I have been using 2 percent hydroquinone for 4 weeks today, should I continue? (Photos)

Question

I have only seen about 20 percent improvement. Should I continue? Am I jumping the gun? Could it take more time?? I have only had melasma for under a year. Could it be dermal? I'm using 4 percent hydroquinone on a small area to watch its performance. I am also using adapaline .03....just started that bevause the .01 helped my cheek area pretty well. Any thoughts?

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 suggest doing a fractional treatment for melasma.  Apply hydroquinone morning and evening two weeks prior to your treatment.  The fractional treatment would help to suppress the discoloration and improve texture of your skin along with shrinking your pores.

Marcus Davis, MBBS, MRM, FRCSEd (Plast) · Answer

Many thanks for your question and pictures.
I would recommend 4% Hydroquinone with the addition of Tretinoin or Retinol 1% - thsee work synergistically with the Hydroquinone to improve the effect it has on the melanocytes. You can only use the Hydroquinone for 5 months, after which it is recommended that you have a 3 month break from it before recommencing for another 5 month cycle if required. You should of course use a broad spectrum SPF50 sunblock daily every day of the year.
Consult a Board Certified Plastic Surgeon or Dermatologist who can examine and advise you.
Best of luck.
Marcus

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes, its working well if you are only using HQ at 2 percent. I always evaluate my patients at 14 weeks. 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.

I have been using 2 percent hydroquinone for 4 weeks today, should I continue? (Photos)

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