Compounded topical cream storage (photo)

Question

I have a really expensive compounded topical cream for the treatment of my melasma. It consists of hydroquinone powder, tretinoin acid powder, hydrocortisone acetate powder in a Cetaphil moisturizing cream base with the addition of propylene glycol solution. It has a 28-day shelf-life and is rather expensive. Would it extend the longevity of its use if kept in a refrigerated container

Raffy Karamanoukian, MD, FACS · Answer

Application of the Melarase Brightening Kit can help reduce your melasma methodically. Twice daily application followed by Clear and Brilliant laser can signficantly reduce discoloration. I do not believe in longterm use of steroids on the skin. Best, Dr. KaramanoukianLos Angeles

Jason Emer, MD · Answer

I recommend following up with a pharmacist about increasing the shelf-life for this product. Keep in mind, 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. See an expert for a formal evaluation. Best, Dr. Emer

Hratch Karamanoukian, MD, FACS · Answer

melasma should be treated with a combination of lasers, peels and creams. I recommend a topical regimen from Kare Skin called the Brightening Kit. I recommend to all of my patients. Best

Davin Lim, MBBS, FACD - Account Suspended · Answer

Keep in the fridge and away from light. That is the best way to store this formulation. Melasma ideally should be treated with a combination of lasers and creams. 
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

Compounded topical cream storage (photo)

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