Cysteamine 5% cream for melasma?

Question

ThIs cream seems to be new alternative to hq for melasma. I want to try but want to know if it makes skin sensitive to sun similar to hq? Does one has to avoid this cream in hot summer and wear spf to avoid getting more spots ? Thanks you

Raffy Karamanoukian, MD, FACS · Answer

I would start Melarase AM, Melarase PM, Melapads, and Replenish to reduce pigmentation on the skin. Once you use it for a month, start Melapeels once monthly to further reduce pigmentation. Best, Dr. KaramanoukianLos Angeles

Anil R. Shah, MD · Answer

Hello, there are other treatments available. Please read below. Melasma is a condition which requires multiple steps and treatments to effectively improve the condition consistently over time.  In our office, here are steps which are effective:
-Pico lasers- The best type of laser for improving the condition.  Please note it takes multiple steps to improve melasma safely
-Nd:YAG Nano lasers with toning- Here a laser is used for deeply resistant melasma to break up particles without generating excessive heat
-Melanage peels- A variety of peels can work and melanage is one of the best for melasma
-Skin topicals- A variety of products including use of lighteners (we prefer natural lighteners such as arubtase found in our product Luminoso) as well as sunscreens can help improve the condition
-Lifestyle choices-Avoiding the sun, hormonal changes (we have a hormone expert in Dr. Chughtai in our office) can all impact melasma.
While melasma is common, patients must understand a multi pronged approach is often the best strategy and controlling this condition.
Best, 
Anil Shah MD

Hratch Karamanoukian, MD, FACS · Answer

Cysteamine is a strong agent and may cause hypopigmentation.Melasma treatments are lifelong and should be tailored for each patient.
Melarase is a great regimen to add or a Brightening Kit in its entirety.
I also recommend that you add one of two of these oral supplements for pigmentary control: Scler-X PIH Relief Complex from VenaSmart or Pigmentation Correction Complex from KareSkin.
You will need wide spectrum UV protection with SPF 30+ sunblock as well. 
H Karamanoukian MD FACS

Davin Lim, MBBS, FACD - Account Suspended · Answer

As with any other cream, start slow, then work up. Video explains how to use creams. Any active ingredient can irritate skin. 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

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