How to treat pigmentation
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- เผยแพร่เมื่อ 16 มี.ค. 2017
- / drdavinlim
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How to treat pigmentation- melasma.
Otherwise known as chloasma, pigmentation of pregnancy.
Melasma presents as patchy brown pigmentation on sun exposed areas of the face. This condition is more commonly seen in darker skin types, and is more common in females. Though the condition may respond to treatment, it is usually recurrent.
Causes of melasma
The cause of melasma is multifactorial. Genetic predisposition, sun exposure, and hormonal influences all play a role in this condition. Patients of darker skin colour, including Asian, Hispanic, Middle Eastern and Mediterranean cultures are more prone to this condition. Melasma is more common in women and maybe associated with hormonal changes including the oral contraceptive pill, IVF treatment and pregnancy. Ultraviolet (UV) radiation (UVA and UVB) stimulates melanocytes (the pigment producing cells) causing them to produce melanin (pigment).
Clinical Features
Melasma presents as dark patches which may be light brown, tan or even dark brown/black depending on the depth of the pigment in the skin.
Treatment
Photoprotection is the cornerstone of management. Strict and absolute protection with a broad-spectrum sunscreen, covering both the UVB and UVA spectrum is essential. Sunscreens should be applied twice a day.
Cream Treatments: these, together with sun protection form the basis of management.
Hydroquinone HQ 2-8% as a cream of lotion either in a stand-alone formulation or mixed with other active ingredients is the most widely used method to treat melasma. The higher the concentration of HQ, the higher the incidence of irritant dermatitis. Application should always be titrated according to skin sensitivities.
Vitamin A creams including tretinoin can be used as a stand-alone treatment or in combination with other agents. Application should be titrated according to skin irritation.
Ascorbic acid or Vitamin C can be used as adjunctive treatment of melasma. It acts as an anti-oxidant, as well as a pigment-inhibiting compound.
Azelaic acid 20% has been reported to improve epidermal cases of melasma.
Combination topicals: Modified Kligman’s formulation consists of variations in concentration of Hydroquinone, retinoid, and a topical steroid and is considered the gold-standard for melasma management at present.
Chemical peels: superficial peels are preferable to medium or deep peels form melasma given this condition affects those with darker skin.
Glycolic acid peels are the most commonly used agent.
Lactic acid peels may also be used.
Low-strength tricholacetic acid peels
Medium to deep chemical peels should not be used to treat melasma due to a high incidence of complications
Laser and light based treatments: Only certain lasers should be used with conservative settings and are best performed by a dermatologist. Multiple treatments are necessary to see an appreciable benefit. A detailed discussion with your dermatologist about the appropriateness of laser therapy for your melasma is essential.
1064nm Q Switch Nd Yag laser, at low power settings is, to date, the most promising laser for melasma. Several treatments are required over many months to see improvements.
Vascular laser may be used to treat the erythrotelengiectatic subtype of melasma
Non ablative fractional laser is not commonly used, but has been reported in the literature
Ablative Fractional lasers are only appropriate for those with light skin. Complications are high if used in those with dark skin.
Intense Pulsed Light can be effective in some cases of epidermal melasma in lighter skin only. It should be noted that even if they are effective recurrence is usually seen.
Tranexamic acid has been reported for treatment of melasma. Newer Q-Switched picosecond lasers may prove to be more helpful than the current nanosecond Q-Switched technology.
Prognosis
Epidermal melasma has a better prognosis than mixed or dermal melasma but all types are recurrent and require ongoing maintenance therapy.
Melasma associated with pregnancy has the best prognosis, with pigment gradually fading over months. However, subsequent pregnancies often result in recurrences.
Dr Davin Lim, Laser and aesthetic dermatologist.
Brisbane. Queensland. Australia.
Lasers and Lifts. - แนวปฏิบัติและการใช้ชีวิต
Dear Dr Lim
This is actually a painful topic for some women. Thank you for your video. It actually is more than just skin deep. When a woman has a brown upper lip, it actually cuts at her heart. Your job isn't just surface, it helps with self-esteem and self-worth. Thank you for this video on pigmentation. Please, keep us up to date on advances in pigmentation treatment. In South Africa, there isn't a picosure laser, so treatment is limited. Your videos on pigmentation mean more to women than you realize.
