Recovery
Results
Treatment Time
Aftercare
The science of Ashy Dermatosis Treatments
- Ashy dermatosis is a common cause of pigmentation in ethnic skin types
- Treatments are medically based, however lasers can be effective in some cases
- Picosecond lasers provide the highest rate of clearance with no side effects
- Even with the best technology success rate is only 40-50%
- It can take up to 4 months to notice improvements
- Joint management with a medical dermatologist is required in all cases
The picosecond laser can be effective in some cases of Ashy Dermatosis. Picosure Pro provides fast clearance without any downtime.
What is Ashy Dermatosis?
Ashy dermatosis is an acquired disorder of pigmentation that presents as dark flat patches that affects the face, neck, trunk & limbs. By definition, it is not itchy (no symptoms). Ashy runs a chronic course, often taking many years before improving (if at all).
What is the cause of Ashy dermatosis?
In short, the cause is unknown, however genetics, infection & inflammation may play a role in the development of pigmentation. Ashy is more commonly seen in dark ethnic skin, namely Asian & Central American patients.
Our Gallery of Results
What is the mainstay of treatment for Ashy dermatosis?
A medical dermatologist can guide you accordingly. The 4 main treatment arms are-
- Sun protection to reduce pigment due to Ashy.
- Creams to help fade pigment.
- Tablets.
- UVB.
*Note: Dr Davin Lim is a procedural dermatologist, namely his work focuses on lasers, deep peels & other physical treatments of pigmentation. He does not prescribe medications for Ashy dermatosis & will refer you to a colleague in Sydney for joint management. Cutis Dermatology Brisbane has medical dermatologists who can assist in the management of all forms of pigmentation.
Hori, faded (not completely) in only 2 sessions with Picosure Pro
.
👉End point> Stippled frosting focally over my usual end point of gray/oedema. More aggressive settings give faster clearance, albeit higher risks of post inflammatory hyperpigmentation
.
👉Ideally 2 more sessions
.
Dr Davin Lim
Dermatologist
Brisbane | Sydney,
Australia🇦🇺
.
#melasmaclinic #hori #horinaevustreatment #drdavinlim #sydneydermatologist #pigmentationclinic
Hori, faded (not completely) in only 2 sessions with Picosure Pro
.
👉End point> Stippled frosting focally over my usual end point of gray/oedema. More aggressive settings give faster clearance, albeit higher risks of post inflammatory hyperpigmentation
.
👉Ideally 2 more sessions
.
Dr Davin Lim
Dermatologist
Brisbane | Sydney,
Australia🇦🇺
.
#melasmaclinic #hori #horinaevustreatment #drdavinlim #sydneydermatologist #pigmentationclinic
Pigment is a glow distractor
.
👉Understanding the level of pigment > first step in optimizing your outcome
.
👉Match a wavelength to the level > predictable outcome
.
👉Match an ‘ingredient’ to pigment output > better outcome
.
👉Match an injectable to the level > the icing on the cake
.
👉Reducing UV & visible light > an essential step
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, 🇦🇺
Australia
.
#melasmaclinic #melasma #drdavinlim #sydneydermatologist #pigmentation
Pigment is a glow distractor
.
👉Understanding the level of pigment > first step in optimizing your outcome
.
👉Match a wavelength to the level > predictable outcome
.
👉Match an ‘ingredient’ to pigment output > better outcome
.
👉Match an injectable to the level > the icing on the cake
.
👉Reducing UV & visible light > an essential step
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, 🇦🇺
Australia
.
#melasmaclinic #melasma #drdavinlim #sydneydermatologist #pigmentation
For melasma, it does not mean the deeper you go, the better the results💯
.
👉Superficial peels: slow & steady with glycolic over lactic acid
.
👉TCA: outdated, though 8-10% single to double coating can reduce pigment in some cases
.
👉Phenol: for recalcitrant cases, with the risk of PIH & long lasting hypo
.
👉Novel Peels: probably gives the best results, with a hit rate of around 60+%, best used with medical therapy
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney,
Australia🇦🇺
.
#tcapeel #cosmelanpeel #viprecisionpeel #chemicalpeel #melasmatreatment #melasmaclinic #drdavinlim #phenolpeel #pigmentation
For melasma, it does not mean the deeper you go, the better the results💯
.
👉Superficial peels: slow & steady with glycolic over lactic acid
.
👉TCA: outdated, though 8-10% single to double coating can reduce pigment in some cases
.
👉Phenol: for recalcitrant cases, with the risk of PIH & long lasting hypo
.
👉Novel Peels: probably gives the best results, with a hit rate of around 60+%, best used with medical therapy
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney,
Australia🇦🇺
.
