My wife is from Philippines and has got hyper-pigm on her face due to sun exposure (2yrs back) & then she delivered baby, the dark spots became worse. We consulted dermatologist (last 10months), he did: 1) 3 Fraxels 2) 4 IPL’s 3)Tretinoin cream- last 3 months – before every otherday & now everyday. (She was breast feeding before). I don’t see changes,just few light spots,do I need to wait? Is the IPL per month necessary? In sun- light spot become dark (with spf)?
Hyper Pigmentation Removal with Fraxel and Ipl
Doctor Answers 2
post inflammatory hyperpigmentation or melasma, may be difficult to treat. A combination of topical therapy and possible Fraxel Dual may help, but religious use of sunblock is important. Sometimes light chemical peels, the "Kligman" formula of hydroquinone, Retin A, and steroid cream can help. There are important side effects of the cream so discuss it with your doctor. All lasers and peels have a risk of making the post inflammatory hyperpigmentation worse. If hydroquinone irritates the skin, then Lumixy or the newer Elure lightening cream may help.
Facial hyperpigmentation/melasma treatment
The hyperpigmentation that gets worse in the sun and after having a baby sounds like melasma. Melasma is sometimes tough to treat especially if it has a dermal component. You mentioned Fraxel, IPL and tretinoin. Has your wife used hydroquinone? Or particularly the triple therapy with hydroquinone, fluocinolone and tretinoin? Does she use a broad-spectrum sunscreen every single day? Melasma can get worse with even a small amount of exposure.
I recommend trying the triple therapy, such as Tri-Luma in the evenings. And a broad spectrum sunscreen in the mornings. I would hold off on the laser treatments for now. It's true that IPL and fractional laser in combination usually work well for melasma but you should have seen some improvement from the procedures already. Maybe not perfect but some improvement nonetheless.
There are also other topical therapy options which may be helpful such as azelaic acid, kojic acid and others. You mentioned your wife just had a baby. None of these medications including Tri-Luma should be used during pregnancy or breastfeeding.