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.
Picosure Pro as adjunctive therapy for melasma
.
🔫Lasers vs Peels: lasers provide better remodelling of skin, leading to longer remission times as compared to novel peels such as Cosmelan. Additionally lasers (pico) have no downtime nor skin irritation as compared to superficial peeling systems. They do however take several sessions (2-5) for optimal results
.
👉Tip: tailor melasma treatment according to the patient. Understand the potential as well as the limitations of peels, skin care, medical therapy, injectables & energy devices for melasma to formulate a plan based upon the individual
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#picosure #picosuresurepro #picolaser #melasmatreatment #themelasmaclinic #sydneydermatologist #drdavinlim
Picosure Pro as adjunctive therapy for melasma
.
🔫Lasers vs Peels: lasers provide better remodelling of skin, leading to longer remission times as compared to novel peels such as Cosmelan. Additionally lasers (pico) have no downtime nor skin irritation as compared to superficial peeling systems. They do however take several sessions (2-5) for optimal results
.
👉Tip: tailor melasma treatment according to the patient. Understand the potential as well as the limitations of peels, skin care, medical therapy, injectables & energy devices for melasma to formulate a plan based upon the individual
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#picosure #picosuresurepro #picolaser #melasmatreatment #themelasmaclinic #sydneydermatologist #drdavinlim
Novel peels are useful for some cases of melasma. At the clinic we employ these peels for individuals who travel to our clinic from far. Peels have the advantage over lasers, namely less sessions to deliver similar outcomes (in actual fact, lasers are better with a ‘hit’ rate of 80-85% as compared to peels with 60-70% success)
.
🍌Peels: We have the Dermamelan, Cosmelan, novel Melanopro & Vi Precision peels as well as Jesser, TCA, salicylic acid, AHA, & retinoic acid peels. We perform focal phenol peels, but not segmental phenol peels for melasma as the risks are too high for our mode of practice
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, Australia🇦🇺
.
#melasmaclinic #melasma #melasmatips #dermamelan #cosmelan #cosmelanpeel #drdavinlim #sydneydermatologist #melanopropeel
.
Disclaimer: lighting slightly different in exposure settings as different camera systems are employed.
Novel peels are useful for some cases of melasma. At the clinic we employ these peels for individuals who travel to our clinic from far. Peels have the advantage over lasers, namely less sessions to deliver similar outcomes (in actual fact, lasers are better with a ‘hit’ rate of 80-85% as compared to peels with 60-70% success)
.
🍌Peels: We have the Dermamelan, Cosmelan, novel Melanopro & Vi Precision peels as well as Jesser, TCA, salicylic acid, AHA, & retinoic acid peels. We perform focal phenol peels, but not segmental phenol peels for melasma as the risks are too high for our mode of practice
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, Australia🇦🇺
.
#melasmaclinic #melasma #melasmatips #dermamelan #cosmelan #cosmelanpeel #drdavinlim #sydneydermatologist #melanopropeel
.
Disclaimer: lighting slightly different in exposure settings as different camera systems are employed.
Picosure Pro can be useful in highly motivated & educated patients as adjunctive therapy for melasma pigmentation
.
👉Results can be seen in as little as 2 weeks, however a series of 3-5 sessions provides the best outcome
.
👉Success rate: 80-85%. Melasma can be significantly improved in most, but not all cases. Pico lasers are best combined with medical therapy for optimal outcomes
.
📅Remission: varies according to radiation exposure, hormonal influx, topical usage, maintenance treatments & adjunctive procedures💯
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, Australia🇦🇺
.
#melasmaclinic #melasma #melasmatips #picosure #picolaser #picosurepro #drdavinlim #sydneydermatologist
Disclaimer: lighting slightly different in exposure settings as different camera systems are employed.
Picosure Pro can be useful in highly motivated & educated patients as adjunctive therapy for melasma pigmentation
.
👉Results can be seen in as little as 2 weeks, however a series of 3-5 sessions provides the best outcome
.
