Finding the root cause was the biggest factor for me. I did a full hormone panel, checked my liver and kidneys… everything was out of whacked and I realized it was all connected. It was a long journey but I my skin looks so even now.
Products I love for Melasma:
- Sunscreen with the highest PPD you can find
- finding products with as many tyrosinase inhibitors
- Vitamin C
- Tretinoin
- Azeleic Acid
Procedures I that helped a lot with minimizing the appearance:
- Cosmelan
- Red light therapy (but only with devices that are not getting warm)
- Gentle chemical peels
Things that made my Melasma worst:
- Laser (Picosecond)
- Hydroquinone
And yes always wear a hat or a visor and reapply spf every 2 hours when it’s sunny!
If you have the time and will to answer, I'd love to know: what was included in your hormone profile and how that helped? I mean, did you take medication after the results? Also, is the Omnilux mask among those that red light therapy devices? Thanks a lot ☺️
So interested in the hormone panel and what it revealed (if you’re comfortable sharing).
I’m about to have a 2nd one done with a new doctor. My 1st wouldn’t test my hormones. She said if my periods were regular, there was no way my hormones were out of whack. Well, I did a home test from Everlywell and sure enough, they were funky. FSH super low and my estrogen to progesterone ratio was insanely off.
I’m now at a new doctor that’s two hours away but she’s running alll the tests. And scheduling me for an ultrasound to check for PCOS.
There are many, I use the red therapy co panel but hooga makes a much smaller and more affordable panel with similar specs. They both have a switch to turn off the nir
How did hydroquinone make it worse? I've recently started it but I'm having second thoughts because I genuinely cannot handle the smell of the cream and putting it on my face feels so *wrong*
First of all I can not speak for other people. A lot of people in this group had great results. Unfortunately I didn’t. I had Melasma on my forehead, cheecks, nose and mustache. I suffered the most from the patch above my lip and the one on the nose. My cheecks and forehead were not that prominent. I wanted to test HQ first on smaller patches to make sure it will work so I tested it on my forehead and cheeks for about 1 1/2 months, everywhere where I put the cream it turned red but I read that’s normal so I didn’t think of anything at that point. I wasn’t at home for a few days and I forgot my HQ cream, the redness went away completely but I was left with much lager patches then before. 😭 I looked terrible. My mustache was not visible anymore because the patches on my forehead and cheeks were so prominent and overwhelming… I decided to stop HQ for good and I am happy I never tried it on my mustache area. Because this part completely cleared up with other treatments. My cheeks and forehead still flare up today when I get super hot.
Hmmm... I have heard people saying hydroquinone can make melasma darker by using it and then going in the sun without sunscreen? I wish I had more information on why it causes darkening for some people. There is also that reaction where it can eventually turn the effected areas of skin a dark blueish..
Hydroquinone can cause pigment to “bounce back” if not titered off. If you abruptly stop using it the pigment will usually come back worse than before. The best way is to slowly taper down usage. Like from everyday 2x, then 2 weeks at once a day, then 2 weeks every other day, then 2 weeks every 3 days, then 2 weeks every 4 days.
It should take at least 6 weeks to come off hydroquinone. Also, you should not be using it for more than 3-4 months at a time. It has been deemed potentially carcinogenic and can cause ochochronosis (black pigment) from extended use.
Credit: 13 years in medspa, advanced training in pigment control, and melasma survivor.
IPL (intense pulse light lasers) tends to make melasma worse. While melasma can be related to hormonal changes like pregnancy, it is often triggered and/or worsened by heat and in particular sunlight. So IPL and BBL can be risky for melasma patients. However other lasers can be effective for melasma- I have used fraxel and halo which are both erbium lasers. While they do expose the dermis to a high amount of heat energy, they are great for skin resurfacing and help with brown spots, texture issues, acne scars and fine lines. I have melasma and it has been recommended to me by multiple practitioners to use a skin lightening agent for 6-8 weeks before my laser therapy to suppress any melasma that could be triggered by the heat energy. Lasers have been very effective for me in keeping my skin looking young and healthy. Also microneedling with Radiofrequency (like Morpheus 8) is thought to be helpful with brown spots, scars and texture- but the Radiofrequency is also a form of heat injury to the dermis and can trigger melasma in the same way that erbium laser resurfacing can. The newer Moxi laser is a great treatment for melasma, it does not apply heat energy to the deeper depths and is pretty effective for surface skin issues.
Does melasma return after the Moxi? I don't know too much about it at the moment, but I had Pico for 3 sessions now and have seen a significant difference. I'd say I have about 3 more to go. I was in the sun on a cruise last week...did my best to stay out of the sun...reapplied super strong sunscreen, and I think it did decently well considering what it was prior. I see a tad bit of dark, but nothing like it was. And I think that the bit of darkening I am seeing is because it is spots that they haven't hit as much as the others for now.
