Melasma is a challenging condition to treat.
This is because there are multiple causes of melasma including sun exposure, hormonal causes (pregnancy, contraceptive pills) and genetics.
It is good that you are doing your best in wearing sunscreen and using the necessary sun protection.
You are correct that melasma is very difficult to get rid off. In fact, melasma can be "improved and well-controlled" rather than "totally removed".
Lasers are effective but they are not the first line treatment for melasma.
Treatment for melasma includes:
First Line Melasma treatments
- Sun protection & sun avoidance,
- Discontinuation of birth control pills or intra-uterine devices containing oestrogen,
- Medical-grade whitening creams - Hydroquinone 2/4% daily for up to 6 months or Triple Combination creams
Second Line Melasma treatments
I usually consider second line melasma treatments if there is no response from first line treatments after 6 months.
- Azelaic acid
- Kojic acid
- Ascorbic acid
Third Line Melasma treatments
- Glycolic acid peels
- Lasers like Nd:YAG lasers
- Oral tranexamic acid
Most of the time, creams and chemical peels can already give you good improvements for melasma.
Beyond the marketing hype, Lasers should be used for stubborn melasma that does not improve despite other types of treatments (creams/peels).
The key for melasma treatment is to find a doctor who is experienced in treating pigmentation because melasma treatment is a long journey. I liken it to a marathon, not a sprint!
Hope this helps! Warmest regards,
Dr Justin Boey