I have melasma with irregular, brown pigment. Should I do lasers,chemical peels, or nothing at all?
The answer to this question almost always depends on an evaluation by your skin care specialist physician. There are several factors involved with irregular pigmentation. There is a connection to sun exposure and to female hormones as with pregnancy, or in birth control or hormone replacement therapies. The problem itself is due to irregular amounts of melanin pigment being manufactured within some cells in the skin at different rates. There are two aspects to solving the problem. The first is to suppress or regulate a more even production of new melanin. The second is to remove the excessive melanin pigment currently present in the outer skin levels using some exfoliation process. This may be by phototherapy, lasers, or chemical peels. All may be able to play a part.
The degree of severity may dictate a preference for one method of treatment over another. My preference in my practice has been to use medium depth Trichloro Acetic acid (T. C. A.) peels because this peel also smoothes the skin and removes wrinkling at the same time as correcting the pigment problem. With any exfoliation it is important to condition the skin with a melanin suppression prior to the exfoliation procedure. Hydroquinone has been the primary chemical used for melanin suppression around the world. Recently hydroquinone has been forbidden by the FDA equivalents in Europe, Japan, Korea, and Australia. It is still available for use in the United States within a controlled level. There are several skin brighteners ingredients that may be used instead of hydrochloride such as Kojic acid or Arbutin.