What Melasma Actually Is
Melasma is a hormonal and hereditary pigmentation disorder. Unlike sun spots, which come from accumulated UV radiation, melasma surfaces mainly under hormonal influence: pregnancy, the pill, fertility treatment. The sun is the trigger, but not the cause.
It shows up as brown-grey patches in a symmetrical pattern: on the cheeks, above the upper lip, on the forehead. The patch is flat, with no raised edge, sometimes with a greyish cast. Among women after childbirth this is one of the most common concerns.
The Mistake That Can Make It Worse
The natural expectation is to come in for a treatment that targets the patch directly. That treatment exists, and it is called IPL. It works beautifully on sun spots. But on melasma, IPL on its own can make things worse instead of helping.
The reason: melasma sits in inflamed tissue. Any thermal stimulus, IPL included, can prompt the melanocytes to produce more melanin as an inflammatory response. The result: the patch returns a month or two after treatment, sometimes darker than it was.
This does not mean IPL is entirely off-limits in melasma. In certain cases, in experienced hands, at a very controlled dose, it can be part of the protocol. But never on its own, and never as the first step.
In melasma, the accepted approach leans mainly on professional actives and sun protection, not on thermal technology.
The Protocol That Actually Works
The approach that works on melasma is layered and demands patience. At my clinic the protocol is built like this:
Step 1, month 1: mapping the condition of the skin with a Wood's Lamp. This lamp makes it possible to see pigmentation in depth and to tell surface spots apart from deep melasma. That distinction changes the entire treatment plan.
Step 2, months 1 to 3: daily actives. Tranexamic acid 5 percent, day and night. Vitamin C 15 percent in the morning. Arbutin, or retinol at a concentration your skin tolerates, at night. All of these act on the pigmentation engine at different points: vitamin C and arbutin inhibit the tyrosinase enzyme, tranexamic acid works on the inflammatory and vascular axis that stimulates the melanocytes, and retinol speeds up cell turnover and the dispersal of melanin.
Step 3, months 2 to 5: gentle chemical peels. Mandelic acid 10 to 20 percent, lactic acid, once every three weeks. We are not peeling the patch away; we are speeding up the turnover of the upper cells in which melanin collects.
Step 4, only if needed: IPL at a very low dose. If after three months of treatment the actives deliver only partial improvement, we consider adding IPL at a controlled intensity and with carefully assessed individual tolerance.
Step 5, ongoing: sun protection as a way of life. SPF 50, mineral, in winter too, and indoors in front of a window. Without it the entire protocol is pointless.
How Long It Takes
First noticeable result: 8 to 12 weeks.
Significant result: 4 to 6 months.
Maintenance: for life, because melasma is a hereditary tendency, not a passing problem.
When to Come to Me
- You have given birth and noticed symmetrical patches that were not there before pregnancy
- You take the pill and see new patches on your cheeks or upper lip
- You have tried IPL in the past and the patches came back or grew stronger
Not Suitable If
- You are currently pregnant or breastfeeding (some of the actives are not permitted)
- You have come back from a holiday with a fresh tan (a 4-week wait is required)
- You are taking photosensitising medication
- You are taking Accutane (isotretinoin), or you stopped taking it within the past six months
- You have active herpes in the facial area
- You have a history of keloid or hypertrophic scarring
- You take anticoagulants or antiplatelet medication, or you have a clotting disorder
- You have an active autoimmune condition or are on immunosuppressive therapy
- IPL is not suitable for every skin type. On deep skin tones (Fitzpatrick 5 and 6) the risk of burns and of pigmentation is high, and suitability is decided individually.
For details on care to improve the appearance of pigmentation in Ashdod.
