Melasma treatment, after dermalen mask, going on hydroquinone 10%..but is it possible to maintain results?

Question

I am fully focussed on my treatment at the moment. I have stubborn melasma that didn't lift with dermalen mask. Now, my derm is putting me on hydroquinone 10% for 2 months. First, any chance this stubborn pigmentation can resolve with hydroquinone 10% + retin A 0.5%? WHat if it's dermal/deep? Derm says maintenance using dermalen cream 2-3 times a week and hydroquinone only if I notice any dark spots. I don't feel hopeful that results can be maintained like this? Please advise from your experience.Thanks

Anil R. Shah, MD · Answer

Hello, there are other treatments for Melasma, see 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 not 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

Raffy Karamanoukian, MD, FACS · Answer

High dose HQ has its pitfalls. I would suggest light chemical peels, Clear + Brilliant laser, and Melarase AM, Melarase PM, and Melapads. Best, Dr. Karamanoukian Los Angeles

Davin Lim, MBBS, FACD - Account Suspended · Answer

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. Real Self Advisory Board

Melasma treatment, after dermalen mask, going on hydroquinone 10%..but is it possible to maintain results?

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Melasma treatment, after dermalen mask, going on hydroquinone 10%..but is it possible to maintain results?

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Everything you need to know about Laser Resurfacing

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