Can you help me with a topical cream for my melasma? It truly is making me depressed (Photo)

Question

I am 54 years old, Japanese, born and raised in Hawaii. I now live on the East coast. Dermatologists here do not have much experience with Asian skin and melasma. I have the typical patterns/patches of melasma on my cheeks. Pretty much tried everything over the counter and presribed methods (Triluma, Vivatia, chemical peels, etc.).

Jason Emer, MD · Answer

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. For a topical cream, I recommend the hydroquinone 4% bleaching cream. See an expert for a formal evaluation. Best, Dr. Emer

Raffy Karamanoukian, MD, FACS · Answer

Melasma and age spots can be due to hormones, aging, sun exposure, thyroid dysfunction, and genetics. Treatments range from IPL to laser therapy; but pigmentation may recur if not complemented with topical creams to stabilize the pigment cells. 
I would suggest starting with Melarase Brightening Kit with Melaclenz, Melapads, Melarase AM, and Melarase PM to help stabilize pigmentation and reduce recurrence. Once started, an active protocol that includes Covalent peels, IPL, fractional laser, and microneedling can further remove pigmentation.
Best, Dr. KaramanoukianRealself100 Surgeon

Jeff Angobaldo, MD · Answer

Thank you for your question.  You can treat the discoloration with two topical creams. Applying a thin layer of  Hydroquinone morning night  and retinol in the evening.  You can also do a laser treatment every four weeks called the Fractional laser treatment.  Its very effective for treating melasma, improving skin texture, shrinking pores, and rejuvenating the skin.

Anteneh Roba, MD · Answer

Triluma contains Hydroquinone but at 4% which is not effective in some patients with deep Melasma. You may need up to 8% plus other topical such as retin A, an exfoliant. You will need to see a Dr for more aggressive treatment. Cosmelan would be a good option.

Davin Lim, MBBS, FACD - Account Suspended · Answer

You do need to see a good dermatologist who has experience in Asian skin types and laser dermatology - Dr Ron Moy is a well known dermatologist who visits Hawaii and comes highly recommended. Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments.

I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production by decreasing the activity of the cells that produce pigment. Laser itself is not aimed at ‘blasting’ pigment, but to slow down the rate of melanin production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)

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 according the type of melasma. Majority of patients will have mixed dermal and epidermal melasma. Approach melasma as a medical condition and not a cosmetic concern, and the success rate will be much higher.

Consult a Board Certified Laser dermatologist with a special interest in disorders in pigmentation as well as one who has experience in treating all skin types, including darker Ethnic skin.

All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.

Can you help me with a topical cream for my melasma? It truly is making me depressed (Photo)

Answers (5)

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