Wow – I hear you on this. It can feel like an intractable problem sometimes. Here are some thoughts for help moving past this problem.
Is your diagnosis correct?
I can’t tell you how many patients we’ve seen over the years who come in with a diagnosis of melasma (or something else) who really don’t have melasma. It’s something else or….a combination of melasma, sun damage, skincare product irritation, rosacea, or other skin diseases.
Some things to consider:
- Any skin irritation and often hormones can make melasma worse!
- Are you taking hormones of any kind, especially oral contraceptives, or have some hormonal imbalances? A good gynecologist or endocrinologist may be able to help, if your primary care doctor doesn’t know much about this.
- Lasers can make this worse. Is it possible that all these laser treatments are aggravating it? Have you tried just a period of skin rest, meaning no lasers or peels for 6 months? Just great skincare products, double sunscreening and hats?
- Do you have undiagnosed rosacea? Melasma is sometimes worst in areas of dilated capillaries. If the rosacea is better controlled, that may help. After good control of rosacea, a VBeam may be helpful to reduce the capillaries.
- Is one of your skincare products irritating you? You can try for several weeks just using a very bland cleanser, moisturizer (like CeraVe) and the sunscreens. When you start your products back add one every week so you can tell if one is a problem.
- Look up some of Dr. Pearl Grimes research out of UCLA. She has been and is a pioneer in treating this problem.
- Talk to you dermatologist about tranexamic acid preparations.
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You’re doing a great job already, but here are some more things to try.
- Watch the hydroquinone 4% carefully. About 10% of patients develop irritation from it that’s subtle, and the melasma just slowly gets worse. The “triple” creams are better because they contain a little tretinoin (retin A) and a low strength (safe) steroid that helps with this irritation factor.
- Double sunscreen. You’re using 18% zinc which is the best, but that still won’t block everything. Try using a mineral powder over that like the Colorscience or even Jane Iredale mineral powder makeup.
- If you’re sure the Lytera isn’t irritating you, can you use it twice a day.
- If you’re in an office, be aware that windows do NOT block UVA which is key for melasma.
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