Melasma needs long term commitment with skin care and avoidance of skin factors such as sun exposure (Spectrase Sun Block) which has wide UV spectrum and SPF 30+ protection. Accutane sensitizes your skin to injury from sun rays.
Daily good habits with topicals may well help you chieve your goals with a good skin system ike the Brightening Kit from KareSkin (see link). You may want to start with Melarase and Pigmentation Correction Complex. Scler-X from another vendor is for PIH relief (see link).
Clear + Brilliant laser can be added once you start your pretreatment with topicals.
H Karamanoukian MD FACS
I would suggest treating the rosacea with light lasers followed by Melarase AM, Melarase PM, Melapads, and Replenish creams for the melasma.
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. In your case, rosacea compounds the situation, so HQ creams should probably be 2-3%, with hydrocortisone. May modify the treatment to use laser genesis, 1064 alternating with Q Switch lasers to treat both rosacea and pigment. I think V BEAM may worsen your melasma but improve your rosacea if the power is too high.
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help.
More information on available treatments in the video below.
All the best,
Dr Davin Lim.
Laser, surgical and aesthetic dermatologist.
Brisbane, Australia .