Thank you for your question. Melasma is a chronic skin pigmentation condition commonly seen in Asian women. It is challenging to control melasma successfully due to its remitting and relapsing course, influenced by factors such as hormones, sun exposure, unsuitable skincare, and heat.
There are different treatment options for melasma, depending on its severity. After making lifestyle adjustments to control its triggers, medical grade lightening creams, and the addition of oral medicines when needed, yield good results. For cases that are more severe, added options such as chemical peels and lasers can be included in the treatment plan.
Chemical peels
These are used in some individuals where topical and oral medicines are insufficient in improving melasma. They work by removing the surface layer of skin which contains superficial pigmentation, leading to regeneration of new skin. The Cosmelan peel programme is a multi-ingredient chemical treatment containing a blend of acidic agents which exfoliates skin. Advantages of a cosmelan peel are that it is quick and fuss free. It also contains chemical ingredients that are known to inhibit pigmentation directly. For instance, both kojic acid and retinoic acid inhibit an enzyme(tyrosinase) involved in melanin formation, while azelaic acid targets overactive melanin cells. With Cosmelan peel, skin renewal is promoted together with a decrease in certain textual irregularities in some individuals. However, chemicals can exacerbate sensitivity, and because of the multiple ingredients used in cosmelan peel, individuals with sensitive skin might experience prolonged side effects like redness, discomfort and occasionally scarring. Like other chemical peels, Cosmelan treatment does not only treat selected pigments but the whole treatment area, which results in indiscriminate peeling. The penetration depth of chemical peels depends on factors such as the chemicals chosen as well as their concentration, the number of coats used, the duration of time applied, as well as the patient’s skin type. Chemical peels are mainly limited to treating more superficial epidermal pigments, and may not be suitable for pigments with a deeper dermal component, as a deep chemical peel may lead to scarring or post inflammatory hyperpigmentation.
Lasers Lasers are a good alternative to peels, and a combination of various lasers from picosecond to long-pulsed options are used to improve melasma. Not only do they selectively target and reduce melanin, certain lasers also decease skin redness that accompany melasma. It is very suitable for individuals with sensitive skin using the appropriate laser settings. Unlike chemical peels whereby the depth of penetration depends on several factors, lasers are precise and its settings can be calibrated to adjust for depth. If you did not notice much change in your condition, some possible reasons could be inadequate pre and post-treatment care, or that laser settings used were too gentle or too strong. The experience and expertise of the doctor is also important in choosing which laser to use and tailoring your treatment protocol.
I would urge you to consult a doctor to assess if your pigmentation is melasma, or a combination of other pigmentation. If it is indeed melasma, a multimodal treatment approach will have better and faster effects, hence both cosmelan peel and lasers can be used depending on the expertise of your physician. In my opinion, after using both, lasers tend to give a better result, reason being that peels are more effective in select cases only. Lastly, strict sun protection with a broad spectrum sunblock goes a long way in preventing relapses in melasma. Hope you found this helpful!
