This condition is not only hard to treat but is mainly thought to correspond with the estrogen of the melanin (pigment) producing cells of the skin. Melasma normally shows as a patterned hyperpigmentation, mainly affecting the forehead, cheeks, temples and upper lip. Pregnancy is a frequent culprit, however it is estimated that the 30 to 50% of women taking oral contraceptives will have some degree of melasma. The pigmented areas are found in the deep layers of the skin so traditional exfoliating scrubs and peels usually show little to no improvement in pigmentation. IPL or Intense Pulsed Light therapy is touted as a cure all, but since it is not a true laser, it is generally not very effective. IPL involves light therapy, with many different wavelengths of light scattering across the skin. It is not a consistent therapy for hyperpigmentation or skin rejuvenation.

Right side before	Right side after 3 months of using the full NuDerm system by Obagi

Topicals and true laser treatments are the therapy of choice for the hyperpigmentation of melasma, sun and age spots and damaged skin.

St. Louis Skin Solutions has the distinction of being the only center in the greater St. Louis area to offer the Aura Laser for these treatments. This laser is able to focus a single wavelength of light directly to the melanin already produced in the skin but does not harm the melanocyte, the cell that produces pigment. Darker areas are thus lightened without the risk of hypopigmentation. Treatments take anywhere from 15 to 45 minutes and are painless. There is some slight flushing after the procedure, which resolves in 15 to 20 minutes. Makeup can be applied immediately afterward. Areas with densely packed melanin will get darker or grayer for a few days and then flaking off the skin. It is important not to pick at the flakes and let the exfoliation occur at its natural pace. After treatment, melasma triggering factors should be avoided by changing to a low dose contraceptive and limiting UV light exposure.

Smooth skin laser peels can also help, with the deep peeling, this can not only allow the topicals to penetrate more, but gets deeper than a microderm or IPL.