I forgot to put the Tri-luma Cream in the refrigerator for 24 hours? Is still safe to use?

Thank you for your question.   I would recommend to start using hydroquinone 4% morning and night six weeks prior to laser treatment. Fractional treatment is very effective for suppressing discoloration and evening out skintone.  Skinpen which is a microneedling device that would also be beneficial for getting rid of melasma.  The microneedling treatment helps to wake up your natural growth factors, shrink your pores, fade discoloration and acne scars, and help increase collagen and elastin production. You would do a treatment every 4 weeks and stay out of the sun as much as possible and always wear spf 50 broad sprectrum.  Always consult with your physician first before starting a treatment. 

Yes, no problems with this.

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.