Thank you... yes, I do really understand this. I realise the trauma of this condition, as I have patients flying in from around the country seeking help. Pico is not really needed, its a advanced procedure, but nano can be effective. Dr Davin Lim. Brisbane. Australia.
Thank you. :)
Hello dr davin lim.....im always watch your video couse im suffering now with melasma.....can i a favor please help me what i use to treat my melasma please send me pictures of a product that you show in this video
@@drdavinlim Is this technology called Q swich????
very informative as usual, good work Doc
Thanks once again Samantha. DL
Melasma can be difficult to diagnose and tricky to treat. Pigmentation such as freckles, sun damage etc.. can be treated by non- specialist, but melasma should be medically managed as this condition can flare up if treated incorrectly. Above all, sun protection is the foundation of management.. Dr Davin S. Lim. Brisbane. Australia.
Is melasma common in diabetics?
Lasers and Lifts by Dr Davin Lim pellse call 0508694492
Dear Dr Davin Lim, I'm a dermatoligist as well, and so impressed of your succsessful treatment protocol of melasma. Would you advise me parameters of Q switched laser (Spectra Lutronic).
Lasers and Lifts by Dr Davin Lim pls call me
Ok ty😄
Incredibly informative and thorough. Superb. Thank you.
Thanks for watching. Davin Lim.Brisbane. Australia.
Thank you for this very interesting information!!!
Welcome ... Dr Davin Lim
Amazing Dr Lim .
You are the best Dr. Lim!!
:)
I truly enjoy your channel 👍 lasers are amazing tools! Thx Stacy
Thanks for viewing, Davin Lim, Skin Specialist. Brisbane.
Wow!Amazing information! Thank you!
Thanks for viewing, Dr Davin Lim. Brisbane Skin specialist.
Thank you Doctor.. This video has been very helpful
Welcome, thanks for viewing. Dr Davin S. Lim. Brisbane Dermatologist.
Thank you for the great vid!! I have a couple spots and wondered the best way to treat it! Your channel is growing!! Yay!!
Yes, it its, thanks you the support of you guys.... I could take the short cut and pop pimples all day.. but I'm after educational content... so cheers for watching. Dr Davin Lim
Great info Thank you so much!
Thanks . Davin Lim
Hi Dr Davin Lim,
I am one of your subscriber and an aesthetician suffering melasma. Living in sunny Spain, lot of people suffer this. Your channel is informative and despite being in the industry for few years, your hints and tips are very useful. I have sent you a message with your clinic link to come and have a consultation at the end of this month. Look forward to meeting you in person...
Thank you Dr. Lim for your informartive videos! 👍👍👍
Indeed you are welcome. DAVIN LIM , BRISBANE SKIN specialist.
This is a great video.
Thanks for the video. Very educational.
Cheers, Davin Lim.
Thank you very much for your information. Awesome!!
Thanks for viewing. DL
Thanks A lot Dr . Davin Lim , its really a very informative video, plz do continue to enlighten us !!
Cheers, Davin Lim.
Brisbane, oz
Thank you, doctor.
Thank you doctor Lim, this one video has concisely sumed up all my current online research for me to consider my laser options. Im currently using both the sunscreens you mentioned both great under makeup. Im a Perth girl so sunscreen a must!
Welcome. DL
Thank you so much for this amazing information, I would like to live in Australia to treat my Melasma and ochronosis with you.
Thank you! I had NO idea IPL was not recommended!! I had one session several years ago, and my melasma must be the surface type because it did lighten it up enough so that I wasn't quite as bothered by it, but now I'm motivated to look into the other machines and peels in the video. I also used Tri-Luma years ago and it was so-so. Last year I started using Missha Time Revolution Night Repair and after a month I was surprised to see that it also helped.
Newly subscribed and love how down to earth you are and how informative it is each subjects you have mentioned. Thank you! Wish you live in California near me 😀
thanks, every sub counts, cheers, Davin Lim
Great video very informative.
Thank you .
Loved this thank you
I'm so glad you mentioned Transexamic acid. I've been prescribed it for my periorbital melisma as well as topicals.
