What should you know about fractional laser for melasma?

Melasma causes irregular brown or grey-brown patches, often on the cheeks, forehead, nose or upper lip. Fractional treatment makes microscopic zones in the skin to encourage renewal, but the inflammation and heat from treatment can also stimulate pigment in some people. A clinician should first confirm that the patches fit melasma and consider factors such as skin tone, recent sun exposure, pregnancy or hormonal treatment, and previous reactions to procedures.

Discuss whether a topical pigment plan and strict light protection should come before or alongside laser. Use the prescribed sunscreen consistently, seek shade and use a hat because visible light and ultraviolet exposure can encourage melasma to return. Avoid unapproved bleaching products, harsh exfoliation and picking during recovery. Expect the treatment plan to be adjusted if the skin becomes irritated; gradual control is more useful than chasing rapid lightening.

Ask for review if patches become darker, new areas appear quickly, or burning, swelling, crusting or persistent redness follows treatment. Urgent care is appropriate for facial swelling with breathing difficulty or eye pain or vision change. A dark patch that is changing, bleeding or unlike the others should be assessed rather than assumed to be melasma.

Ask how the diagnosis was made, why fractional laser is being considered, what alternatives may be suitable, how irritation will be prevented, which sunscreen and topical products to use, and how recurrence will be managed after the visible patches fade.