"rendered":"\n<p>Of the many conditions that skincare professionals encounter today, one of the most prevalent and mysterious is <b>Melasma<\/b>. Just ask Charlie\u2019s Angels actress Drew Barrymore \u2013 the 46-year-old starlet isn\u2019t shy about her \u201ccrazy level 10 Melasma\u201d, and once likened her condition to having \u201cdirt all over my face.\u201d<\/p>\n\n\n\n<p>Sounds like an exaggeration, but for many patients with this condition, it isn\u2019t really.<a href=\"https:\/\/clearifirx.com\/blog\/melasma-treatments\"> <span class=\"s1\">People<\/span><\/a><span class=\"s2\"><sup>1<\/sup><\/span> with melasma can refuse to leave home, ruminate ceaselessly about their melasma, and feel inferior to others due to their skin condition. It is therefore not uncommon to hear of individuals feeling depressed, frustrated, and ashamed.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<p>Melasma, which often presents as brownish patches on the cheeks, can appear on other parts of the face, jaw and neck as well, and is brought about by a mixture of genetic, hormonal, and environmental factors.<i> <\/i><span class=\"s3\">Melasma is very common among Asians, and tends to affect women more than men.<\/span><\/p>\n\n\n\n<p>And here\u2019s the kicker: <b>Melasma is a chronic condition that is incurable. <\/b>But it <i>can<\/i> be managed \u2014 provided you undergo the correct treatments that <b>improve and not worsen<\/b> your condition.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<p>In this article, allow me to explain why melasma is so difficult to treat, the limitations of pigmentation treatments in Singapore, and why some lasers can worsen your melasma.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><b>The causes of melasma<\/b><\/h2>\n\n\n\n<p>The crux of the condition involves your skin\u2019s pigment-producing cells,<a href=\"https:\/\/www.sciencedirect.com\/topics\/biochemistry-genetics-and-molecular-biology\/melanocyte\"> <span class=\"s1\">a.k.a<\/span><\/a><span class=\"s2\"><sup>2<\/sup><\/span> Melanocytes, becoming overactive and producing way too much melanin. While we don\u2019t have a complete understanding of what exactly makes these cells start behaving in this way, there is strong evidence that the following triggers melasma or pigmentation in general:<\/p>\n\n\n\n<ul>\n<li><b>Sun or UV exposure: <\/b>Melasma is influenced by UV rays, just like sunspots. Those who have melasma may notice that their dark spots appeared or worsened after a period of sun exposure.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/li>\n\n\n\n<li><b>Hormonal changes:<\/b> This can occur in the form of hormonal imbalances, pregnancy, or the use of oral contraceptives. Pregnancy is famously notorious for causing flare ups of melasma \u2013 so much so that the condition has been christened \u2018the mask of pregnancy\u2019.<\/li>\n\n\n\n<li><span class=\"s3\"><b>Other causes:<\/b> Family history of melasma, hormone replacement therapy, thyroid disease, low testosterone levels, and more.<\/span><\/li>\n<\/ul>\n\n\n\n<p>For some melasma sufferers, the normal rebalancing of hormones after pregnancy can cause ensuing dark spots to fade on its own. This is what we call <b>transient melasma<\/b>. Unfortunately, for most others, melasma is frustratingly persistent.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><b>Classifications of melasma<\/b><\/h2>\n\n\n\n<p>Why do some melasma sufferers successfully treat their skin with sunscreen and topical creams, while others struggle hopelessly even with the use of Pico lasers and other costly treatments? <b>Let\u2019s find out:<\/b><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>&nbsp;<\/td><td>\n<p class=\"p4\"><span class=\"s1\"><b>Epidermal melasma<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\"><b>Dermal melasma<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\"><b>Mixed melasma<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\"><b>Vascular melasma<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\"><b>Melasma islands<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\"><b>Mottled melasma<\/b><\/span><\/p>\n<\/td><\/tr><tr><td>\n<p class=\"p4\"><span class=\"s1\"><b>What is it?<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">This means that the pigment (melanin) is in the more superficial layers of the skin called the epidermis.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">With Dermal melasma, the pigment is in the deeper layers of the skin, the dermis.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">As a combination of epidermis and dermal melasma, mixed melasma is the most difficult to treat. It occurs with other pigmentation issues like nevus and lentigines.<\/span><\/p>\n<\/td><td>\n<p class=\"p5\"><span class=\"s2\">Vascular melasma\u2019s calling card is vascular proliferation, or <\/span><span class=\"s3\">increased vascularity.