One of the most difficult skin conditions to treat as an Aesthetician and a Laser Tech is Melasma. First, you need to know what it is, understand it, and be able to recognize it. Melasma is a condition of the skin that has no known exact cause. We do know however, that it is most common in pregnant women and women of darker skin types i.e. Hispanic and Asian.
When melasma occurs during pregnancy, it is also called chloasma or “mask of pregnancy.” When a women is pregnant she has increased levels of hormones, however, it is not thought to be the estrogen hormone rather the progesterone hormone that causes the melasma. In some cases when the hormones even out after pregnancy the melasma will disappear. Always give your client adequate time after birth to allow her hormones stabilize.
Other known contributors to melasma are birth control, hormone replacement therapy, anti seizure medications or other medications known to cause pigmentation disorders. One main common factor that all melasma has in common is the sun! No matter what type of melasma a person has or why they initially contracted the skin disorder, if they get UV exposure with or without sun block it will darken. In fact studies show that a history of daily direct sun exposure is the leading cause of melasma disorders. Anyone diagnosed with melasma and or being treated for melasma MUST wear daily SPF UVA/UVB physical block plus a hat if in the sun and must re-apply every 30-45 minutes and should stay out of direct sun exposure.
When talking to a client about Melasma and its treatments, it is important that first and foremost, you explain that you are treating the symptoms not the problem. Always under promise and over deliver! Your client must know all of their treatment options and that one or all the treatments might be ineffective. It is important that your client trusts you and knows that you will assist them in making the best treatment decision. Melasma can be treated with lightening creams, chemical peels or laser treatments. If treating with Laser it is extremely important that your client know that it could worsen their condition. I always tell my clients that it is a 50/50 chance and let them weigh their options.
I have personally achieved great results with Foto Facial but I have also had a few cases where it darkened and at the end the client was unsatisfied with the treatment; not with me because I was honest with her from the beginning. It is also important that your client pre treat with a bleaching cream like hydroquinone, not only to make the treatment safer for them but to make it more effective if they chose to treat with Laser. Scientists believe that hydroxyphenolic chemical; (HQ) blocks a step in a specific enzymatic pathway that involves Tyrosinase; the enzyme that converts dopamine to melanin. Melanin gives skin its color. In other words, it slows the melanin production making the skin less likely to darken. After the treatment series it is also important for the client to know that this will need to be kept at bay with a cream like hydroquinone and also to maintain results, the client may need to multiple treatments through the year; typically post summer because it will darken through the summer months. Other cream options are tretinoin (Retin A), Azeliac gel, Tri-Luma; it is a combination prescription cream containing fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%.
The most common Chemical peels to treat melasma are TCA (Trichloracetic acid) Glycolic 30-70%, Lactic, and Azelaic. There are many chemical treatments out there that combine many of these acids to achieve great results. All of these treatments can be very effective in treating melasma and in some cases can completely diminish Melasma. The results can be lasting, but once a client has this problem they need to know that it can come back and they need to be proactive every day in keeping their skin shielded from the sun; especially direct sunlight.