#tcapeel #cosmelanpeel #viprecisionpeel #chemicalpeel #melasmatreatment #melasmaclinic #drdavinlim #phenolpeel #pigmentation
As with everything medical, advice is based upon probability not possibility, taking into account outliers
.
🧴Creams: can flare melasma. More potent creams containing a mix of estrogen, especially estradiol over estriol (acknowledging that estriol is the predominant form in pregnancy) has a higher chance of flares. The greatest risk is in sun exposed areas
.
💊HRT tablets / systemic/ patches: Has a higher risk compared to creams. Dose related threshold that depends on individuals. Estradiol has a higher risk compared to estriol
.
👉Vaginal Estrogen Creams: risk is very low as systemic absorption is limited
.
🤷🏻♂️Non-hormonal estrogen receptor modulators (Emepelle): risk unquantified
.
👉💯Tips: avoid creams on sun exposed areas, including face /chest / arms
.
👉Are you on HRT, & has your melasma flared up because of it?
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, 🇦🇺
Australia
.
#melasma #HRT #hormonereplacement #themelasmaclinic #melasmaclinic #drdavinlim #sydneydermatologist #menopauseclinic #menopause #menopausemelasma
As with everything medical, advice is based upon probability not possibility, taking into account outliers
.
🧴Creams: can flare melasma. More potent creams containing a mix of estrogen, especially estradiol over estriol (acknowledging that estriol is the predominant form in pregnancy) has a higher chance of flares. The greatest risk is in sun exposed areas
.
💊HRT tablets / systemic/ patches: Has a higher risk compared to creams. Dose related threshold that depends on individuals. Estradiol has a higher risk compared to estriol
.
👉Vaginal Estrogen Creams: risk is very low as systemic absorption is limited
.
🤷🏻♂️Non-hormonal estrogen receptor modulators (Emepelle): risk unquantified
.
👉💯Tips: avoid creams on sun exposed areas, including face /chest / arms
.
👉Are you on HRT, & has your melasma flared up because of it?
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, 🇦🇺
Australia
.
#melasma #HRT #hormonereplacement #themelasmaclinic #melasmaclinic #drdavinlim #sydneydermatologist #menopauseclinic #menopause #menopausemelasma
In the past 10 years there has been a tremendous increase in knowledge regarding the cause/s of melasma, enabling better treatments with longer remission times & higher clearances
.
👉Peels: are a novel way to reduce pigment. They can be effective in 50-60% of cases. We perform Cosmelan, Dermamelan, Vi Precision, AHAs & Jessner. In some cases they provide a slightly faster clearance rate compared to lasers, however their ‘hit’ rate is not as good, providing devices are dialed in correctly. As per diagram, there are many other pathways to consider when treating melasma pigment 💯
.
🙏🏼🙏🏼🙏🏼Sunscreen: correct application overlooked by the majority of patients. This is step on in the algorithm, get this correct before embarking on peels, skin care & lasers
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, 🇦🇺
Australia
.
#melasma #cosmelan #chemicalpeelmelasma #themelasmaclinic #melasmaclinic #drdavinlim #sydneydermatologist
In the past 10 years there has been a tremendous increase in knowledge regarding the cause/s of melasma, enabling better treatments with longer remission times & higher clearances
.
👉Peels: are a novel way to reduce pigment. They can be effective in 50-60% of cases. We perform Cosmelan, Dermamelan, Vi Precision, AHAs & Jessner. In some cases they provide a slightly faster clearance rate compared to lasers, however their ‘hit’ rate is not as good, providing devices are dialed in correctly. As per diagram, there are many other pathways to consider when treating melasma pigment 💯
.
🙏🏼🙏🏼🙏🏼Sunscreen: correct application overlooked by the majority of patients. This is step on in the algorithm, get this correct before embarking on peels, skin care & lasers
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, 🇦🇺
Australia
.
#melasma #cosmelan #chemicalpeelmelasma #themelasmaclinic #melasmaclinic #drdavinlim #sydneydermatologist
Effectively building & keeping collagen in the upper layers of skin can potentially prevent & treat some forms of pigmentation, especially the ones related to aging. This includes late onset melasma & ‘dermal’ dropout, more common in darker skin types
.
👉How to? Topical retinoids can potentially provide very low levels of collagen, more efficient modalities include lasers, RF microneedling (correct depth & settings) as well as HIFU & biostimulatory injectables. The ideal biostimulus depends on the clinical presentation & age of the patient🙌🏼
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney,
Australia🇦🇺
.
