Would it be safe and advisable to use Meladerm instead of hydroquinone 4% as pre-treatment for Fraxel repair and Fraxel restore to help prevent PIH? How about for Post-op? Or is Meladerm either not as good as hydroquinone or there's no experience with Meladerm for this purpose? For how many days should either cream be used and stopped prior to treatments for best results?
Meladerm Before Fraxel Repair and Restore?
Doctor Answers 3
Meladerm pre-treatment for prevention of hyperpigmentation with Fraxel Laser
Meladerm, which contains kojic acid is not as potent an agent as prescription strength hydroquinone. Most doctors have more experience with the latter. If you are allergic to hydroquinone, kojic acid may be an option. If not, I suggest you follow your doctor's recommendation. If hydroquinone is recommended, go with that.
Meladerm and Fraxel Laser Treatments
The active ingredient in the Meladerm is kojic acid which is a natural skin lightening cream. I have had some success with this in my practice, but it is still unclear as to it's overall effectiveness and dependability relative to hydroquinone. You do have to watch for skin hypersensitivity with prolonged use of the kojic acid preparations. I basically have the patient use the kojic acid for about 2 weeks before a treatment. Stop several days before and resume one week after for the Fraxel re:store. I presently do not use it on the re:pair unless there are early signs of PIH. The protocol is not as scientific as we would like it to be because there are no definitive studies that I am aware of and we treat by anecdotal success.
Is Meladerm as good as hydroquinone before Fraxel?
I routinely use hydroquinone on all Fraxel patients who have darker skin tones and are more likely to tan than burn (Fitzpatrick scale IV-VI). The reason for this is to minimize the risk of hyperpigmentation (or darkening of the skin) after the treatment. As a result, I've been able to keep my rate of hyperpigmentation after Fraxel very low. I do use Kojic acid derivatives for other reasons in my practice, but not as a replacement for hydroquinone. I don't believe there is any good scientific data comparing them, but Kojic acid is a lot weaker skin lightener than hydroquinone.
In terms of timing, I have my patients start hydroquinone one month before Fraxel, twice a day, and then stop it 5 days before the Fraxel. They resume it 5 days after Fraxel and continue on that protocol until all the treatments are done. Good luck.