Best Protocol for Melasma

LED Protocols for Fair Skin versus Darker Skin Tones

When it comes to treating melasma with LED Light Therapy, one size does not fit all. It’s ‘fair’ to say that, on account of differences in melanin in fair and darker skin tones, and the depth to which melanin resides in the skin according to skin phenotype, it is necessary to make adjustments to protocols for treating melasma. Whether red light or near infrared light is best for treating melasma will depend on where you lie on the Fitzpatrick scale.

Fair Skin (Fitzpatrick I-III)

In fair skin (Fitzpatrick I-III), melasma tends to be occur in the epidermis, which is the superficial layer of the skin. Melanin in fair skin is less concentrated than darker skin and of the pheomelanin type.

Red light (620-660 nm) can effectively target the epidermis because it penetrates 2-3 mm deep—just enough to reach the pigmented areas without going too deep. This makes red light therapy safe to treat surface-level pigmentation like melasma in fair skinned individuals. Since there is less melanin to absorb the light, red light penetrates the skin without causing overheating* or excess melanin production, making it ideal for those with fair skin. Red light effectively targets superficial pigmentation in fair skin individuals without causing overstimulation of melanocytes, which could lead to further pigmentation issues.

A study by Schroeder et al. (2009) showed that red light therapy effectively treated pigmentation in fair-skinned individuals without increasing the risk of hyperpigmentation. The study emphasized that red light stimulates collagen production and helps reduce skin discoloration.

Dark Skin (Fitzpatrick IV-VI)

Darker skin tones are melanin-rich, with a higher content of eumelanin the higher the number on the Fitzpatrick scale. With skin tones IV – VI, melanin exists not only in the epidermis but also in the deeper layers of the skin, the dermis.

For individuals with darker skin tones, LED therapy requires more caution. Melanin-rich skin is more prone to adverse effects such as post-inflammatory hyperpigmentation (PIH), especially when energy levels are too high or when treatment protocols are not specifically adjusted for darker skin tones.

Reduced light penetration: In melanin-rich skin, because a significant amount of light is absorbed by melanin at the surface, the energy reaching the deeper layers is diminished. As a result, the cells deeper in the skin (such as fibroblasts responsible for collagen production) may receive less of the intended therapeutic dose. This can lead to less effective treatment outcomes compared to lighter skin tones, where more light can penetrate the dermis.

Localized heating: When melanin absorbs light, it can generate heat in the upper layers of the skin. This is because eumelanin, the darker pigment present in melanin-rich skin, is more likely to absorb red light. This localized heating can over stimulate melanocytes, the cells that produce melanin, potentially triggering increased melanin production in response to the heat. Treatment with red LED light in dark skinned individuals can lead to an increased risk of pigmentation issues if treatment isn't carefully managed. This can exacerbate conditions like melasma or cause post-inflammatory hyperpigmentation (PIH).

Near-infrared light (800-1000 nm) is a better option for darker skin tones because it can penetrate deeper into the skin without being absorbed by the melanin in the epidermis. This reduces the risk of overstimulating melanocytes and triggering hyperpigmentation.

The energy settings should be kept low to moderate (2-10 J/cm²) to prevent overheating of deeper tissues, which can still lead to pigmentation issues in some cases.

Goldberg’s research study shows that NIR light can treat melasma effectively in darker skin by reducing inflammation and bypassing the melanin-rich surface

And Alexiades-Armenakas (2006) found that NIR light was more effective than red light for treating pigmentation disorders, especially in darker skin tones. This study highlighted that NIR light can treat hyperpigmentation effectively without the risk of worsening melasma or triggering excess melanin production.

 

Can Fair Skinned Individuals Combine Red and Near Infrared?

While red light alone is often sufficient for treating melasma in fair-skinned individuals, there are some cases where combining red and NIR light can be beneficial. For example:

• If inflammation is present: If melasma is accompanied by inflammation or if deeper layers of the skin are affected (e.g., due to other skin conditions or more stubborn cases of melasma), NIR light could help by reducing inflammation and promoting healing in the deeper tissues.
• When additional skin rejuvenation is needed: NIR light has been shown to promote collagen production and improve skin elasticity in deeper layers. If you’re looking for overall skin rejuvenation in addition to treating melasma, combining red light (for pigmentation) with NIR light (for deeper tissue repair) could offer comprehensive benefits.

If your main concern is superficial pigmentation, however, consider using red light only. Adding NIR could unnecessarily target deeper tissues that are unaffected by melasma in fair skin individuals. This is especially true for Fitzpatrick I-II, where there is minimal risk of pigmentation issues associated with deeper tissue damage. While LED therapy is considered a non-thermal modality, near-infrared light can cause mild heating in deeper tissues because it’s absorbed by water molecules within the skin. In fair-skinned individuals, where melasma is generally surface-level, this deeper penetration and the resulting mild warming are unnecessary and could potentially cause discomfort without additional benefits.

Conclusion:

When to Use Red, NIR, or Both

• Fair Skin (Fitzpatrick I-III): Red light alone is typically sufficient for treating melasma because the pigmentation is primarily superficial. There’s less risk of deep tissue damage, and NIR light may cause unnecessary heating in the deeper layers. Combine Red and NIR light if there’s deeper tissue inflammation or if additional skin rejuvenation is desired.
• Darker Skin (Fitzpatrick IV-VI): NIR light is preferred because it penetrates deeper without being absorbed by the melanin in the surface layers, reducing the risk of post-inflammatory hyperpigmentation (PIH). Red light should be avoided or used with caution due to its higher absorption by melanin, which can worsen pigmentation issues.
• Pulsed LED increases light penetration, amplifies cellular energy production and accelerates cell turnover, which can potentially help reduce pigmentation faster. Most importantly for melanin-rich skin, pulsed LED allows for ‘cooling’ of the skin between pulses, mitigating the risk of stimulating melanocytes to produce melanin and potentially worsening pigmentation issues.

By understanding these nuances and tailoring your approach to your skin type, you can optimize LED light therapy for treating melasma safely and effectively.

Recommended LED Therapy Devices:

For fair skinned individuals who would like to use red light only, Maysama’s PRANA LED Mask or Pulse40 LED Panel both offer this setting. These devices offer the option to use red LED only (without near infrared) in line with science studies that support treating pigmentation issues in fair skin individuals. Pulsed LED can be selected as an option, which improves light penetration and outperforms regular red light for the production of cellular energy and collagen and improves the absorption of skincare active ingredients.

For individuals with darker skin tones (Fitzpatrick IV-VI) who would like to use near Infrared only, Maysama Pulse40 LED Light Therapy Panel provides a customisable resolution, incorporating pulsed LED light technology for enhanced outcomes for skin rejuvenation. Maysama’s Pulse40 panel is a targeted treatment device for face, neck and decolletage. The Pulse40 panel offers pulse light frequencies at 10,20 and 30Hz, which science studies support is ideal for treating melasma in melanin-rich skin. The shorter frequencies provide longer for cooling of the skin between pulses, mitigating overstimulation of melanocytes in the melanin-rich epidermis.

To read our full blog on to treating melasma with LED therapy click here.