Published Mar 22, 2023

Why is my melasma not improving in Singapore?

Introduction

 "Doctor, I have not seen much improvement from my past melasma treatments in Singapore, what should I do?"

This is a common question posed to me during many first consultations with different patients, over the past 10 years of my medical career treating melasma. In that time, I have also seen my fair share of patients who are no closer to finding a solution for this pigmentation problem, than when they first started treatment. In fact, some patients have even worsened their melasma because of incorrect diagnosis or inappropriate treatment!

I have also seen first-hand how this so-called “trivial” skin condition can affect a patient’s self-esteem, making them feel self-conscious and sometimes even embarrassed! Precious time, effort, and money (tens of thousands of dollars!) have been spent unnecessarily by many to try and solve this pigmentation problem, often without much results.

For more background information about melasma, read about how Dr David has helped 3 tough cases of melasma .

How long it takes to treat melasma

Melasma is a common but challenging pigmentation problem on the face, especially for those in the middle-aged group, past 40 years old, and with Asian skin tones.

From my experience, if melasma patients are suitable and willing to follow through with the recommended treatment regimen, it will take just a few months for them to see progressive and obvious results.

Thus, if there is no significant (>50%) visible improvement or lightening to your melasma, for instance after 6 months of treatment, then perhaps it may be a good time to revisit the issue and treatment regimen.

Why is your melasma not improving?

Let me share with you a few common reasons.

1. Incorrect diagnosis

Melasma may not be easily diagnosed at times, and can often be mistaken for other pigmentation problems such as Hori’s Naevus, freckles, solar lentigines, etc. When this happens, the wrong treatment could be administered, rendering the treatment ineffective and at times even worsening your melasma. Each type of pigmentation requires its own tailored treatment; hence a customised skin pigmentation treatment is vital for each patient based on their skin condition and profile.

“But a qualified doctor should be able to identify my pigmentation type easily, right?”

It is important to note that the clinical experience of a doctor is far more critical compared to just knowledge gleaned from a textbook. The doctor should be backed by years of experience in treating melasma to guide him or her to the correct diagnosis, and thus administer the most effective treatment for the patient.

Read: Why your pigmentation is not improving after laser treatment

2. Inappropriate treatments

Nowadays, everyone can conduct a Google search and easily learn about the different treatment options for melasma such as topical creams, lasers, chemical peels, sun protection, etc.

While they all work in their own ways, the KEY factor in achieving the most favourable outcome for melasma is the clinical experience of the skincare doctor.

For example, it takes in-depth medical expertise to know:

  • When to use topical creams or other treatments
  • When lasers are required
  • What laser power settings to use and the interval time required between laser sessions
  • How to manage potential side effects from the lasers
  • What to do when the melasma fluctuates in intensity.

Without the doctor’s relevant skills and foresight, the following can happen:

  • Worsening of the melasma

Personally, from my own experience, lasers that come with downtime (i.e. with a few days of redness or scabbing) should ideally be avoided when treating melasma. If not careful, such “strong lasers” may aggravate the melasma and worsen its appearance.

Also, frequent laser treatment at short intervals (such as having laser treatment every week), is not preferred, as it may result in a higher chance of complications, such as post-inflammatory hyperpigmentation (PIH) or hypopigmentation (abnormal white spots)(1) on the face.

  • Subpar results

Some patients like to chase the latest and sexiest laser technology in the market, thinking it will solve their melasma once and for all; in reality, laser treatments are not “magic bullets” or the “Holy Grail”.

Don’t get me wrong — an effective laser device is essential; it can make a significant difference in your treatment outcome. However, what is of greater importance, is the clinical abilities of the doctor in handling the lasers and customising the treatment for you.

Think of this as getting a haircut — have you heard of anyone who chooses a hairdresser based on the scissors used? When considering a hairstylist or hairdresser, customers rarely question what technology or brand of scissors is used; instead, the hairdresser’s skills in creating the desired hairdo, the eventual outcome, and his/her reputation as a hairdresser usually take priority.