...great... you have a dermatologist that keeps up to date. Cheers, Davin Lim
I love your channel. I have been under the care of a dermatologist since I was 21 for acne and I'm now 41 and I'm always learning about skin care and procedures. Thank you for all the info
Welcome ....DL
Elaine T
all are not rich enough to go to dermatologist every week
Thank Dr. Very informative video
😍👍👍
Appreciate your view. Davin Lim
What a great doctor.
NOPE.. all doctors should do this, ie. this is not exceptional- its the standard of practice. Thanks anyway. Davin Lim. Brisbane Dermatologist.
Lasers and Lifts by Dr Davin Lim Indeed, you are totally right. I was talking about your personality. Nobody likes entitled doctors with bad emotional intelligence skills. All the best.
Thank you so much. It is wonderful to be able to watch your channel and become informed because, as you said, there's so much information out there and it's hard to know what works and how. I feel that, as I continue to watch you, I am understanding more and more and my skincare is much more effective ie.Anthelios SPF50.
Thanks, ....support is awesome for this channel. DL
Thank you for this video.
Welcome. Thanks for viewing. Dr Davin Lim. Brisbane. Australia.
I love your channel :)
Watched several of your videos tonight. Love all the information and with a 😊. If you’re ever in the lone star state of Texas, I will need an appt.
Thanks. Davin Lim.
great info doc thank u
Welcome. DL
Dear Dr Lim, thank you for share with a good videos for us. I AM from Brazil and I wish go to Australia to treat with you my melasma (cheek) who knows , I wish. I LOVE YOUR POSTS /VIDEOS ABOUT YOUR SAFETY TIPS FOR HELP US :) : )
Great information
Thanks. Dr Davin Lim. Laser Dermatologist. Brisbane. Australia.
Hi Dr what vitamin C do You think is good for melasma , thanks ,,love your videos btw
brilliant video and a great explanation about all your lasers. What a difference on the lady with the most melasma, she must be thrilled with her results. Back in Utah where spring has arrived and I am sitting on my veranda with, you guessed it, a glass of wine. getting late, goodnite from Utah
Nite Utah. Davin
I absolutely love watching you, best channel of all time...I do have skin concerns that does not seem to have an answer, that is hypopigmentation from scarring. It is located on my face and is no fault of my own. This reminder is just horrible to look at in the mirror. Can you make any suggestions?
Thank you Doc, Beee
No prob....davin lim
thank you sir....your all videos are so much helpfull....:)....have a great day
Welcome, DL
Shasank Pandey how mach totl pemnt and sharja u in k dubai
Love your videos! I am skincare junky and for several years have started focusing on anti-aging. I am Asian and of course struggle with hyper pigmentation. What would you recommend for under eye circle and bag? And how long should I use hydroquinone for? In what order should I apply it in my skincare? A good skincare regiment would be great and what products REALLY work. Thank you for the great videos! 😊
Yeah, need to be careful as to what products work, and what is marketing... see a good general dermatologist for products, and a procedural - laser dermatologist for correction. All the best, Dr Davin Lim
Hi Dr! I really enjoy your video:)
Is Melasma and Ochronosis is the same thing? What is the treatment for Ochronosis that caused by prolonged used of HQ?
Dr. Lim your explanation of the different type of laser is very helpful. I myself have been battling with skin pigmentation for the past 8 years. I had few dark spots on my face after giving birth to my daughter. So I went to see a Dermatologist. They prescribe Triluma. I must have an adverse affect bc now my spots are much bigger and darker. So now I finally decided to go with Laser. But your vdo says to stay away from IPL for malasma. So is Pico the best thing to use?
Thank u doc
I absolutely love you videos! Ok so I just went for a consult today on my fine lines, moderate rosacea, and moderate melasma. I'm wanting to do the CO2 fractional laser for fine lines but since I have moderate redness from rosacea, they wanted to do 4 sessions of IPL first to get rid of the redness...BUT you said the IPL makes melasma worse. What protocol would you follow to improve my 3 skin problems??? AND do you have any suggestions for doctors in the USA??? preferably Arizona?? I wish I lived near you!!! Thanks!!!
here in the states, at least in Chicago, it's impossible to find a doctor who knows how to use this for melasma. it's only available for tattoo removal. I've called half a dozen places looking for pico sure treatment and all I've heard is "it's only used for tattoos" ...
and the before and afters are not always that great, unless you have very pale skin.
