Using Obagi Nu Derm for melasma. Is my hyperpigmentation darker because it is being brought to the surface? (photo)

Question

I am using Obagi Nuderm to treat melasma. I have seen a difference in my skin in some areas. The hyperpigmentation on my upper lip seems darker. Is it true that the pigment is being brought to the surface and looks darker? I have been using it for 3 months but not aggressively.

Raffy Karamanoukian, MD, FACS · Answer

Melasma is associated with hyperpigmentation caused by a combination of hormones, sun exposure, inflammation, and deposition of melanin pigment. In our office, we specialize in melasma treatments and start with Melapads, Melarase AM, Melarase PM, and Replenish; followed by pulsed dye laser to eliminate inflammatory erythema and light fractional laser. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hi rblocher.  Treatment with hydroquinone based products like Obagi does not bring Melasma to the surface as you mentioned.  It is possible that the Melasma can look worse if you are getting too much irritation from the product, which can happen when you are using Retin A too aggressively or are sensitive to hydroquinone.  If you are getting darker in treated areas, we would suggest returning to your prescriber to ask about progress.  To see examples of or Los Angeles Melasma patients after using our non-retin A gel with 8% hydroquinone, click on the link below.

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, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Davin Lim, MBBS, FACD - Account Suspended · Answer

Combination treatments using both skin care and lasers gives the best results. I like adding low powered QSL lasers in the nano and pico wavelengths to the Obaji range. 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. 
  
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

David E. Berman, MD (retired) · Answer

the Picosure laser is a breakthrough laser because it fires 1,000 faster than other lasers. this means that there is little to no redness so you can return to work after the treatment. you should plan 3 treatments on your entire face (you can also treat your neck, chest hands etc, ) spaced one month apart. you will want to stop any strong skin care products 3 days before your laser treatment.david berman md

Using Obagi Nu Derm for melasma. Is my hyperpigmentation darker because it is being brought to the surface? (photo)

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