Of course, other factors like price, service, reviews, or convenience matter, but not the technology or brand of the scissors most of the time. So just sit back and leave it to your trusted hairdresser to do the magic for you!

Thus, the doctor ideally should be treating melasma day in and day out for years, to gain the necessary clinical experience in order to effectively treat this challenging skin condition.

3. Excessive sun exposure lifestyle

Normal skin, especially darker Asian skin tones, react to the sun rays by increasing their production of melanin (pigment particles), which in turn results in a darker skin tone. This tanning mechanism is a protective response by your skin to strengthen its ability to tolerate further damage by ultraviolet (UV) rays from the sun.

However, one of the major causes of melasma is excessive sun exposure. Individuals who adopt a lifestyle with extensive sun exposure are more prone to developing or aggravating melasma.

Simple sun protection measures may include the following:

  • Correct application of a good quality sunscreen (SPF 50 with PA+++).
  • Draw the curtains or blinds of the windows at home or in the office.
  • Cover up with clothing, including a broad-brimmed hat, UV-blocking sunglasses, or carry an umbrella when outdoors.
  • Lifestyle changes such as exercising outdoors during non-sunny hours (e.g. late evening or early morning) or indoors at the gym.
  • Try to stay under the shade or indoors.
  • Do not get a sunburn.
  • Avoid tanning and UV tanning booths.

Unfortunately, if melasma patients do not practise adequate sun protection measures such as the application of a good quality sunscreen during their treatment or maintenance, their melasma results will likely be poor as well.

4. Non-compliance to doctor’s treatment and reviews

Treatment of melasma will only work if there is good teamwork between you and your skincare team. We already know what it takes to solve your melasma issues and how to prevent it from worsening.

Simply put, the best skincare doctor/team and treatment plan in the world will be deemed USELESS, if you do not comply with the treatment plan and instructions. Thus, adapt your skincare regimen and sun protection measures in the way you have been instructed by your skincare doctor.

I have also seen patients whose melasma improved during the initial phase of treatment which led them to become over-complacent and hence stopped attending subsequent follow-up reviews with their doctor. This unfortunately resulted in their melasma recurring and even deteriorating.

Do adhere to your doctor’s reviews closely, since he or she may have to adjust your treatment regimen accordingly along the way, in order to achieve desirable and sustainable results. In doing so, you are more likely to see significant and sustainable improvement to your melasma in the long run.

5. Lack of skincare maintenance after treatment

Medical treatments can help remove or improve the appearance of your melasma, but by no means can they eradicate the problem for good. Chances are, your melasma may recur eventually if nothing is done to upkeep the results.

Just like a weight loss fitness program, once you have achieved your desired fitness or weight loss outcome after going through the initial intensive regimen, you would still have to do some form of upkeep or maintenance, be it eating healthily or exercising, to sustain your results in the long run.

So, these are some suggested post-treatment maintenance for melasma:

  • Use quality sunscreen with broad-spectrum or SPF 50/PA+++ every day, and practice sun protective measures as mentioned above in Point 3.
  • Apply your topical creams or skincare regimen (e.g. moisturisers) for maintenance as recommended by your skincare professionals, since maintaining good skin health can help to keep melasma under control.
  • Review periodically with your skincare team or doctor to keep your melasma at bay.

Take home message



As we all know, a Google search for “melasma treatment in Singapore” may link you to many differing treatment information and options. The reality is that melasma is not an easy problem to deal with, but with the RIGHT doctor and skincare team, you will be within reach of effective treatments, and see REAL and sustainable results.

If you have any inquiries about melasma issues, feel free to WhatsApp me at +65 9822 2989 or call in at +65 6222 2262, I’ll be happy to address all of them.

You can also e-mail me at:
askdrdavid@onefaceclinic.com

Cheers!

Dr. David Ng C H


References

01. Yisheng Wong, Siong See Joyce Lee, and Chee Leok Goh
Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments
Ann Dermatol. 2015 Dec; 27(6): 751–755.

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