My melasma started on both cheeks. It has spread to my forehead, nose, upper lip & recently below my lower lip. I have been using kojic acid and meladerm every night & have tried azelaic acid & hydroquinone. I was dignosed with low pregesterone, high testosterone & vitamin D deficiency but unsure if that is related. I am hoping a doctor can give me some advice as to why it continues to spread and remain unresponsive to treatment. I cannot find a derm in my area that specializes in melasma.
January 13, 2015
Answer: Melasma Spread Generally speaking, Melasma is not well understood. All evidence points to hormonal changes that trigger it, but the exact way in which it starts and spreads is unknown. For this reason, no one can give you an answer as to why it's spreading. As to how to mitigate the concern, the first piece of advice is diligent sun screen every day, at least 30 SPF and more likely 50 SPF with a chemical and physical sunblock. Step 2 would be diligent sun avoidance. Any sunlight (UV), winter, summer, vacation, even cloudy days can make Melasma worse so avoid the sun at all costs. When you do need to be outside, use sunscreen diligently and wear a full coverage hat or visor.Finally, we use hydroquinone formulations between 6% - 8% to treat it. We use greater than the standard 4% to treat it because many of our Melasma patients have failed 4%. We also take patients off the product every three months because of the higher strength of the hydroquinone. Finally, the formulation does not use a steroid or Retin A. Below you can see before and after pictures of our Los Angeles and Orange County Melasma patients that have used our product.
Helpful
January 13, 2015
Answer: Melasma Spread Generally speaking, Melasma is not well understood. All evidence points to hormonal changes that trigger it, but the exact way in which it starts and spreads is unknown. For this reason, no one can give you an answer as to why it's spreading. As to how to mitigate the concern, the first piece of advice is diligent sun screen every day, at least 30 SPF and more likely 50 SPF with a chemical and physical sunblock. Step 2 would be diligent sun avoidance. Any sunlight (UV), winter, summer, vacation, even cloudy days can make Melasma worse so avoid the sun at all costs. When you do need to be outside, use sunscreen diligently and wear a full coverage hat or visor.Finally, we use hydroquinone formulations between 6% - 8% to treat it. We use greater than the standard 4% to treat it because many of our Melasma patients have failed 4%. We also take patients off the product every three months because of the higher strength of the hydroquinone. Finally, the formulation does not use a steroid or Retin A. Below you can see before and after pictures of our Los Angeles and Orange County Melasma patients that have used our product.
Helpful
October 22, 2015
Answer: Melasma is a chronic condition with different treatment options. Hello there,Melasma has many different causes, and must be approached this way. One common cause is hormonal imbalance or use of hormone medications such as oral contraceptives or supplements. Please be sure to check in with your internist to make sure everything is ok. If you are using any unnecessary supplements, stop those. Sun exposure is another important trigger of melasma. Be sure to wear a mineral sunblock every day, and re-apply throughout the day if possible. The ingredients you should look for include: zinc oxide, titanium dioxide, and ferrous oxide. Powder sunblocks are a great addition to your daily routine. You can even take supplements such as Heliocare, which provides internal sunblock, or niacinamide, which can decrease the uneven pigmentation and any inflammation. Wear a hat and/or use umbrellas when you walk outside.Next, at-home prescription and physician-dispensed treatments can help. Medications like Triluma contains a lightener (hydroquinone), retinoid (tretinoin) and anti-inflammatory (fluocinolone). Usually my patients use a medication like this for 4-6 months until they achieve their aesthetic goals, and then we transition to a tretinoin-only product. Procedures such as chemical peels can also help. Please caution use of lasers, as this can cause worsening of melasma if done incorrectly. Of course, good skincare is very important. Use gentle cleansers and moisturizers, and avoid using acids at home, which can irritate the skin. Good luck!
Helpful 1 person found this helpful
October 22, 2015
Answer: Melasma is a chronic condition with different treatment options. Hello there,Melasma has many different causes, and must be approached this way. One common cause is hormonal imbalance or use of hormone medications such as oral contraceptives or supplements. Please be sure to check in with your internist to make sure everything is ok. If you are using any unnecessary supplements, stop those. Sun exposure is another important trigger of melasma. Be sure to wear a mineral sunblock every day, and re-apply throughout the day if possible. The ingredients you should look for include: zinc oxide, titanium dioxide, and ferrous oxide. Powder sunblocks are a great addition to your daily routine. You can even take supplements such as Heliocare, which provides internal sunblock, or niacinamide, which can decrease the uneven pigmentation and any inflammation. Wear a hat and/or use umbrellas when you walk outside.Next, at-home prescription and physician-dispensed treatments can help. Medications like Triluma contains a lightener (hydroquinone), retinoid (tretinoin) and anti-inflammatory (fluocinolone). Usually my patients use a medication like this for 4-6 months until they achieve their aesthetic goals, and then we transition to a tretinoin-only product. Procedures such as chemical peels can also help. Please caution use of lasers, as this can cause worsening of melasma if done incorrectly. Of course, good skincare is very important. Use gentle cleansers and moisturizers, and avoid using acids at home, which can irritate the skin. Good luck!
Helpful 1 person found this helpful
