Melasma and Pigmented Skin Lesions.

In Cderma we understand that Melasma or dark spots, as commonly known, is a difficult cutaneous condition, which in Cderma we fight against it using different Lasers and depths as well as with magistral formulations.

Melasma are dark skin patches that appear in some face zones due to exposition to the sun.


Melasma is a common cutaneous disorder. It is mainly present in young women with carmel skin tones, but it can affect any person.

Melasma is frequently related to the female hormones estrogen and progesterone. It is common in:

  • Pregnant women
  • Women taking contraceptive pills (oral contraceptives).
  • Women takin hormone therapy (HT) during menopause.

Being exposed to the sun gives Melasma more possibilities to develop. The problem is more common in tropical climates.


The only symptom of melasma is a change in the tone of skin. However, this change of color can cause suffering regarding appearance.

The changes in skin color are almost always a uniform brown color. Generally, they appear in the cheek, forehead, nose and upper lip. The dark patches are generally symmetric.


There is not one treatment mode which has a 100% of success by itself, therefore it is common to use several simultaneous alternatives in the same patient.

However, by experience it has been observed that the treatment with a well handled Laser and with low power is the one that offers the best results if iterated as Monotherapy.

  • Hydroquinone: is normally the first active principle that is used in the cases of melisma. It can be found in pharmacies in the form of cream, gel or lotions. It acts during the night clarifying the skin which has an excess of pigmentation. The products that are sold without the need of a medical prescription have an inferior strength of hydroquinone and consequently are less effective.
  • Glisodin Skin Brightening: very effective cosmoceutics nowadays which are taken for periods of 90 days and that diminish significantly the solar damage and therefore the secondary hyperpigmentation.


    • Tetrinoin: it can be used alone or with hydroquinone. It has the same clarifying effect over the skin. It is recommended that a physician be the one who indicates when to use this type of creams.
    • Corticosteroids: this type of creams can also have a clarifying effect on the skin, but the strength of corticoids must be small to avoid having side effects on the long term. Even though they are safe products, it is better to have a physician indicating how much, how long and how to apply this type of creams. Nowadays there are creams than mix hydroquinone, tetrinoin and corticosteroids with good results.
    • Other products: creams of azelaic acid or kojic acid also have clarifying effects on the skin. These substances are also used in other skin affections like rosacea or acne.
    • Chemical exfoliation or microdermabrasion: eliminate the superficial layers of the skin in several sessions sufficiently separated in time can eliminate the excess of pigmentation in specific zones. They are techniques that require a previous evaluation by a dermatologist, because if not performed correctly and in a specific tone of skin, it can cause other skin diseases.

    Laser: to use laser sessions of low power can help the progressive clarification of the skin, along with the use of the previously mentioned creams. The dermatologist could plan the sessions, which would be separated 30 days minimum one from the other.

    The most used Lasers or Laser Light Sources are:

    • Fractional CO2 laser
    • Fractional or flat Erbium YAG
    • Nd:YAG 1064nm, 532 nm Q switched
    • Nd:YAG 1064 short pulses
    • IPL

    Nowadays the use of the Fractional CO2 used in an intelligent and slow way improves alone from 60% to 90% of Melasma.