Have any of you doctors had a patient's melasma get worse after they use Cosmelan? (photo)

Hi Mary.  The answer is yes.  If the trauma of the peeling (from Retin A) is too great then the effect can be post inflammatory hyperpigmentation, which is a darkening of the skin caused by the trauma and the associated healing process.  The good news is that it will go away.  It's a different type of pigment than the Melasma and does not make Melasma worse, but it may look darker temporarily.  There are a couple reasons we do not use Cosmelan anymore.  First, the company was dishonest with us back in 2006-2008.  They were importing it as a beauty product even though it had high strength Retin A and hydroquinone.  Patients were leaving the Retin A on too long and getting burned (which causes the PIH above).  The FDA investigated and prevented them from importing the product.  Their next step was to import the product without the active ingredients, but in the process lied to practitioners they were selling to by saying nothing had changed.  In fact a lot had changed.  The Retin A and hydroquinone had been removed.  Shortly after the FDA stopped them from importing the product with active ingredients, they started compounding the product in the US after importing it.  Here they added Retin A and hydroquinone.  The problem was that the quality control was very poor and much of the hydroquinone we were getting was turning brown (expiring) and not working.  All of this happened at a time when the company was trying to tell us that nothing had changed.  In addition to the ethical issues noted above, the other issue is price.  The product sells to physicians offices for $300- $400.  We had to charge double that for in office peels and the take home product and it got to be too expensive for many of our patients.  Finally, many patients did not like the 3-5 day recovery that the peel caused and wanted something that they could use with no downtime.For all these reasons, we switched to an 8% hydroquinone gel that is used daily at home with no downtime.  It's easier to use, cheaper and has no downtime.  For results, you can view the link below.  We are sorry to hear that Cosmelan caused the darkening, but this is a potential adverse outcome, especially when the mask is left on for too long.  

In our office, we use Cosmelan to treat Melasma with great results. 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

Hello, The non-melisma area lighten up much faster so the contrast may project the worsening of melisma. But most importantly, While on treatment, Direct Sun exposure damage badly the skin. I recommend my patients, aside from good sunblock, to wear a hat and avoid direct sun exposure. Cosmelan products are great but the patients' compliance with maintenance is the main barrier. After few months or so when everything is going well suddenly, a trip or something else, and melisma comes back. Cosmelan does not cure melisma but it just fade it away as long as you are using treatment.I would recommend combination of modalities including Fraxel.All the BestRay Bayati, MDElite Medical AestheticsSacramento Area, California