#melasma #melasmaclinic #biostimulator #skin #melasmatreatment #sunscreens #bioremodelling #drdavinlim #dermatologistsydney
Effectively building & keeping collagen in the upper layers of skin can potentially prevent & treat some forms of pigmentation, especially the ones related to aging. This includes late onset melasma & ‘dermal’ dropout, more common in darker skin types
.
👉How to? Topical retinoids can potentially provide very low levels of collagen, more efficient modalities include lasers, RF microneedling (correct depth & settings) as well as HIFU & biostimulatory injectables. The ideal biostimulus depends on the clinical presentation & age of the patient🙌🏼
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney,
Australia🇦🇺
.
#melasma #melasmaclinic #biostimulator #skin #melasmatreatment #sunscreens #bioremodelling #drdavinlim #dermatologistsydney
90% of CALM or cafe au lait macules can respond to pico or QSL.
.
👉This patient: treated with 532 Hollywood Spectra nano laser, sessions spaced 8-10 weeks apart. Anecdotally facial lesions respond better than extra-facial lesions
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#spectralaser #lutronic #calmbirthmark #birthmarktreatment #cafeaulaitbirthmark
#birthmarkremoval #drdavinlim #davinlim #sydneydermatologist
90% of CALM or cafe au lait macules can respond to pico or QSL.
.
👉This patient: treated with 532 Hollywood Spectra nano laser, sessions spaced 8-10 weeks apart. Anecdotally facial lesions respond better than extra-facial lesions
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#spectralaser #lutronic #calmbirthmark #birthmarktreatment #cafeaulaitbirthmark
#birthmarkremoval #drdavinlim #davinlim #sydneydermatologist
🍊Vitamin C is useful, only if your skin can tolerate it. Why? High bioavailable vitamin C has an acidic formulation with a low pH, much lower than the already acidic environment of skin. This can lead to irritation, which means more potent pigment correctors can’t be applied
.
👉Formulations: L -ascorbic acid, preferably in the morning under make up & a thick layer of tinted sunscreen
.
👉Tips: concentrate on getting your sunscreen application correct before product selection, 90% of melasma sufferers haven’t got this step correct
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #vitaminc #ascorbicacid #vitamincskincare #themelasmaclinic #sydneydermatologist #drdavinlim #themelasmaclinic
🍊Vitamin C is useful, only if your skin can tolerate it. Why? High bioavailable vitamin C has an acidic formulation with a low pH, much lower than the already acidic environment of skin. This can lead to irritation, which means more potent pigment correctors can’t be applied
.
👉Formulations: L -ascorbic acid, preferably in the morning under make up & a thick layer of tinted sunscreen
.
👉Tips: concentrate on getting your sunscreen application correct before product selection, 90% of melasma sufferers haven’t got this step correct
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #vitaminc #ascorbicacid #vitamincskincare #themelasmaclinic #sydneydermatologist #drdavinlim #themelasmaclinic
Can creams fade treat Ashy dermatosis?
Creams have a marginal effect on Ashy dermatosis, however can be useful in the active phase of this condition. Your dermatologist can guide you. Three types of creams can be used, depending on the phase of Ashy.
- Calcineurin inhibitors such a tacrolimus or pimecrolimus (Protopic or Elidel). This group of creams do not have the long term side effects of steroids.
- Pigment inhibitors are used when Ashy dermatosis is in the remission phases. They include hydroquinone, arbutin, azelaic acid, ascorbic acid & cysteamine. Creams are marginally effective & ideally should be combined with lasers & medical therapy.
- Corticosteroids to reduce inflammation. Example; Advantan Fatty ointment. This is used in a pulse manner (your dermatologist will guide you). Steroid creams are only useful in the very early phase of Ashy, even then, their use is controversial as it is used more commonly in other skin conditions that may look like Ashy- eg. lichen planus pigmentosus.
The Melasma Clinic difference
Our specialist clinic is overseen by dermatologists who provide a comprehensive & bespoke approach to skin care. We take into account the complexity and individuality of your skin. Our pigment solutions include preventing future recurrences of melasma. Our ethos is to improve & maintain your skin’s health & vitality as an ongoing commitment to our patients.
What results can I expect from a Picosure laser?
To date, this is the most effective laser for Ashy Dermatosis. Even with the latest in technology, clearances are not predictable with an efficacy rate of less than 50%. It can take up to 3-4 months before results are seen.
Lasers are always adjunctive to medical management of Ashy, namely lasers are combined with tablets & topical creams.
Dr Davin Lim
645K subscribersHow many sessions will I require to clear Ashy pigmentation?
