Melasma: Is there any other treatment than Hydroquinone? (Photo)

Question

Hi doctor, I am having pigmentation on my both cheeks, similar to a butterfly wing. I am on and off on contraceptive pills. I've tried hydroquinone under prescription but it worsen the melasma. Now I am applying AHA 10% which slightly fades the pigmentation. Is there any other treatment than Hydroquinone? If I apply any whitening cream will it help reducing the melasma as I am shedding now?

Jeff Angobaldo, MD · Answer

Thank you for your question.   I would recommend to start using triluma morning and night six weeks prior to laser treatment. Fractional treatment is very effective for suppressing discoloration and evening out skintone.  Skinpen which is a microneedling device that would also be beneficial for getting rid of melasma.  The microneedling treatment helps to wake up your natural growth factors, shrink your pores, fade discoloration and acne scars, and help increase collagen and elastin production. You would do a treatment every 4 weeks and stay out of the sun as much as possible and always wear spf 50 broad sprectrum.  Always consult with your physician first before starting a treatment.

Anil R. Shah, MD · Answer

Hello, please see options below. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please not it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

Raffy Karamanoukian, MD, FACS · Answer

I would suggest Susu skincare with specializes in advanced non hydroquinone creams for melasma. Follow with fractional laser, PRP, and light chemical peels. Best, Dr. KaramanoukianLos Angeles

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Narin (Joe) Apisarnthanarax, MD · Answer

Thank You for your question,First I recommend that you go in for a consult with a Dermatologist. Clear & Brilliant (Permea) Laser is the best fractional laser that is safe to treat Melasma, our patient's typically get 6 treatments ranging 4 weeks apart and will combine it with a prescription Triluma or Hydroquinone cream, we do offer Skin Ceuitcals Advanced Pigment Corrector for those who prefer not to use a bleaching cream. There are other options such as chemical Peels. There is no cure for melasma but it is treatable. You must refrain from prolonged sun exposure and use a pure zinc sunscreen at all times, most sunscreens only last 80min. There is also a oral antioxidant  called Heliocare that helps when you are going to be in prolonged sun exposure ( use in conjunction with sunscreen) that's great for melasma patients, it helps protect against the aging effects of free radicals from the UV sun rays and is made from all natural ingredients. If you are on birth control it could enhance your melasma symptoms.

Hratch Karamanoukian, MD, FACS · Answer

A multimodality approach to melasma is key to successful reduction in hyperpigmentation and ongoing maintenance. You would need an in person examination but Melasma can be treated with a comprehensive approach.  You should avoid sun exposure with wide spectrum high SPF sun block and Spectrase is a great product for this. Consideration should be given to stopping birth control pills. As well, topical creams that are non hydroquinone based. Sclerovase. I have been shown to be very effective in our practice.
Hratch L Karamanoukian MD

Thomas D. Griffin Jr., MD · Answer

There are a number of different treatment options for melasma. A combination of topical medications which include a zinc and titanium based daily sunscreen with prescription strength medications such as hydroquinone, azelaic acid, tretinoin, hydrocortisone or kojic acid generally forms the foundation of a good treatment plan. In addition to this topical regimen, chemical peels and energy based treatments are helpful. The most widely used energy based treatments for melasma are fractionated devices like Halo, fraxel and clear and brilliant. Some well equipped physicians will combine fractionated treatments with light BBL or radio frequency treatments. Overall, the treatment of melasma is a challenge. You should expect a well rounded treatment regimen that combines therapies. You should also expect to have a plan for maintaining your results over time as melasma tends to recur after treatment.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours.
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. If HQ is not suited to your liking Lytera can be prescribed. 
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

Melasma: Is there any other treatment than Hydroquinone? (Photo)

Answers (8)

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