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Shows Melasma on a patient

Blemishes, Pigmentation, and Melasma at Pure Dermatology

Pigmentation or blemishes are dark marks or spots that result from injury to the skin. They are often unsightly and difficult to cover with makeup. Also known as post-inflammatory hyper-pigmentation, pigmentation can occur after acne, burns, rashes, or eczema; as age spots; as familial pigmentation on the cheeks; under eye circles; and as melasma.

Age spots are unsightly blemishes that arise on the face, neck, chest and arms as people age. Also called lentigines or liver spots, they are sharply defined, rounded, brown or black, flat patches of skin that may appear alone or in clusters. These are often easy to treat and more information can be found about age spots here.

Melasma, also called chloasma or mask of pregnancy, is a common skin problem most often seen in women. It causes brown to gray-brown patches on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. Less commonly, it can appear on other sun-exposed parts of the body, such as the forearms and neck. It is much more common in women and much more common in skin of color. It can, however, present in men.

Common Melasma Triggers Include:

  • Sun Exposure
    Ultraviolet (UV) light from the sun stimulates the melanocytes, the skin cells that produce pigment. Melasma often presents or worsens in summer because of the increase in UV light exposure. Melasma often recurs because even a small dose of sun can make melasma come back after it is treated.
  • Heat and indoor light
    There is new evidence to show that infrared light (IR) or heat may contribute to the development of melasma. Indoor lights in the visible spectrum may also have some influence on melasma. It is, therefore, very important for patients wanting to improve their pigmentation to have a sunscreen they love and to wear it EVERY DAY, even indoors.
  • Hormones
    Pregnant women often get melasma. Birth control pills and hormone replacement medicine may also trigger melasma.
  • Cosmetics and Topical treatments
    Skin care products that irritate the skin may worsen melasma and can induce post-inflammatory hyperpigmentation in those with sensitive skin.

Melasma is not curable.  It is a condition that dermatologists can often control and improve greatly, but not cure. Melasma requires constant maintenance, including proper sun protection and brightening regimens.

Melasma and Pigmentation Treatment at Pure Dermatology

Providers at Pure Dermatology selects medical grade skincare and prescriptions tailored to each patient. We offer many safe and effective treatments for pigmentation.

Treating pigmentation requires a partnership with the patient and a dedication to sun protection and to safe sun practices. A series of treatments is necessary for clearance, and maintenance treatment periodically is recommended. Strict sun protection and habitual skincare is critical to controlling melasma and pigmentation. Because heat and light may influence pigmentation, it is very important to our providers, Dr. Holcomb, Dr. Haseltine, and Cherie Albro, NP, that patients find the RIGHT sun protection to wear EVERY DAY.

African American Woman Applying Cream

“To help patients achieve healthy, clear skin through education and personalized care. To accentuate patients’ natural-born PURE beauty through efficient skincare and treatment.”

– Dr. Kate Zibilich Holcomb

We offer a variety of medical grade topical options for fading and eliminating brown spots and uneven pigmentation. These treatments provide additional benefits to improve the appearance and texture of your skin, such as softening wrinkles and tightening the skin, removing redness and broken blood vessels, hair removal, skin cancer and pre skin cancer treatments, and helping treat acne and rosacea. There are also prescription treatments for melasma like retinoids, hydroquinone, and tranexamic acid (a prescription pill for melasma) which we will discuss at your visit.

Laser treatments, chemical peels, and other procedures for melasma must be considered with caution and care. While many lasers immediately improve melasma, it is the long-term implications that matter. We select treatments very carefully with each patient to minimize the likelihood of worsening and have extensive experience treating all forms of skin discoloration.

Medical grade topical treatments are critical to prevent and treat brown discoloration in a safe and healthy way. We offer and help select medical grade cosmeceuticals specific to your skin needs like Lytera, EvenTone Correcting Serum, Discoloration Defense, various alpha, beta, and poly hydroxy acids and exfoliants. Pure Dermatology carries distinguished product lines such as skinbetter science, Heliocare, GliSODin, SkinMedica, Revision Skincare, and Avène, in addition to our own Pure Dermatology line of products.

