Melasma-Differential Diagnosis + Pior Response to medical therapy & peels + Woods Land examination Epidermal, Dermal, Mixed, Intermediate Ochronosis Post Inflamatory hyperpigmentation Phototoxic Reaction Erythema Melanosis

1. Melasma-Differential Diagnosis + Pior Response to medical therapy & peels + Woods Land examination
• Epidermal, Dermal, Mixed, Intermediate
• Ochronosis
• Post Inflamatory hyperpigmentation
• Phototoxic Reaction
• Erythema
• Melanosis
Skin biopsy
If needed
Photoprotection
• Sunscreen > SPF 30, broad range, with TiO, ZnO
• Physical barriers
Camouflage Optional
Topical agents that
target melanogenesis
Goal: Hyperpigmentation
Triple Combination therapy
-4% HQ 0.025% - 0.05% retinion +
0.01% flucinolone
Review at 4 and 8 weeks for
compliance, response and topical
adverse effects
First Line Theraphy

2. Laser & Light
ical peels(biweekly)
Melanin Removal
colic acid ++
ic acid++
cylic acid+
hloroacetic acid+
ination peel
tic acid
ndelic acid
mbination peel
ed Nd: YAG Laser 1064nm
nce mode laser
Erbium- Glass or Intense Pulsed Light (IPL) + Q
Switched Nd: YAG Laser 1064 nm low
Fluence mode laser
Second line Therapy (Decision based on factors like % decrease in MASI score)
Peels 6-8
Sessions
fornightly
id line Therapy (Decision based on factors
like % ⬇ decrease in MASI score)
Weekly
1- sessions
or fornightly
6-8 sessions 1- sessions of Erb-Glass or IPL
and fornightly 5 sessions of Q
switched Nd: YAG
Maintenance Phase Therapy
Topical agents that the target melanosis
- Only non-HQ or 2% HQ
Maximum
1 year
Photoprotection
• Sunscreen > SPF 30, broad-range, with TiO, ZnO
• Physical barriers
Triple
Combination
Twice a week,
maximum 1 year
Camouflage Optional