👉Success rate: 80-85%. Melasma can be significantly improved in most, but not all cases. Pico lasers are best combined with medical therapy for optimal outcomes
.
📅Remission: varies according to radiation exposure, hormonal influx, topical usage, maintenance treatments & adjunctive procedures💯
.
😎Dr Davin Lim
Dermatologist
Brisbane | Sydney, Australia🇦🇺
.
#melasmaclinic #melasma #melasmatips #picosure #picolaser #picosurepro #drdavinlim #sydneydermatologist
Disclaimer: lighting slightly different in exposure settings as different camera systems are employed.
Melasma can be effectively treated in most cases with a combination of medical therapy as well as energy based devices & novel peels
.
👉This case: Lutronic Q switch nano short pulse (5ns) laser. 5 sessions, spaced 2 weeks apart
.
🔫Laser concepts: low fluence 1064 nm q switching reduces melanin transfer to cells, reduces melanin production, vaporises the stratum corneum allowing better penetration of topicals, shrinks down the dendritic arms of the melanocyte & has limited shattering of pigment particles. Flares are uncommon, results are seen in over 80% of cases
.
👍🏻Laser: Lutronic Hollywood Spectra: is the gold standard in QSL nano laser technology, it has an excellent beam profile with a short pulse duration with super accurate & steady state fluence.
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#lutronic #hollywoodspectra #dermaltoning #toninglaser #melasma #melasmaclinic #drdavinlim #melasmatreatment
Melasma can be effectively treated in most cases with a combination of medical therapy as well as energy based devices & novel peels
.
👉This case: Lutronic Q switch nano short pulse (5ns) laser. 5 sessions, spaced 2 weeks apart
.
🔫Laser concepts: low fluence 1064 nm q switching reduces melanin transfer to cells, reduces melanin production, vaporises the stratum corneum allowing better penetration of topicals, shrinks down the dendritic arms of the melanocyte & has limited shattering of pigment particles. Flares are uncommon, results are seen in over 80% of cases
.
👍🏻Laser: Lutronic Hollywood Spectra: is the gold standard in QSL nano laser technology, it has an excellent beam profile with a short pulse duration with super accurate & steady state fluence.
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#lutronic #hollywoodspectra #dermaltoning #toninglaser #melasma #melasmaclinic #drdavinlim #melasmatreatment
This is generally what happens, hence why it takes a few weeks before best outcomes are achieved following pico laser (providing the diagnosis & settings are accurate)
.
👉Exceptions: if pigment production is not halted, e.g. melasma or PIH, this may result in more (paradoxical) pigment production. For dermal pigment, the rate limiting factor is pigment removal via the immune system, or if the particles are broken down to much smaller pieces that reflect light
.
👉Concept: in some cases, pigment worsens before improving. This momentary increase in pigment lasts 2-4 weeks. Our clinicians will discuss this with you if we employ these settings💯
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#picosure #picosuresurepro #picolaser #melasmatreatment #themelasmaclinic #sydneydermatologist #drdavinlim
This is generally what happens, hence why it takes a few weeks before best outcomes are achieved following pico laser (providing the diagnosis & settings are accurate)
.
👉Exceptions: if pigment production is not halted, e.g. melasma or PIH, this may result in more (paradoxical) pigment production. For dermal pigment, the rate limiting factor is pigment removal via the immune system, or if the particles are broken down to much smaller pieces that reflect light
.
👉Concept: in some cases, pigment worsens before improving. This momentary increase in pigment lasts 2-4 weeks. Our clinicians will discuss this with you if we employ these settings💯
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#picosure #picosuresurepro #picolaser #melasmatreatment #themelasmaclinic #sydneydermatologist #drdavinlim
Retinoids such as #tretinoin & retinol can be useful in addressing melasma as they address cellular aging, increasing turnover of cells, & reduce pigment production (extremely weak action compared to other pigment correctors) 💯
.