OxyGeneo 3-in-1 Super Facial gently bubbles away damaged skin cells and helps to improve cell stimulation. This action can prime the skin for topical treatments. OxyGeneo also oxygenates and infuses nutrients into the skin, revitalizing a dull complexion. This treatment has no downtime and is safe for patients who suffer from hyperpigmentation and melasma.

Chemical peels

At Pure Dermatology, we offer several peels that are safe and effective for hyperpigmentation in all skin types and even some gentle enough for melasma. As board-certified dermatologists, Dr. Haseltine and Dr. Holcomb have extensive experience choosing peels that are best for each skin type and need. Cherie Albro, NP, rounds out our team of providers who choose appropriate peels based on skin type and need. Superficial peels often cause minimal dryness to a few days of peeling. The cost of superficial peels starts at $150 per peel and we also have special package pricing for Pure Dermatology Patients.

Excel V can be used in select patients with melasma and hyperpigmentation, especially in those with a red background to their discoloration. The settings used for Excel V are unique and customizable but we have to go low and slow to not worsen melasma. This may mean more treatments but also means no downtime. Treatment costs range from $150-$525 per treatment depending on the area treated.

Excel V also treats the following skin concerns:

  • Rosacea
  • Diffuse redness (red face)
  • Bruising seen after fillers, surgery, or injury
  • Scars
  • Poikiloderma (sun damage)
  • Blue veins under or around eyes
  • Broken blood vessels (Telangiectasias)
  • Acne
  • Acne scarring
  • Large pores
  • Pigmented brown lesions or brown spots
  • Folliculitis or hair bumps
  • Laser hair removal in dark skin types 
  • Spider veins
  • Stretch marks (early red color)
  • Leg Veins
  • Cherry angiomas (hemangiomas)


Enlighten Laser is the treatment of choice for age spots and sunspots may be used in some forms of hyperpigmentation. It also gently tightens and refreshes the skin. There are 2 portions to the Enlighten laser treatment, a directed spot treatment of sunspots which flake away over 5-7 days and the PICO genesis laser toning which further clarifies and brightens skin and improves wrinkles. This laser takes about 20 minutes and it is a minimal discomfort treatment. It does not require numbing medication. The PICO genesis is a favorite at Pure Dermatology as there is minimal to no downtime or healing time. There is a specific method for treating melasma using PICO genesis that must be directed by our board-certified dermatologists to make sure it is safe for each patient.


Enlighten laser also treats the following skin concerns:

  • Sunspots or lentigines
  • Freckles
  • Liver spots
  • Unwanted tattoos
  • Pigmentation or hyperpigmentation
  • Uneven skin tone
  • Mild wrinkles and skin texture
  • Under eye texture
  • Face and body
  • Acne scarring (select cases)

Some discoloration is caused by shaving bumps also called folliculitis or PFB (pseudofolliculitis barbae). Pure Dermatology offers safe and effective laser hair reduction for all skin types and colors. Dr. Haseltine and Dr. Holcomb have extensive experience choosing laser settings that are best for each skin type and for maximum effect. Cherie Albro, NP, rounds out our team of providers who choose appropriate laser settings for the best results. Treatment costs range from $75-$750 per treatment depending on the area treated.

Secret RF and microneedling do not completely erase pigmentation, but they are low risk of worsening pigment while also treating other concerns. These treatments reduce the appearance of pore size, treat wrinkles, neck lines, blemishes, acne scars, and stretch marks. Secret RF and microneedling both have minimal downtime.

Secret RF also treats the following skin concerns:

  • Acne scars
  • Dull complexion
  • Sun damaged skin or premature aging
  • Scars from injury or surgery
  • Skin revitalization or adding luminosity to the skin
  • Active acne (especially when combined with topicals)
  • Overall skin rejuvenation
  • Stretch marks also known as striae
  • Large pores 
  • Neck lines (necklace lines)
  • Skin tone and texture
  • Fine lines and moderate wrinkles
  • Blackheads
  • Mild skin laxity
  • Crepey skin of the neck, knees, and upper arms
  • Hyperhidrosis (excessive sweating)

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