You had a wonderful video with a drawing of the skin to teach the science if treating melasma and it was very informative but it seems like the video was taking down. Do you still have it
Dr. Lim what would you suggest for dark upper eyelids? I am not sure if it is melasma but they are dark and make me look tired and older. Thanks for any suggestions and all of your helpful videos!!!
CanDoesIt niacinamide and kojic Acid helped me.
Hi Dr lim I am fan of your videos.thanks for providing useful info. I have open pores and acne scares problem and currently taking derma roller treatment. Wi dermaroller solve open pores problem . Also my doctor advice me to use Hyalugel .. is it good for skin.
Nope. Video guides you. Cheers, Dr Davin Lim
Thanks a million Dr Davin, I am struggling with melasma for a while now. Any recommandations for my dermatologist I should know, please from Canada?
Cosmelan.. Research about it.. I did it and 14 days I was clean.. No regrets and I am African send me your IG to send you photos but you are welcome to check results on IG
+Dr. Lim I enjoyed video. I am sunscreen shopping and kept seeing in the comments on Amazon advice to buy a sunscreen with Mexoryl. L'real Ombrelle was the only one I found. I did see a La Roche moisturizer that contained it. I'm interested in your thoughts.
Hi Dr, I simply love your videos. I have a few questions.
1. Would microneedling help with melasma especially if used together with HQ, Tretinoin and vitamin C?
2. What is the best treatment for dermal melasma as I understand that it is the type which is very difficult to treat?
3.I have heard that use of lasers are not advisable in those ethnic pigmented skin, eg. Latins and Indians as they might cause PIH? Is this true?
4.Can one crush tranexamic acid tablets to use on the face (mixed with water like a paste and applied to skin though understandably oral TXA works best?
5. what would you do for resistant and rebound melasma?
Keep up the good work Dr. Your channel is my holy grail for getting the best advice for skincare.
1. Yes, but gentle
2. Pico, plus T.Acid, time
3. False
4. Great idea, cream now on trial.
5. explore all other options, revisit spf, consider glutathione
all the best, Dr Davin Lim. Brisbane. Australia.
Sorry may i know what is pico? Where can we get it? Tq
Thank you Dr Lim, l always enjoy your informative videos. I have moderate melasma. I live in Sydney but am in Taiwan (where my family is from) at the moment. I was recommended using a Nd-Yag laser on my skin here. Is this similar to any of the lasers you mentioned in this video? Is it the same as a Q-switched Yag? Do you recommend me trying this laser over several sessions?
Yes, depending on the setting and your end goals. Dr Davin Lim
Lasers and Lifts by Dr Davin Lim Thank you!
Doc aside from being intelligent and smart, you’re also handsome. Thanks for a very informative video.
Thank you! I have a question. I have a brown spot on my knee which I am not sure it is Melasma(but it's the same as the spots that you explained) or not. Also, There are some small brown spot that recently appeared on my right hand and some on my face. Also, I don't have any child and I always use sunscreen. Is there any treatment about brown spot? Could you introduce to me? Thanks
If I lived in Australia, I'd apply for an admin position for sure. Lol Not even kiddin either. And 👀 everything, this work is such an important one, not for vanity reason (ok, well maybe some, lol) but it actually helps so many ppl feel better about themselves. I appreciate Davin for sharin these experiences & his patients with the world. @DrDavidLim thank you!!
WElcome.
Lasers and Lifts by Dr Davin Lim thank you for sharin.
hello Dr....which one is best treatment removing face holes and no side effect....plz ....which treatment is best
what about derma pen treatment.....plz tell Dr...
Thanks Dr Lim - I was considering IPL, but now it's definitely off the list. Sunscreen daily SPF 30 (layered sunscreen, then tinted sunscreen, then SPF foundation powder) has certainly reduced pigmentation for me. Also, I stopped applying perfume to my neck!
What ever you do.. don't do IPL, far safer and cheaper methods to treat melasma. Dr Davin Lim. Brisbane. Australia
Excelent video! I have cuestión you hear about the ordinary products what are you think about the products?
If it suits your skin.. do it. Davin Lim
Do you prefer Pico Sure over Pico Genesis for melasma treatment? If so, why? This information would be extremely helpful.