👉In some cases our clinicians may titrate retinoids into your melasma routine, along with other pigment correcting ingredients
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#retinol #tretinoin #retinylaldehyde #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist
Retinoids such as #tretinoin & retinol can be useful in addressing melasma as they address cellular aging, increasing turnover of cells, & reduce pigment production (extremely weak action compared to other pigment correctors) 💯
.
👉In some cases our clinicians may titrate retinoids into your melasma routine, along with other pigment correcting ingredients
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#retinol #tretinoin #retinylaldehyde #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist
Retinoids such as #tretinoin & retinol can be useful in addressing melasma pigmentation. Best applied at night due to photosensitivity
.
👉Vitamin C: can be used as an antioxidant or as a pigment corrector. Personally I prefer patients to apply in the am, under sunscreen
.
👉Azelaic acid: can be applied twice daily
.
👉Glycolic acid: can be potentially photosensitising (in theory, however practically not too much of an issue)
.
👉Pigment correctors: generally applied in the PM, with exceptions such as #thiamidol, azelaic acid, HQ that can be applied twice daily depending on other skincare actives
.
👉Sunscreen: at least twice daily, AM & midday application
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #skincaretips #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist
Retinoids such as #tretinoin & retinol can be useful in addressing melasma pigmentation. Best applied at night due to photosensitivity
.
👉Vitamin C: can be used as an antioxidant or as a pigment corrector. Personally I prefer patients to apply in the am, under sunscreen
.
👉Azelaic acid: can be applied twice daily
.
👉Glycolic acid: can be potentially photosensitising (in theory, however practically not too much of an issue)
.
👉Pigment correctors: generally applied in the PM, with exceptions such as #thiamidol, azelaic acid, HQ that can be applied twice daily depending on other skincare actives
.
👉Sunscreen: at least twice daily, AM & midday application
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #skincaretips #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist
Vitamin C is useful in most cases of melasma, however formulations matter. Low pH formulations offer better bioavailability with the downside of higher rates of skin irritation
.
👉How to use: Apply under sunscreen as an antioxidant, or at night as a pigment corrector, or, in some cases twice daily. We prefer a combination vitamin C & ferulic acid plus #tocopherol or vitamin E in a stabilized low pH formulation. The most well known tiple combination is patented at a fixed percentage of 15% L-ascorbic acid with a distinctive metallic smell that stains whites. Several drops go a long way
.
👍🏻Tips: Spend the most amount of time & money on photoprotection. Over 90% of melasma patients do not get this correct, but rather spend efforts on skin care products & procedures. You will get the biggest traction out of understanding how to photoprotect your pigment as well as identifying triggers (beyond the usual ‘it’s hormonal’, think IR heat, additional sources of radiation, frictional components, including cosmetic (self induced) skin irritation). Skin care is always adjunctive to UV & visible light protection💯
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #vitaminC #ascorbicacid #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist #ceferulicacid #vitamincskincare
Vitamin C is useful in most cases of melasma, however formulations matter. Low pH formulations offer better bioavailability with the downside of higher rates of skin irritation
.
👉How to use: Apply under sunscreen as an antioxidant, or at night as a pigment corrector, or, in some cases twice daily. We prefer a combination vitamin C & ferulic acid plus #tocopherol or vitamin E in a stabilized low pH formulation. The most well known tiple combination is patented at a fixed percentage of 15% L-ascorbic acid with a distinctive metallic smell that stains whites. Several drops go a long way
.
👍🏻Tips: Spend the most amount of time & money on photoprotection. Over 90% of melasma patients do not get this correct, but rather spend efforts on skin care products & procedures. You will get the biggest traction out of understanding how to photoprotect your pigment as well as identifying triggers (beyond the usual ‘it’s hormonal’, think IR heat, additional sources of radiation, frictional components, including cosmetic (self induced) skin irritation). Skin care is always adjunctive to UV & visible light protection💯
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #vitaminC #ascorbicacid #melasmaclinic #davinlim #melasmatreatment #themelasmaclinic #sydneydermatologist #ceferulicacid #vitamincskincare
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.
