Chloasma (or melasma) is often called “liver spots”, pregnancy spots, or butterfly spots: yellowish-brown pigmentation is seen on the face with a butteryfly-type distribution on the cheeks (zygoma). Women are more often affected and associated with high estrogen levels in the blood. Because of this, this condition is seen during pregnancy, when taking oral contraceptives. Melasma is very susceptible to sun exposure or if local inflammation is induced (trauma, sun exposure, irritation, aggressive peels or aggressive lasers which generate heat).
Traditional treatments with intense pulsed light (IPL) give unpredictable results because IPL treatments generate local heat at the site of the treatments. Similarly, irritation caused by chemical peels can actually make melasma worse.
Using a combination of treatment parameters with the 1064nm wavelength and different delivery modes (carbon peel, double mode, etc), 4 to 6 treatments with the picosecond laser give good results. However, further maintenance treatments together with the use of appropriate topical pigment modulators is necessary. This condition requires great care and expertise on the part of the surgeon but yields very satisfying results.