Combination Therapy Addresses Dermal and Epidermal Components of Melasma

by Alexandra Kilpatrick

microdermabrasion treatment

Melasma treatments tend to fail, because they don’t address both the dermal and the epidermal components of the skin condition, one expert told

“Unfortunately, our treatments for melasma have been relatively unsuccessful [to date],” Arielle N.B. Kauvar, M.D., director of New York Laser & Skin Care and a clinical professor of dermatology at the New York University School of Medicine, told

Kauvar explains that a number of topical combinations can help reduce the skin’s melanin production and chemical peels help some but not all patients.

“And it turns out that the vast majority of laser treatments will not help and often exacerbate melasma,” Kauvar told the site.

Many of the lasers used to treat melasma, like Q-switched and fractional lasers, can cause inflammation because they operate at high energy levels, according to Kauvar. Ablative lasers can also peel surface skin, a process that often causes inflammation and a key trigger, along with sunlight, in exacerbating melasma.

The Dermal Component

Melasma is often difficult to treat, because most patients have extra pigmentation in both the epidermis and dermis.

“If you use a peeling procedure or an exfoliating topical treatment, you can help the people with epidermal melasma, who generally do well,” Kauvar stated. “But the vast majority of people with melasma have a dermal component.”

Kauvar devised a new treatment that targets both the superficial and deep pigmentation with a method that avoids inflammation.

“Q-switched Nd:YAG lasers penetrate extremely deeply – up to 1 cm – and it doesn’t take much energy with these lasers to destroy melanosomes,” Kauvar told “I start with microdermabrasion, just to help penetration of the laser.”

Microdermabrasion helps to eliminate the dead cell layer, reduce light scatter when the laser hits the skin and stimulate skin exfoliation.

“With the combination of microdermabrasion and the Q-switched Nd:YAG laser, we can break up sufficient amounts of pigment,” Kauvar explained to

The immune system clears this pigment over time. Patients tend to require two to four laser sessions at one-month intervals for optimal results, according to Kauvar. In one study involving 227 patients with refractory melasma, patients required an average of 2.6 treatments, spaced one month apart.

Adding Topicals

In addition to breaking up existing pigment with a laser, patients require a topical regimen to suppress hyperactive melanocytes’ ongoing pigment production. Study patients used a combination of hydroquinone 4 percent and either tretinoin or vitamin C. They also avoided the sun and applied water-resistant broad-spectrum sunscreen daily.

Study patients underwent follow-up assessments three to 12 months after final treatment, showing that 22 patients or 81 percent had greater than 75 percent clearance of melasma, while 11 of these patients had greater than 95 percent clearance.

“Remissions lasted at least six months and in a substantial subset of patients, more than a year,” Kauvar explained to the site. “The vast majority of patients already have noticeable improvement [a couple months after beginning the topical regimen]. Once they achieve more than 90 percent clearance, I will have them reduce the topicals. If patients experience irritation or inflammation from a product, they must call me right away.”

Microdermabrasion, a crucial part of the dermal component of this therapy, works well to improve the skin of both melasma patients and those without the condition. If you are a Skokie resident and wish to learn more about microdermabrasion, please feel free to schedule a consultation or contact one of our representatives today!

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