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">This type of melasma occurs near the eyes.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">This melasma pattern might be due to previous over-lasering resulting in white patches and spots. <span class=\"Apple-converted-space\">&nbsp;<\/span><\/span><\/p>\n<\/td><\/tr><tr><td>\n<p class=\"p6\"><b>Treat-<\/b><\/p>\n<p class=\"p4\"><span class=\"s1\"><b>ment<\/b><\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">As this type of melasma is superficial, it usually clears with the regular use of topical creams, sun avoidance, and other similar<span class=\"Apple-converted-space\">&nbsp; <\/span>treatments.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s2\">An effective combination of superficial treatments such as topical creams and sunscreen, plus Secret RF and microneedling are needed.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/span><\/p>\n<\/td><td>\n<p class=\"p6\">While you may get promising results from a chemical peel, they tend to be short-lived.<\/p>\n<p class=\"p4\"><span class=\"s1\">Different laser protocols are needed for various mixed melasma conditions.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">Antivascular pigmentation treatment with the Curas Laser, and vascular treatment with the Proyellow Laser works best for positive outcomes.<\/span><\/p>\n<\/td><td>\n<p class=\"p4\"><span class=\"s1\">This type of melasma can be hard to manage. It is best treated with Picomax and Secret RF.<\/span><\/p>\n<\/td><td>\n<p class=\"p6\">Non-aggressive laser treatment is needed to avoid hypopigmented spots. Aggressive laser energy will only worsen any white spots.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n<p class=\"p4\"><span class=\"s1\">Tranexamic acid oral treatment and microneedling with Secret RF will yield good results.<\/span><\/p>\n<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/ozheanzoey.com\/wp-content\/uploads\/2021\/12\/melasma-400x400.jpg\" alt=\"\" class=\"wp-image-4198\"\/><\/figure><\/div>\n\n\n<h2 class=\"wp-block-heading\"><b>Why is melasma so difficult to treat?<span class=\"Apple-converted-space\">&nbsp;<\/span><\/b><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><b>Laser treatment could worsen melasma<\/b><\/h3>\n\n\n\n<p>Recurrence rates after successful treatments are reportedly<a href=\"https:\/\/www.nsc.com.sg\/Patient-Guide\/Health-Library\/Types%25252520of%25252520Skin%25252520Conditions\/Pages\/Melasma.aspx\"> <span class=\"s1\">high<\/span><\/a><span class=\"s2\"><sup>3<\/sup><\/span>, and for more severe cases, chemical peels, IPL therapy, laser treatments and the like tend to offer variable, lackluster, and gloomily short term results.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<p>What many are unaware of is that pigment laser treatment is also known to <b>worsen <\/b>melasma and produce a<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5418955\/\"> <span class=\"s1\">risk<\/span><\/a><span class=\"s2\"><sup>4<\/sup><\/span> of <b>post-inflammatory hyper or hypopigmentation (PIH)<\/b>. The heat from such technology tends to make melasma worse, and can trigger the formation of <i>even more<\/i> pigment in the weeks following treatment.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><b>The Q-switched laser: friend or foe?<\/b><\/h3>\n\n\n\n<p>Some of you might be familiar with <b>Q-switched lasers<\/b>. These lasers became commercially available in the 90s, and have since grown to be wildly popular in Singapore. Prior to this, dermatologists only used lasers for treating the skin surface, which is why the Q-switch laser is so special: It selectively targets and treats pigmentation <i>within<\/i> the skin.<\/p>\n\n\n\n<p>While these lasers have successfully helped treat pigmentation disorders such as freckles, solar lentigines, and ABNOM, it is not reliably effective when it comes to managing melasma. Q-switch lasers help break down melanosomes at the bottom of the epidermis, which contain melanin, and does so without any redness, bruising, or downtime.<\/p>\n\n\n\n<p>However, the Q-switch laser does not<i> <\/i>successfully confront any of the root causes of melasma, which means that melanocytes in the epidermis are still producing lots of melanin, and that frequent relapses, or even a worsening of conditions, is bound to happen.<\/p>\n\n\n\n<p>And while the repetition and quantity of treatments varies across the differing technologies, Q-switched lasers require the greatest number of treatment applications for good results.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><b>Melasma requires a multi-pronged approach<\/b><\/h3>\n\n\n\n<p>One key point to consider is that while laser treatments can accelerate the removal of melasma-related hyperpigmentation, they are far from cures. The most effective management of difficult melasma cases often includes a combination of technologies and therapies.