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Melasma & Pigmentation

1) What are the common types pigmentation?
There are several types of pigmentation commonly seen. Generally we can put them into 2 categories: superficial (epidermal) and deep (dermal). Examples of superficial pigmentation are freckles and lentigines.  Common deep pigmentation including Nevus of Hori’s, Post inflammatory Hyperpigmentation (PIH) and Nevus of Ota. Superficial pigmentations are easier to manage compare to deep pigmentation.

2) What is Melasma?
Melasma is a common pigmentation disorder seen in Asian women. The causes of melasma are complex as related to genetic factors, hormonal factors, sun exposure etc.
Melasma usually starts at sun exposure area such as cheeks, forehead, and upper lips, which presented as irregular brownish pigments and gradually spreading to other area of face. Melasma can be both superficial and deep pigmentation. It is one of the most difficult pigmentation disorders to treat.

3) What are the treatment options for Melasma?
There are not many treatment options for Melasma:
1) Topical medication- usually results in temporary clearing with possible long-term complications and recurrence.
2) Chemical peeling-may not be ideal especially for dermal melasma. Inappropriate post treatment care may cause worsening of melasma.
3) Conventional Intense Pulsed Light (IPL) show poor results with high risk of worsening of pigmentation or permanent hypopigmentation.
So far, the best and the safest treatment option available for Melasma is Q-switched Nd:YAG laser treatment. Medlite® Laser and Revlite® Laser (both from Hoya-ConBio, USA) are currently the gold standard for melasma treatment worldwide. Both lasers deliver excellent result with low or no downtime, and little adverse effect. Adjuvant treatments with other types of laser and topical medication will further improve the outcome. Nevertheless, UV radiation protection remains the most important treatment as well as prevention of Melasma.
In recent years, fractional Erbium:Glass laser has shown promising results in treating Melasma.

4) How soon can I see the results?
It depends on the severity of melasma, treatment modalities, and most important, compliance to post treatment care. On average, most people will see improvement after 2-4 sessions of Medlite® C6 or Revlite® laser treatment if everything goes well. Other treatment modalities may give unpredicted results.

5) Do I need long term treatment?
Unfortunately there is no cure for melasma up untill today. There is always a chance for rebounce after clearing of the pigments by all treatments. Revlite® laser has shown promising results with very few rebound cases. Nevertheless, good maintenance treatment strategy is vital to ensure the result is long lasting.

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