Why would Cosmelan make my melasma worse?

Question

I have melasma on my upper lip. For the past several years I have done cosmelan with success every winter. However this year when I went into my dermatologists for the second touch up application the before/after photos showed since the cosmelan my melasma had gotten worse. I'm so frustrated. I did notice on the cosmelan box that it was almost expired. I did the mask in November, the cosmelan was apparently compoundd in august and the expiration date was a week away. Could this be the reason?

Raffy Karamanoukian, MD, FACS · Answer

I would start with the Melarase Brightening kit followed by chemical peels and Clear and Brilliant to restore your skin complexion. Best, Dr. KaramanoukianLos Angeles

Jason Emer, MD · Answer

This is tough to answer without before and after pictures. It is unlikely that this is why your melasma got worse. As you know, melasma needs lifelong maintenance, but usually a combination approach will give the best improvement. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, and sometimes erbium laser (coollaser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Hratch Karamanoukian, MD, FACS · Answer

Cosmelan is a sensitive product and unfortunately has expired. I recommend a physician formulated skin care regimen from KareSkin clled Brightening Kit. There may be others on the market but I like the entirety of this KIt for brightening. BestH Karamanoukian MD FACS

Davin Lim, MBBS, FACD - Account Suspended · Answer

We can speculate on the reasons why - as Dr Emer says Before and Afters would be useful, however if  it confirms worsening, the above may account for why. Now to aim to improve melasma you should understand the cause. 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.

Why would Cosmelan make my melasma worse?

Answers (4)

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