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Mastering the Treatment of Melasma
By: Raffy Karamanoukian, MD, and Hratch Karamanoukian, MD
Posted: February 28, 2012, from the March 2012 issue of Skin Inc. magazine.
Because melasma is a chronic condition with high rates of recurrence, clients who are predisposed to developing melasma may find current treatment modalities needlessly frustrating and difficult.
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As a skin care professional, imagine yourself in your client’s shoes. Although you as a professional understand that melasma may take months, if not years, to completely clear, clients are often under the false impression that all cosmetic skin treatments can be performed at the speed of light. Because of this, it is often prudent to discuss a time line for treatment, including intervals for follow-up and timing of ancillary procedures, such as lasers, chemical peels and IPL. Clients will appreciate an organized treatment plan and may be less likely to be frustrated when their skin is not completely improved at the one-month point.
An organized time line can provide clients with an honest perspective in regard to what they should expect at the one-month, two-month, six-month and one-year points. It facilitates increased compliance with ancillary-procedure scheduling and empowers clients to seek your expertise at regular intervals. The time line should also address general questions about what a client should expect at these intervals, and provides an outstanding forum to address commonly asked questions about the treatment protocol.
Photography plays an important role in the management of melasma. Clients who begin treatment should first undergo a clinical examination followed by clinical documentation of melasma severity. Photographs provide objective evidence of melasma lesions on the skin and should be taken against a blue background with five basic views.
- Left oblique
- Left lateral
- Right oblique
- Right lateral
Digital copies should be labeled and stored in a secure location. High-resolution printed copies should be made and placed in the clients’ chart for future reference.
Photographs allow for an objective comparison of variable factors, including the degree of suntanning, measuring UV exposure; progressive aging; and the existence of concomitant skin lesions, such as solar lentigenes, scars, age spots, freckles and sun damage. Most importantly, photographs allow for the incremental comparison of melasma lesions objectively.