Great information!!! Thanks. I too have Melasma on my face. Is the Pico sure and picocare 450 same and give the same result??
No, the most important factor is NOT the laser, its the specialist. All the best, Dr Davin Lim
thnx for ur reply....can u please tell me which laser is best for skin whitening..
Depends, QSL nano vs pico.
Hey dr .. amazing job the results speak for themselves .. I have a hyperpigmenation on my leg caused by burn with hot water about 20 yrs ago how can I get rid of it? .. thanks
That would be difficult. Tech yet to catch up. Davin Lim, Brisbane Dermatologist.
I love how you demonstrate that the pico laser can strip paint then immediately switch it on your hands and say It's a "gentle" laser. :D Haha you're great Dr. Lim
Thank you Dr. Davin Lim.. I have melasma and used hydroquinone for long time and when I stop it .it came back worse what is your advice..
Hello dr Lim, thankyou for being so cooperative:) i got my tca cross a month ago, the areas have filled up but they are dark brown now, all the spots i had tca crossed, would IPL work for them?
No
What would be the treatment?
I just subscribed. Your video is very detailed thanks a lot. I'm suffering from Melasma and using kojicol acid but it's not helping much. My Melasma is due to hormonal disorders.
Yes, see a good laser dermatologist, 95% of melasma can be treated. Davin Lim
Hi Dr. Lim, hope you can answer some of my questions about melasma treatment. I'm currently doing picosure+piQo4 laser and just finished my 3rd round (4 weeks apart) but I still see the melasma! Im debating if I should continue to waste my money for the 4rd treatment I have scheduled. For the kind of money i have spent $800 per session) doesnt justify for the result i have. It got lighter, but by no means gone. How many sessions are usually recommended to do? Thanks!
thank you
Welcome, Dr Davin Lim
Hey doctor Lim, how much to remove my melasma
Dr.Lim, I wish you were in the US :/
Ive been suffering from melasma for months ive on my 1st session with my revlite lazer and it works, but not completely gone, your video is so informative i should really practice using sunscreen everyday thanks doc davin, i wish i can buy a hydroquinone (did i spell it right?) In the philippines
Your dermatologist can prescribed this.. Davin Lim
Hi Dr. Lim, I have a dark brown spot on one side of my forehead (where I don't have bangs hanging over) and have been treated with a q-switched laser once. I don't feel like it got any better....maybe even worse. I looked pretty bruised afterwards and after one week the scabs came off an revealed pink skin that went right back to brown. I am living in Germany where it is winter currently. I have been protecting the area with SPF 50 by Eucerin. I have only used cosmetic treatments such as Caudalie yet with no result and am currently starting the Eucerin pigment line. Do you have any ideas what route I could take? The rest of my face is pigment free.....the area first started showing after half a day in the bright sun without sunscreen (no sun-burn involved). Thank you so much!
Where is this treatment.??
Dr Lim, great video! Love your knowledge! QUESTION: How old are you? I was thinking you said you were older than your bro. You look like a college kid, but obviously you're older. I'm lucky my Derm is the Pres of our State Derm Board in the US and he creates guidelines and training on lasers. The new laws and training has really made a decrease in docs who just don't know what they're doing. There was a period 15 years ago, where we were seeing disfigurement cases a good bit. I've had some laser for broken capillaries and sun damage on my face. Works great, but I tend get really swollen for 2 weeks. Others seem to have nothing.
Closer to 50 than 40.... much closer! My joints and back feel like 70...no kidding, looks are easy (IMO) to reverse, but joints from too much sport and injuries in the 80s, well .. that is impossible to reverse.
We are the same age then. :) For a man is still young but for a woman is different.....Feel your back pain. Yoga and massage help a lot. :)
Hi, do u sell this Pico laser machine?
I am new to your channel. I live in Upland, CA and have monthly Tribeam laser treatments for several years for my Melasma. I apply 4% hydroquinone on a weekly basis and sunscreen every single day. I use to apply the HQ cream every day. So far the melasma is under control but its a daily battle especially during the summer months. Do you suggest HQ cream twice a week or TriLuma for maintenance purposes ?
Depends on your previous records, be guided by your dermatologist as they know your type of melasma. Dr Davin Lim.
