For Melasma, why does hydroquinone such as obagi or tri-luma work for some women and not others?
Doctor Answers 5
Some cases not responsive to HQ.
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. If you have tried 10% HQ along with the methods outlined below, and your pigmentation has not shifted, you probably have marked dermal melsama or ochronoisis from long term HQ use. I suggest you see a dermatologist for evaluation.
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.
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help.All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia
Melasma can manifest superficially in the skin and this is where creams such as Tri-Luma or systems such as Obagi Nuderm are most effective. Melasma slightly deeper in the skin responds to Chemical Peels, Fraxel Laser, or Pico Lasers. There are Melasma subtypes that are very resistant to treatment. Always be sure to protect your skin with sun exposure and discuss all triggers and a stepwise approach to treatment with your dermatologist.
Melasma treatment with Melarase PM
Some melasma has a hormonal basis so until you correct that problem, there is no longterm solution for melasma.
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Melasma and Treatment
Not all cases of Melasma are the same. Some require more aggressive treatment then hydroquinones, especially if they were made worse by laser treatments such as through IPL or Fraxel. Cosmelan or chemical peels may be needed. Please consult a specialist in melasma. Best, Dr. Green