Melasma: how do I use Aziderm and Retinol to treat it? Laser did nothing.

Question

I have melasma. I have already taken laser treatment but to no avail. I have been recommended to use Aziderm 20% and Retinol 0.05%. I am scared about the medication now . Could you please advise how to apply these medicines and how many times in a day. Thank you!

Jason Emer, MD · Answer

Thank you for your question, Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + Brilliant, peels, microneedling/PRP, Aerolase, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Jeff Angobaldo, MD · Answer

Thank you for your question.   I would recommend to start using triluma 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

Raffy Karamanoukian, MD, FACS · Answer

Dark spots on the skin are caused by sun UV exposure, hormonal load, birth control pills, and genetics. If you’re thinking about dark spot correction or melasma correction, you would be best advised to start with creams that control the production of melanin before starting lasers or chemical peels. I recommend Melarase creams first for pigment correction, followed by a protocol of lasers, chemical peels, exfoliation, IPL, and pulsed dye laser. 
  
 
  
Recommended Creams: Melarase Brightening Kit
  
MelaClenz
  Melapads
  Melarase AM
  Melarase PM
  Replenish Retinoid Cream
   
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

David E. Berman, MD (retired) · Answer

You should consider getting at least 3 treatments with the picosure laser. however, this may not be a good choice for you, if you have very dark skin (types 5 or 6). This is more effective than any other peel or lasers. You should pre-treat with HQ for 2-3 weeks and use HQ or Lytera after your laser treatment. You also need an excellent sunblock.david berman md

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. 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. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia.

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