Melasma Series Part 3 - The Most Important Aspect of Melasma Treatment

Treatments that only erase pigment will not solve the problem.

During melasma treatment consultations, many people think like this:

‘Will it disappear after a few laser sessions?’

‘Should I just keep getting laser toning?’

However, melasma is not simply a condition with excess pigment, but rather a complex skin disorder accompanied by:

Inflammation

Blood vessels

Skin barrier issues

Dermal structural changes

It is a complex skin disease where all of these appear together.

Therefore, melasma treatment is not a ‘treatment that only removes pigment,’ but rather

a treatment that stabilizes the skin environment first.

Today, I will summarize the order of melasma treatments that are considered important in actual clinical practice.

1️⃣ Cosmetic Correction

For melasma patients, cosmetic usage habits are more important than you might think.

The skin of melasma patients

often has a weak skin barrier

and is frequently sensitive to irritation.

However, in reality, we often see them using:

Exfoliating products

Strong whitening products

Heavily fragranced cosmetics

Irritating functional cosmetics.

These products can induce:

Dermatitis

Micro-inflammation

Contact dermatitis,

and as a result, they sometimes worsen hyperpigmentation.

Therefore, in melasma treatment, it is important to first:

✔ Stop using irritating cosmetics

✔ Use cosmetics focused on the skin barrier.

(Zeroid, Aestura, and Atopalm products: These are mild enough for children to apply, and for those with atopy or dermatitis. They protect the skin barrier and contain all the necessary ingredients for the skin.

Since cosmetics mostly have the same ingredients and only differ in formulation, there are too many products like skin, toner, essence, lotion, cream, etc., but you do not need to apply the entire line. In fact, you need to go on a ‘cosmetic diet’ for your skin to improve!!

If cream is enough, just use cream -> If it feels a bit dry with just cream, use cream + lotion)

2️⃣ Lifestyle Correction

Melasma is a condition heavily influenced by lifestyle habits.

The most representative influencing factors are:

Sunlight

Heat stimulation

Friction

Stress

Lack of sleep.

In particular, factors like:

Saunas

Hot compresses

Hot showers

Excessive pressure, such as washing your face directly with a showerhead

Habits of rubbing or touching the face

Situations where acne bacteria and Demodex mites multiply due to frequent, repeated application of products like cushion compacts

can increase skin inflammation and vascular responses,

which can worsen melasma.

Therefore, it is crucial in melasma treatment to build lifestyle habits that irritate the skin less.

3️⃣ Sun Protection

The most fundamental treatment for melasma is sun protection.

UV rays can induce:

Increased melanin production

Inflammatory responses

Oxidative stress

Basement membrane damage.

Thus, for melasma patients, it is highly important to:

✔ Consistently use sunscreen

✔ Reapply it repeatedly when going outdoors.

Many studies have reported that melasma can be improved simply by blocking UV rays.

4️⃣ Radiofrequency (RF) + Collagen Boosters

The next most important aspect of melasma treatment is improving the skin environment.

Recent studies report that in melasma-prone skin, the following are observed:

Dermal structural changes

Fibroblast aging

Basement membrane damage.

Therefore, rather than treatments that simply remove pigment,

treatments that improve the skin environment can be helpful.

Representative treatments include:

✔ RF treatments (Thermage, Density, Serf)

✔ Collagen boosters (Juvelook Volume, Radiesse).

These treatments can help with:

Improving the dermal environment

Skin regeneration

Stabilizing the skin barrier.

5️⃣ Skin Regeneration Treatments

Treatments that serve as helpful adjuncts in melasma treatment include:

Rejuran

LDM

Potenza

and similar therapies.

These treatments can assist in:

Skin regeneration

Stabilizing inflammation

Improving the skin barrier.

Because melasma is often accompanied by sensitive skin and a weak barrier,

treatments that stabilize the skin condition are often beneficial.

6️⃣ Pigment Lasers

Once the skin environment has stabilized to some extent, pigment laser treatments can be considered.

Commonly used lasers include:

Fotona / Hollywood Spectra

Pico toning lasers, etc.

These lasers work by slowly reducing melanosomes to gradually improve pigmentation.

However, pigment lasers should not be the starting point of melasma treatment;

it is better to think of them as a treatment to be used after the skin environment is stabilized.

7️⃣ Oral Medications

Oral treatments that are helpful for melasma include:

Transamin (tranexamic acid)

Luthion tablets (glutathione).

Transamin can help with:

Inhibiting plasmin

Stabilizing blood vessels

Inhibiting melanin production.

Luthion can help with:

Antioxidant effects

Regulating melanin production.

Therefore, when undergoing pigment treatment, if there are no contraindications,

we recommend taking them for about a week after the treatment, and if possible,

we sometimes recommend long-term use for 6 months or more.

8️⃣ Thoughts on Topical Medications

Commonly used topical medications for melasma include ingredients like:

Hydroquinone

and retinoids.

However, in actual clinical practice, it is often difficult to use these medications.

Especially in cases involving:

Dermatitis

Atopic skin

A weak skin barrier

Frequent recurrence after pigment treatment, topical medications can cause:

Stinging

Allergic contact dermatitis

and skin irritation.

In such cases, post-inflammatory hyperpigmentation (PIH)

can actually occur instead.

Thus, depending on the skin condition, it is sometimes better not to use topical medications.

Summary

Melasma treatment is not simply a treatment to remove pigment,

but a treatment to stabilize the skin environment.

To summarize the priorities of treatment:

1️⃣ Cosmetic Correction

2️⃣ Lifestyle Correction

3️⃣ Sun Protection

4️⃣ RF + Collagen Boosters

5️⃣ Skin Regeneration Treatments (Rejuran, LDM, Potenza, etc.)

6️⃣ Pigment Lasers

7️⃣ Oral Medications

Approaching it in this order can be helpful.