Sorry I meant Dr. Lim
Does Azelaic acid also help with acne prone skin?
Hey Doctor thank you the best advice. & I have pigment problem so please help me thank you. 🙌
Thanks, DL Brisbane. Australia.
I sent the text because I saw the video. But I don't know any doctor that treat pigment in sweden and I live in a small neighbours hood. And I was wondering if you could tell me a way to treat the pigment without laser like by using cream or any other product. And I will send a picture of my pigment so you could tell me what to use.
_lh3.googleusercontent.com/kmog3DqVwc_MDWF8pSQ9xlG7mlfGH5dxJD9ItLay7H38i_-at3gytOHE7bCsLq912UFN-FbJ_
Dr. Lim, after 4 months of HQ vit A adn anti inflammatory, what is the treatment of choice for daily care for long term? Especially forvthe night. Thank you. Loving your show a lot
Depends on many factors.. DL
..Hey Dc Lim!.. did you said 'be patient!.. Oh God.. that's the hardest one!!!!..
Yup... but its true... go hard, and it will worsen. Go slow and be patient and melasma will improve. Proven fact. Davin Lim, Brisbane Dermatologist. Oz
+Lasers and Lifts by Dr Davin Lim Thanks Dr Lim
doc any good doctor in dubai? for treating melasma? thanks
Haber si lo puedes traducir en español, gracias
I've seen a dermatologist about hyperpigmenation caused by sun damage. They have recommended the elos SRA laser or topical tranexamic acid. Should people who have darker skin (type 4/ type 5 ) avoid these types of lasers?
Dr. Levin
I’m just a bit concerned about the use of the hydroquinone as I have heard that in darker skin tones and Asian skins the spots can come back even darker. Is that correct or is there a specific way to use it so this can be avoided?
It is true. Stay away from this.
I especially appreciate the sunscreen info! I have melasma and am curious, how often would I have to do these treatments the keep the melasma under control after initial treatment plan? I hope that makes sense....
Sunscreen for life.... control...individaulised.. some only need a peel or one laser treatment every few months. Davin Lim. Brisbane. Australia.
Thanks for an informative video and your timely response.
what bout hyperpigmentation..as in melanin treatments
whats product should be safe for melasma reduction in india brand
Thank you so much for this video. I've had melasma for 13 years and tried IPl, which made it initially dissapear, then it came back. I'll look around for dermatologists who have QSL or Pico laser to try. Can the laser be done without hydroquinone? That ingredient irritated my skin.
Yes, but you should use a tyrosinase inhibitor... your dermatologist will guide you. Or do vvvv low strength TCA peels, and add Lytera..
I do have this skin problem condition called melasma..omg hope this will disappear Doc......
Hi Dr Lim, can Hydroquinone be used with Retin A.
Yes, slowly .. add it in. Premixed in Kligmans or Triluma.
Hello doctor
Quite an informative video.
You talked about keeping Pico in a defocus..would you please elaborate. Usually, I keep my laser hand piece edge almost 3 inches away from skin while removing a tattoo. Haven't used picosecond laser for melasma till now..but planning now after your video.
Thanks!!
Hold away and listen to the ping.
Are you practicing in India ? Where is your office?
Hi Dr.Lim, I do laser esthetics here in Toronto Canada and watch all your videos! I use the Lutronic Spectra (q-switch) on clients for melasma as well. I was wondering what spot size and what energy are you using? Also do you prefer 5hz or 10hz? Is it possible to combine glycolic peels with laser? Thank you so much. Keep up the great videos!
Each laser has its own fluence that is NOT standardised. ... go by the clinical effect. Hz depends on how fast you can move. Don't forget the studies on VEGF-1 receptors and T. acid modulation. All the best, Dr Davin Lim. BRISBANE SKIN specialist.
Dr Davin Lim Thank you for responding!
Love the man - bun at 6.22, Dr. Lim.
Segal look from the 90s ...never again .
Dear, Dr. Lim, Why does IPL make melasma worse?
Sir plz tell me and good cream or something which clear my freckles and pigmentation near my eyes
Is this active or passive q switch laser?
my bf did resurfx and we can see that theres an improvement but after awhile it came back, would u recommend the pico laser? thanks