TriLuma is no longer working on my Melasma. What are your thoughts on oral Tranexamic acid?

There are common precipitors for melasma that include hormones (estrogen and progesterone), birth control pills, stress, thyroid problems, sun exposure, and inflammation. In my practice, I use a combination of topicals: 
Melarase AM and Melarase PMMelapadsMelaclenzReplenish Retinoid CreamOnce started, we combine this regimen with fractional laser, pulsed dye laser, Covalent chemical peels, and LED Yag. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

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

Dear itd060198,I would have to examine you but Melasma can be treated with a comprehensive approach.  Stopping or changing the birth control medication, avoidance of UV and direct light, and also retinol and hydroquinone treatment. You should always use sunscreen.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

I recommend getting a formal evaluation with a cosmetic dermatologist. 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, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

it is the best laser since it fires 1,000 faster than other lasers. It can do much more than any cream or chemical peel. you should plan 3 treatments, at least, spaced each a month apart. You should use a good sunblock between sessions. It is safe for Asians and skin types 1-4. david berman md

T. acid is widely accepted in the management of certain forms of melasma. This tablet needs to be medically supervised, but it can be extremely useful for adjunctive melasma management. 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.

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. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams.

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