Additional Treatments for Resistant Melasma & Rosacea Not Responding Variety of Treatments? (photo)

Female-32 years. My treatments: Fraxel Dual x 2: from this worsened Melasma & skin tone & texture significantly changed. 4 IPL- these seemed to help, though, 2-3 weeks after the treatment most came back. Skin Care: 2 x per day: I use Tretinoin Cream .05%, Neova Complex (Hydroquionine 4% & GA), sunscreen, Neutrogena Age Shield Face SPF 110 Broad Spectrum UVA & UVB Meds: Started to take Doxycycline Any suggestions on if I am doing something that is exacerbating this?

Doctor Answers 1

Treatment For Melasma And Rosacea

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The treatment for melasma and rosacea are different.  I recommend you treat your rosacea first since this is somewhat better understood.  Rosacea, also known as acne rosacea, is an inflammatory process.  Dr. Saunders, a dermatologist in Louisiana, first recommended the treatment of acne rosacea using oral lukotriene receptor antagonists.  In my practice, we have created a cream made up from Accolate which is placed on the face twice per day, and while it doesn't cure the inflammatory cascade, it has a great track record for treating acne rosacea. 
Melasma, also known as the mask of pregnancy, seems to be best treated in my practice with a cream that I created with a compounding pharmacist in Aiea.  A main ingredient is kojic acid.
Doxycycline has been given for years, not because of its antibiotic quality, but because it is a very weak anti-inflammatory.  It has minimal value in my opinion. 

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