How is melasma on darker skin types treated?

By darker skin types I assume that you are referring to skin types 4 & 5 which in our local population would be equivalent to Malays and Indians respectively.

The treatment of Melasma has progressed from just using topical hydroquinone 4% and Q switched Nd YAG laser toning.

Now there are safer and newer alternatives especially for darker skin types but essentially can be used for all skin types as well.
These include:

1. Cysteamine cream 5% — this cream works by inhibition of melanin synthesis largely through the inhibition of tyrosinase and peroxidase. It is also thought to be a scavenger for dopaquinone as well as increasing the intracellular levels of glutathione.[1]
2. Dual Yellow Laser — this Laser emits light in 2 wavelengths of green 511nm and yellow 578nm in a ratio of 1:9. When used with the 5mm Handpiece in Shining Bright Mode it utilises the FEM technology to achieve lightening of pigment as well as reduction of the vascularity of Melasma.[2]
3. SYLFIRM RF - this is a pulsed bipolar RF that uses non-insulated electrodes that helps to repair the basement membrane of the skin which prevents the migration of melanin from the epidermis to dermis. In addition, it acts on abnormal blood vessels selectively and reduces VEGF which is known to contribute to Melasma.[3]
4. The use of tranexamic acid either in oral form at doses of 500 mg daily or in a topical formulation of 3% sometimes in combination with niacinamide. Tranexamic acid is thought to reduce UV induced pigmentation through its action on plasmin inhibition.[4]

All of the above can be combined for a better synergistic effect in the treatment of Melasma.

Hope this helps
Regards
Dr Chew

References:

1. Mansouri P, Farshi S, Hashemi Z, Kasraee B. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015;173(1):209-17.

2. Hammami ghorbel H, Boukari F, Fontas E, et al. Copper Bromide Laser vs Triple-Combination Cream for the Treatment of Melasma: A Randomized Clinical Trial. JAMA Dermatol. 2015;151(7):791-2.

3. Kim HM, Lee MJ. Therapeutic Efficacy and Safety of Invasive Pulsed-Type Bipolar Alternating Current Radiofrequency on Melasma and Rebound Hyperpigmentation. Medical Lasers; Engineering, Basic Research, and Clinical Application 2017;6:17-23.

4. Bala HR, Lee S, Wong C, Pandya AG, Rodrigues M. Oral Tranexamic Acid for the Treatment of Melasma: A Review. Dermatol Surg. 2018;44(6):814-825.

By darker skin types I assume that you are referring to skin types 4 & 5 which in our local population would be equivalent to Malays and Indians respectively.

The treatment of Melasma has progressed from just using topical hydroquinone 4% and Q switched Nd YAG laser toning.

Now there are safer and newer alternatives especially for darker skin types but essentially can be used for all skin types as well.
These include:

1. Cysteamine cream 5% — this cream works by inhibition of melanin synthesis largely through the inhibition of tyrosinase and peroxidase. It is also thought to be a scavenger for dopaquinone as well as increasing the intracellular levels of glutathione.[1]
2. Dual Yellow Laser — this Laser emits light in 2 wavelengths of green 511nm and yellow 578nm in a ratio of 1:9. When used with the 5mm Handpiece in Shining Bright Mode it utilises the FEM technology to achieve lightening of pigment as well as reduction of the vascularity of Melasma.[2]
3. SYLFIRM RF - this is a pulsed bipolar RF that uses non-insulated electrodes that helps to repair the basement membrane of the skin which prevents the migration of melanin from the epidermis to dermis. In addition, it acts on abnormal blood vessels selectively and reduces VEGF which is known to contribute to Melasma.[3]
4. The use of tranexamic acid either in oral form at doses of 500 mg daily or in a topical formulation of 3% sometimes in combination with niacinamide. Tranexamic acid is thought to reduce UV induced pigmentation through its action on plasmin inhibition.[4]

All of the above can be combined for a better synergistic effect in the treatment of Melasma.

Hope this helps
Regards
Dr Chew

References:

1. Mansouri P, Farshi S, Hashemi Z, Kasraee B. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015;173(1):209-17.

2. Hammami ghorbel H, Boukari F, Fontas E, et al. Copper Bromide Laser vs Triple-Combination Cream for the Treatment of Melasma: A Randomized Clinical Trial. JAMA Dermatol. 2015;151(7):791-2.

3. Kim HM, Lee MJ. Therapeutic Efficacy and Safety of Invasive Pulsed-Type Bipolar Alternating Current Radiofrequency on Melasma and Rebound Hyperpigmentation. Medical Lasers; Engineering, Basic Research, and Clinical Application 2017;6:17-23.

4. Bala HR, Lee S, Wong C, Pandya AG, Rodrigues M. Oral Tranexamic Acid for the Treatment of Melasma: A Review. Dermatol Surg. 2018;44(6):814-825.