How to remove melasma?

Melasma is a common symmetrical pigmentation disorder on the face, typically affecting sun-exposed areas. Various laser modalities can be used to treat melasma, but recurrence is common, and it may also cause worsening of pigmentation or mottled hypopigmentation. Low-energy, short-interval (every 1-2 weeks) 1064 nm QS Nd:YAG lasers are effective in treating melasma, but have a high recurrence rate. 1550 nm non-ablative erbium-doped fractional laser treatment can also improve melasma, but the main adverse reaction is worsening of pigmentation after laser treatment, and it also carries a certain risk of recurrence. Non-ablative 1927 nm laser treatment is also effective in treating melasma. A study involving patients with facial photodamage, melasma, and PIH showed that low-energy, low-density, non-ablative fractional 1927 nm laser treatment significantly improved melasma without aggravating pigmentation.

In recent years, picosecond laser treatment for melasma has become increasingly effective, with some researchers finding that picosecond laser (532 nm + 1064 nm) combined with 2% hydroquinone cream yields even better results. Other studies have confirmed that topical skin-whitening creams combined with 1064 nm picosecond lasers significantly improve melasma.

In addition, intense pulsed light (IPL) can also be used to treat melasma, primarily for superficial melanocytic lesions in light-colored skin. Due to the frequent occurrence of PIH, ablative laser treatments such as Er:YAG or CO2 lasers are not recommended for melasma. After laser treatment, daily use of broad-spectrum sunscreen is generally recommended to minimize the risk of recurrence.