Melasma and Post Inflammatory Hyperpigmentation: Management Update and Expert Opinion

Bryan Sofen, MD; Giselle Prado, BS; Jason Emer, MD


Skin Therapy Letter. 2016;21(1) 

In This Article


Radiofrequencey (RF) technology has more recently become widely used in cosmetic medicine as a result of its efficacy and safety in a variety of aesthetic conditions including melasma. RF devices produce electrical current using electromagnetic radiation in the frequency range of 3 kHz to 300 MHz.44 When the current is applied to tissue, the resistance (impedance) produces heat that induces dermal neocollagenesis. Fractional RF devices produce low-density ablation with deep penetrating energy, giving these devices the ability to improve texture, tone and color in all skin types, while also improving wrinkles, acne scars, and laxity. Since melanin is not a target of the device, there is little to no risk of hyperpigmentation unless multiple pass treatments are used with fractional devices, thereby inducing too high levels of ablation (Figure 5).

Figure 5.

Fractional radiofrequency (RF). Improvement in dyschromia is seen after 3 fractional RF treatments spaced 3 weeks apart (Venus Viva™, 230 volts, 10–20 msec, single pass per treatment). Note the additional improvement in acne scarring and pores.

One study using a monopolar RF device (Endosit NIR®) for 6 weekly sessions to facilitate drug delivery (phytocomplex of 1% kojic acid) showed mean Melasma Area and Severity Index (MASI) score improvement from 21.3 at baseline to 15.7 after 1 month of treatment. Improvements were maintained after 6 months of no therapy (mean MASI 16.9).[44] Future studies will be investigating the use of RF devices in the treatment of melasma and PIH. One idea being researched is a combination of microneedling with fractional RF for a synergistic approach to treating melasma or PIH.[45]