All melasma is not the same.
We had 4 new patients one day last week. All of them presented with melasma but each one was different.
The first person had early melasma – recently developed in a localised area, and otherwise they had lovely healthy skin.
The second person had melasma plus long-standing rosacea. This, of course, changes how you can treat the melasma as the skin is more sensitive and reactive. Rosacea results in an impaired skin barrier, so the aim here will be to gently improve the rosacea to a point where treating the melasma is possible, and then create a personalised home care and clinic plan to maintain and control both conditions.
The third person had melasma plus acne. In this case, it is possible to target both conditions with the same topicals to begin with, and then move to different clinic care.
The fourth person had melasma plus early aging that they wished to improve. Here we could also start with a topical plan that would improve both areas, and then move to specific clinic care and home care that would maintain and improve both things.
No two faces are the same. Not everyone responds to treatments in the same way. It’s not enough to be told you have melasma and be started on a standardised plan. While we will always have protocols that are our starting place for different skin concerns, they need to be customised for everyone.