Can I use Tri- Luma immediately after use of 4% Hydroquinone?

Question

I have melasma and acne scars/pigment from pregnancy. I have used 4% Hydroquinoin 3 times a week for 3 months. I have been recommended Tri-Luma by another dermatologist. Can I use Tri- Luma immediately after discontinuing use of the 4 % Hydroquinoin or do I need to wait a month in between uses? Also, wondering if the Tri- Luma will Aggravate the acne ? I am also taking 75 mg spironolactone daily. Thanks!

Raffy Karamanoukian, MD, FACS · Answer

Dark pigmentation on the skin can be due to melasma, age spots, and sun damage. Melasma is a specific hormonally-influenced skin condition in which pigmentation is deposited by overactive pigment cells in your skin. 
  
In our office, we individualize treatments for melasma and skin discoloration based on skin type, skin complexion, hormonal influences, and ethnicity. 
  
Treatments for melasma begin with Melarase creams as follows: 
  
MelaClenz
  Melarase AM
  Melarase PM
  Melapads
  Replenish Retinoid Cream
  Additional therapies include fractional laser, fractional RF, Covalent peels, and LED microneedling with Replenish serum. The video demonstrates the clear and brilliant laser that is used alongside Melarase creams. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

A. David Rahimi, MD · Answer

I am not a big fan of Triluma. It actually has a small amount of steroid which over time can thin the skin. Find an office than offersa reliable facials and have monthly Microdermabrasions in addition to Retin A and 4% HQ cream. Also look into a laser called Clear and Brilliant.I believe that this laser will be greatly appreciated by patient with sensitive skin and patients with a darker skin complexion. I have written extensively about Olive and Ethnic skin and appropriateness of laser for this group of people. The Clear and Brilliant laser is ideally suited with patients with darker skin color. It addresses superficial skin imperfections, large pores, fine lines and helps lift the skin.I have treated patients with Asian and Hispanic background with no post inflammatory hyper or hypo-pigmentation. In other words, I have not noticed any light or dark spot arising from the laser treatments.The procedure takes about 20 minutes and is performed after the application of a topical numbing cream. Redness lasts for a few hours and patients can return to work immediately. Post operative care is minimal and includes sunscreen and moisturizers. A series of 3 to 5 treatments are needed to achieve long lasting results.

Davin Lim, MBBS, FACD - Account Suspended · Answer

You can but you MUST titrate your dose or irritation will occur. Combination treatments with lasers work best.

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.

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