A series of 4-8 sessions are required spaced 3-6 weeks apart. Results may take up to 3 months, a failure rate of 50% is not uncommon.
*For deeper dermal pigmentation, more sessions are required, up to 16 sessions over 1.5 years.
What is the treatment like?
Treatments are comfortable & fast, taking less than 2 minutes to perform. On a pain scale of 1 to 10, it rates as a 1 to 2.
Are lasers guaranteed treatment for Ashy?
No, lasers are only successful in less than 50% of cases, even with the most technologically advanced picosecond lasers. It can take up to 4 months before results are seen, often requiring 3-4 sessions. Lasers are always combined with medical therapy.
Can our dermatologists diagnose & manage Ashy dermatosis?
Our dermatologist can diagnose Ashy (the diagnosis is not difficult), however our clinic will not manage Ashy dermatosis as this requires joint management with the medical team. This is primarily due to the fact that multiple follow up appointments are required for medical therapy, especially if tablets are required.
*Our appointment times are limited, hence our dermatologists will refer you for medical management at the Skin Hospital, Darlinghurst, Sydney or Cutis Dermatology, Brisbane.
Peel type |
Recovery |
Number of sessions |
Costs |
|---|---|---|---|
| Glycolic | Nil | 5 | $ |
| Cosmelan | 7 days | 1 | $$$ |
| Jessner TCA | 8 days + | 1 | $$$$ |
Will Ashy dermatosis return after treatment?
Once cleared the chances of recurrence is low, however in some cases active inflammation may cause a rebound of Ashy. If this happens, your dermatologist will start you on medical therapy with tablets & prescription creams.
Our specialist clinic is overseen by dermatologists who have extensive experience in the treatment of all forms of pigmentation, including Ashy dermatosis.
What patient groups are predisposed to Ashy dermatosis?
Ashy dermatosis or erythema dyschromicum perstans is commonly seen in ethnic groups, including Asian (Indians, Sri Lankan) as well as Central – South Americans. It is more common in females than males, often in the ages of 20 to 60.
What are other conditions that may look like Ashy dermatosis?
This is where it gets really interesting, as there are many conditions that may look like Ashy. Your medical dermatologist can guide you. We consider other diagnosis such as-
- Lichen planus pigmentosus
- Riehl’s melanosis
- Idiopathic macular hyperpigmentation
- Melasma
- Fixed drug eruption / drug induced pigmentation
- Dermatomyositis
*Dr Davin Lim will refer you for joint management by a medical dermatologist at the Skin Hospital in Sydney or medical dermatologists at Cutis Dermatology in Brisbane.
How will my dermatologist know the difference between Ashy & other forms of pigmentation?
In some cases a biopsy is required to support the diagnosis of Ashy. This involves taking 2-3 mm of skin in affected areas. The skin is then analyzed under a microscope.
Our dermatologist can provide you with a second opinion, however will NOT be involved in the medical management of Ashy dermatosis as this requires close follow up.
How will my dermatologist know the difference between Ashy & other forms of pigmentation?
In some cases a biopsy is required to support the diagnosis of Ashy. This involves taking 2-3 mm of skin in affected areas. The skin is then analyzed under a microscope.
Our dermatologist can provide you with a second opinion, however will NOT be involved in the medical management of Ashy dermatosis as this requires close follow up.
More of our mostFrequently asked questions
Can chemical peels be effective in treating erythema dyschromicum perstans - Ashy?
What is phototherapy & is it effective for Ashy dermatosis?
What is clofazimine & is it effective?
What is isotretinoin & is it effective in treating Ashy dermatosis?
What are other types of lasers that can treat Ashy dermatosis?
What natural remedies are there for Ashy dermatosis?
A SummaryTreating Ashy dermatosis
Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney
This is a common cause of acquired pigmentation seen by dermatologists. Our clinics in Brisbane & Sydney see 1-2 cases a week. In most cases a biopsy is required. If you have Ashy, we recommend joint management by a medical dermatologist & our clinicians. Why? Because in some cases tablets are required & frequent monitoring is required. Your treating dermatologist can refer you for consideration of laser treatment once a diagnosis has been ascertained.
Lasers can be partially successful in fading some cases of Ashy. A failure rate of 50% is seen. There are no guarantees that even with the very latest pico lasers, your pigmentation will be treated. Test spots are sometimes required.
Laser parameters are tiered towards the patient.
- Low level pico laser. This no downtime protocol takes 4-8 sessions to complete. Sessions spaced 3-8 weeks apart. Risk of PIH is very low (almost never seen).
- Mixed laser settings with two wavelengths- 1064-755; novel laser settings to address pigment in different depths.