<\/p>\n\n\n\n<p>As melasma is aggravated by hormones, it\u2019s also not uncommon for dermatologists and gynecologists to work hand in hand to help patients transition to a low-dose pill, or if possible, wean them off the pill entirely.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><b>Melasma is triggered by uncontrollable factors like the sun<\/b><\/h3>\n\n\n\n<p>Singapore\u2019s never-ending summer is brutally unrelenting, which is why a<a href=\"https:\/\/ozheanzoey.com\/shop\/\"> <span class=\"s1\">broad-spectrum sunscreen<\/span><\/a> with a high SPF needs to be a regular part of your skincare regimen. It\u2019s also a good idea to wear a hat with a wide-enough brim that\u2019ll protect melasma hot spots like your nose and cheeks.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<p>While less challenging conditions can be managed with the consistent use of broad spectrum sunscreens, medicated creams, and staying out of the sun, such methods only bring about an initial clearance of the condition, and have zero to little effects for sufferers of more severe cases of melasma.<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><b>Limitations of current melasma treatments in Singapore<span class=\"Apple-converted-space\">&nbsp;<\/span><\/b><\/h3>\n\n\n\n<p>To summarise, here are some common melasma treatments available in Singapore today:<span class=\"Apple-converted-space\">&nbsp;<\/span><\/p>\n\n\n\n<ul>\n<li><b>Chemical facial peels: <\/b>This process removes discolored patches and melanin, whilst promoting new skin growth. Chemical facial peels, however, <b>present a risk of post-inflammatory hyperpigmentation<\/b>, and <b>cannot be used to treat melasma that affects the deeper dermis.<br><\/b><\/li>\n\n\n\n<li><b>Lasers: <\/b>With lasers, a focused beam of light energy is used to <b>heat and destroy pigment in the skin<\/b>. However, there is a risk of <b>rebound pigmentation<\/b>. Recurrences are high even with low-energy laser treatments.<\/li>\n\n\n\n<li><b>Microneedling: <\/b>Punctures are made in the epidermis to allow the ingredients in topical creams to penetrate into deeper layers of the skin, where your blood vessels and pigment cells are located. While microneedling has developed exponentially over the years and shows much potential, the use of microneedling <b>on its own<\/b> is not yet proven to drastically improve melasma.<\/li>\n<\/ul>\n\n\n\n<p>The inefficacy and variability of these treatments is the reason why Ozhean Zoey utilises a combination of<a href=\"https:\/\/ozheanzoey.com\/secretrf\/\"> <span class=\"s1\"><b>Secret RF<\/b><\/span><\/a> and<a href=\"https:\/\/ozheanzoey.com\/complete-guide-to-pico-laser\/\"> <span class=\"s1\"><b>Pico Laser<\/b><\/span><\/a> to effectively treat melasma. I will speak about this approach in a separate article.<\/p>\n\n\n\n<p><b style=\"font-size: 20.16px; color: #333333;\">References<span class=\"Apple-converted-space\">&nbsp;<\/span><\/b><\/p>\n\n\n\n<ol>\n<li><span class=\"s1\"><a href=\"https:\/\/clearifirx.com\/blog\/melasma-treatments\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">https:\/\/clearifirx.com\/blog\/melasma-treatments<\/span><\/a><span class=\"Apple-converted-space\">&nbsp;<\/span><\/span><\/li>\n\n\n\n<li><span class=\"s1\"><a href=\"https:\/\/www.sciencedirect.com\/topics\/biochemistry-genetics-and-molecular-biology\/melanocyte\" target=\"_blank\" rel=\"noopener\"><span class=\"s2\">https:\/\/www.sciencedirect.com\/topics\/biochemistry-genetics-and-molecular-biology\/melanocyte<\/span><\/a><span class=\"Apple-converted-space\">&nbsp;<\/span><\/span><\/li>\n\n\n\n<li><span class=\"s1\"><a href=\"https:\/\/www.nsc.com.sg\/Patient-Guide\/Health-Library\/Types%25252520of%25252520Skin%25252520Conditions\/Pages\/Melasma.aspx\" target=\"_blank\" rel=\"noopener\"><span class=\"s3\">https:\/\/www.nsc.com.sg\/Patient-Guide\/Health-Library\/Types%2520of%2520Skin%2520Conditions\/Pages\/Melasma.aspx<\/span><\/a><\/span><\/li>\n\n\n\n<li>Trivedi, M. K., Yang, F. C., &amp; Cho, B. K. (2017). A review of laser and light therapy in melasma. <i>International journal of women's dermatology<\/i>, <i>3<\/i>(1), 11\u201320. https:\/\/doi.org\/10.1016\/j.ijwd.2017.01.004<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Of the many conditions that skincare professionals encounter today, one [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4194,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[1],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Why Current Melasma Treatments Don\u2019t Work and Might Make Your Condition Worse - Ozhean Zoey | Korean Collagen Aesthetic Clinic in Singapore<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ozheanzoey.com\/dr-sam-pradeep-why-current-melasma-treatments-dont-work-and-might-make-your-condition-worse\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why Current Melasma Treatments Don\u2019t Work and Might Make Your Condition Worse - 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