- Dr. Kuzel
- Treatments
- Conditions
- Calgary South
- Articles
- (403) 286-6888
- Contact Us
Book a consultation
Melasma is a chronic pigmentary disorder that produces symmetrical brown or grey-brown patches on the face. It is common, often hormonally driven, and readily worsened by the wrong treatment. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, confirms the diagnosis and manages it with a combination of photoprotection, prescription therapy and carefully selected procedures.
Melasma is not sun damage in the ordinary sense and it is not a scar. It is a condition in which the pigment-producing cells of the face become persistently overactive, and it behaves differently from other forms of hyperpigmentation.
Melasma is classified by where the excess pigment sits and by the pattern it forms on the face. Both are assessed at the first visit, because they predict how well and how quickly the condition will respond.
Pigment in the outer layer of the skin. Light to dark brown, with a well-defined border, and more visible under a Wood's lamp.
Pigment deposited in the dermis, below the reach of most topical agents. Blue-grey or ashen in colour, with a less distinct edge.
Pigment at both levels, which is the pattern most patients have. Dark brown with some grey. Responds partially to topical treatment, with the deeper component persisting.
Centrofacial melasma affects the forehead, nose, upper lip and chin. Malar melasma is confined to the cheeks. Mandibular melasma sits along the jawline and is more often associated with long-term sun exposure in older patients.
More patients present with melasma that has been aggravated by treatment than with melasma that has never been treated. Aggressive lasers, intense pulsed light and irritating products all darken it. The first job is to establish the diagnosis; the second is to do no harm.
Calgary sits at over a thousand metres, where ultraviolet intensity is higher than at sea level, and the winter sun reflects off snow. Melasma that improves through a Calgary winter is unusual, which is why photoprotection is year round.
Melasma treatment is cosmetic and is not covered by Alberta Health Care. No referral is required. Book directly with Dr. Kuzel at Rejuvenation Dermatology Calgary South, or call (403) 286-6888 for consultation and treatment fees.
Where the diagnosis is uncertain, or where another skin condition is present, medical assessment may be covered with a referral. The team will advise when you call.
No single treatment clears melasma. Photoprotection and topical therapy form the base of every plan; oral therapy and procedures are added according to the depth and resistance of the pigment.
A tinted mineral sunscreen containing iron oxides, SPF 50, applied every morning and reapplied through the day. The tint blocks visible light, which untinted sunscreen does not. A wide-brimmed hat outdoors. Avoidance of heat sources where practical.
Prescription triple combination cream (hydroquinone, tretinoin and a mild corticosteroid) used nightly for eight to twelve weeks, then cycled off to prevent side effects. Non-hydroquinone agents for maintenance and for pregnancy: azelaic acid, tranexamic acid, cysteamine, kojic acid and vitamin C.
A low-dose oral course, typically three to six months, that reduces pigment production and the vascular component of melasma. Effective for melasma that has not responded to topical therapy, and for mixed and dermal types.
Superficial peels, glycolic or a light Jessner formulation, at conservative strengths, spaced two to four weeks apart. They speed the removal of epidermal pigment and improve the penetration of topical agents. Deep peels are avoided because they provoke rebound pigmentation.
Chemical peelsLow-fluence picosecond laser (PicoWay) fragments pigment with minimal heat and is the safest laser for melasma. Clear + Brilliant provides gentle fractional resurfacing that improves surface pigment and skin quality. Both are used after topical preparation, at conservative settings, with maintenance to follow. Intense pulsed light and ablative lasers are not used for melasma.
PicoWay Clear + BrilliantMelasma recurs when treatment stops. After clearance, a non-hydroquinone topical is continued nightly, hydroquinone is reintroduced in short cycles if pigment returns, and photoprotection continues without interruption. Review before each summer.
Melasma treatmentsThe first visit confirms that the pigment is melasma, establishes its depth and pattern, and sets the base of the plan. Procedures are added at follow-up once the skin is prepared.
Melasma is controlled rather than cured. With strict photoprotection and prescription topical therapy, most patients see substantial lightening within twelve weeks, and epidermal melasma may clear almost completely. Mixed and dermal melasma improve more slowly and less completely, and usually require oral therapy or laser in addition.
Recurrence is expected if maintenance stops or sun protection lapses, and pregnancy or hormonal medication can bring it back. The plan therefore includes maintenance from the outset, and the treatments are chosen so that they can be repeated safely over years.
Improvement is judged against baseline photographs rather than memory, because melasma changes gradually and seasonal variation is large.
Melasma is chronic, meaning the tendency persists, but the pigment itself can be cleared or substantially reduced with treatment. Maintaining the result requires ongoing sun protection and periodic topical therapy. Melasma that began in pregnancy sometimes fades on its own within a year of delivery, but often persists.
No. Melasma is a cosmetic condition, and consultation and treatment are private. No referral is required. Fees are quoted when you book. Where the diagnosis is uncertain, medical assessment may be covered with a referral.
Yes, when prescribed and used in cycles. Hydroquinone is the most effective topical agent for melasma and has been used for decades. Continuous use for many months at high concentrations can cause a paradoxical grey-blue darkening called ochronosis, which is why it is prescribed for defined periods and alternated with non-hydroquinone agents. It is not used in pregnancy.
No, and most lasers make it worse. Low-fluence picosecond laser and gentle non-ablative fractional treatment can reduce pigment when used conservatively after topical preparation, and they are part of the plan for resistant melasma. Intense pulsed light and ablative lasers are not used. Laser without ongoing topical therapy and sun protection leads to rebound.
Yes. Ultraviolet intensity at Calgary's altitude is high year round, snow reflects it, and visible light through windows and from screens stimulates melasma regardless of season. A tinted mineral sunscreen every day, including indoors, is the foundation of treatment.
Tinted mineral sunscreen, azelaic acid, vitamin C and, with caution, topical tranexamic acid. Hydroquinone, retinoids and oral tranexamic acid are avoided in pregnancy and breastfeeding. Active treatment is usually deferred until after delivery, with photoprotection maintained throughout.
Usually because sun protection lapsed, maintenance therapy stopped, or a hormonal trigger returned. Occasionally because a treatment elsewhere, such as intense pulsed light, provoked a rebound. The maintenance plan is designed to prevent this, and recurrences respond to a short cycle of active treatment.
Yes, though far less often. Roughly one in ten patients with melasma is male. Sun exposure, family history and certain medications are the usual factors. Treatment is the same.
Solar lentigines, or sun spots, are discrete, well-defined spots caused by cumulative sun damage, and they respond well to laser. Melasma forms larger, symmetrical, blotchy patches, is hormonally influenced, and worsens with most lasers. Distinguishing the two is the reason to see a dermatologist before any pigment treatment.
Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.
Grouped by what you are trying to find out.
Book directly with Dr. Kuzel. No referral is required.
Rejuvenation Dermatology Calgary South
10201 Southport Rd SW #102
Calgary, AB T2W 4X9
Two blocks west of the Delta Hotel
(403) 286-6888
Referrals by fax: (403) 225-2914
Open seven days a week, with early mornings and evenings on weekdays.
Take the first step toward achieving healthy, radiant, and flawless skin. Contact Rejuvenation Medical Aesthetics today to schedule your personalized consultation and explore the advanced treatments tailored to your unique needs.
