Melasma Treatment Plan

Melasma

Frequently Asked Questions about Melasma

More Information about: Strict Sun Avoidance, EpiQuin Micro, Tri-Luma, Fraxel, Cosmelan, Microdermabrasions, Light Chemical Peels

Melasma is a dark skin discoloration found on sun-exposed areas of the face. Melasma is a very common skin disorder. Though it can affect anyone, young women with brownish skin tones are at greatest risk. Melasma is a chronic recurrent condition that can be controlled but not cured.

Melasma Treatment Plan

Strict Sun Avoidance and Sunscreen

Discontinue all Hormone Treatments (if possible)

Birth Control Pills, Hormone Replacement Therapy

Cosmelan Application in Office

Cosmelan Application twice per day at home x 3 weeks

Cosmelan Application every evening at home

Light Chemical Peel and Microdermabrasions

Sunscreen, Strict Sun Avoidance and Moisturizers

Fraxel Laser Treatment as needed

Melasma Maintenance Plan

Strict Sun Avoidance and Sunscreens

Hydroquinone and RetinA (or Retinol)

Tri-Luma, EpiQuinn Micro or Generics

Microdermabrasions and Light Chemical Peels as needed

Strict Sun Avoidance and Sunscreens

Melasma Exacerbation Plan

Retreatment with Cosmelan as needed

Microdermabrasions (MDA) and Light Chemical Peels (LCP)

MDA and LCPs enhance epidermal turnover and penetration of topical agents

Modified Jessners, Glycolic or Salicylic Acid Peels (non-inflammatory peels) are best

Alternate LCP with MDA for those who can tolerate this (lighter skin types)

Light MDA is better (more forgiving) than LCP especially for Skin Type 5 & 6 (patients of color)

Stop topical meds 7-10 days before LCP. Stop topical meds 1-2 days before MDA.

Lightening Agents

Hydroquinone

Retin A

Finestra (Azelaic Acid) can be used, but use Hydrocortisone with it b/o irritation

Kojic Acid

Tazorotene (Tazorac)

Licorice

Alpha Hydroxy Acids

Salicylic Acids

Arbutin

Ascorbic Acid

Linoleic Acid

Applying Topical Agents for Melasma

Cleanser first, Lightener (HQ & RA) next, then the Moisturizer and the Sunscreen last. Ideally patient should wait 5-10 minutes between application of lightener, moisturizer and sunscreen. Skin must be clean and pores open so lightener gets absorbed.

General Comments about Hydroquinone

You can usually see improvement in 4-6 weeks with Hydroquinone (HQ).

Rotate lighteners to avoid tachyphylaxis (when your skin gets used to the lightener and it no longer has the desired effect). You need a HQ Holiday every 6 months if possible. Increase HQ in the summer.

The Name Brand Hydroquinone Agents:

EpiQuin Micro twice per day. This is 4% HQ and Retinol 0.15% delivered with Microsponge Technology. Start 3 times per week at night and work up to twice per day. EpiQuinn Mico is less irritating and causes less peeling because of it’s Microsponge technology.

Tri-Luma for Challenging Patients. Start with Tri-Luma for 3 months then use another preparation with a less potent steroid or no steroid at all.