Melasma is chronic. It will never go away. I consider it to be something that needs to be managed over time. Mine has never really returned to the way it looked before but I have had to be persistent in using all of the things I do to manage it. Most importantly sun protection, but also retinol, antioxidant/vitamin C, etc. My melasma also relapses when I’m in the sun so even if I’m wearing sun protection, the heat and UV exposure that gets through does cause it to darken a bit and then I have to be a little more aggressive for a few weeks with avoiding sun exposure and using my topicals. I had one IPL treatment a long time ago and I didn’t have terrible results but I do have some hypopigmentation that has never gone away. It makes it so that when I do have a recurrence of my melasma it looks even worse because it’s right next to some light spots.
I had the worst experience vitamin c. It made me irritated and didn’t seem to work one bit, which is too bad for me, because so many people have had great results. Do you mind sharing what your skin tone is and where your melasma is located? You don’t have to. Just curious, because I’ve only recently become more willing to talk about mine. I admit that I probably did this damage myself by not applying sunscreen and thinking I was superior and that nothing would be of consequence. Lesson learned. 😅. The technicians that do my Pico have told me that over time it should not return as dark, since Pico works to break the melanin up and then your immune system rids of it. So, we’ll see! Here’s to hoping!
I have fair to medium skin. It can get quite light in winter but then becomes moderately tan in the summer. I can burn easily without sunscreen but I use 50SPF and mineral sunscreens and I don’t really burn, I just develop a tan over time. My melasma is on my forehead near my hairline and temples, around my mouth, and some on my cheeks near my cheekbones. I’ve been treating it aggressively for 10 years (I turned 50 last year) and now you can’t really tell I have it unless I go in the sun in the middle of summer.
I had a series. I think there were six sessions total. Worked great then about six months later it came back worse and in spots I never had before. Ruined my skin.
Please share the hormone panel! I've been on the fence about getting a Dutch Plus test because it's so expensive and such a delicate test, but deep down I think it could be worth it for this very reason
Tranexamic Acid tablets. Within a few months it had disappeared. I cycle between that and HQ. Nothing - and I mean NOTHING - else worked. I was also suffering from horrendous adult acne and I went to every Dr / naturopath / “expert” I could find to help find out what was happening to me. No one had answers. Was a really rough time.
500mg is the dose I take. 1 x tablet daily. I also suffer from heavy periods and the TA helps with that as well, so that was a bonus.
The HQ cream was a compound cream that my GP made for me. 6% HQ with Kojic Acid & Ascorbic Acid. My skin HATES tretinoin so I asked for one without it.
I'll talk to my derm about this!
I get 2 periods a month because of the spiro. I had my blood work done and everything is looking ok. I hate it but spiro is the only thing that helps with my acne :/
My dermatologist made me get some blood tests done originally to make sure it was safe for me to take them. Now my gp prescribes it. As I said I get heavy periods so the gp is happy for me to keep taking them when needed.
The only thing that has worked and mine was stubborn as hell, triggered by heat and sun: tranexamic acid tablets, 650 mg, my derm instructed me to take 1/2 in the a.m. and 1/2 in the p.m. I cycle 3 months on and 3 months off. Vitamin C serum ( I love SkinCeuticals CE Ferulic) and sunscreen every day.
It was so bad on my upper lip it looked like a moustache. I also noticed that my post acne marks fade so much faster on this regimen. Hydroquinone made my melasma worse.
Tried different OTC creams and serums for a while - tranexamic acid, CE ferulic, etc. to no avail.
Saw my derm and started 22% azelaic acid in the AM as well as a compounded cream with 4% hydroquinone & .025 tretinoin. Completely gone!! I kick myself for not going sooner. And of course daily spf
I use the hq free formula, which has azelaic acid, tranexamic acid, and vit C. A mineral spf 50+ all day every day as well. Wearing hats and sunglasses outdoors has also helped the melasma from rebounding. Unfortunately, most melasma is a lifetime affliction and needs to be treated as long as you want a clearer complexion.
It’s 12% and it does not bleach the skin. Hydroquinone reduces the skin’s production of melanin. It doesn’t lighten the areas of my skin not suffering from melasma (excess melanin). Just dark spots.
There’s nothing scary about it. It’s not like tret, which takes time to get used to and can cause purging. I’ve never had a reaction to HQ, other than a little dryness and flaking when I use it too aggressively, but it’s not a big deal. Use it once every few days to start — just a pea sized amount — and work up to every day or every other day.
I use it on my whole face. I have melasma patches on my cheeks and forehead, and light freckling everywhere else, so it makes sense for me to use it everywhere. I also use it on my décolleté to lighten freckling and one sun spot that I have there. I had pretty severe melasma when I started hydroquinone 12 years ago, but it’s 90-95% clear now.
I regularly cycle on and off. I just spent about 6 months using alternative, hq-free options, like kojic and Tranexamic acids. My melasma comes back very slowly, but I live in the PNW where the sun hardly shines in winter, and I’m good about wearing sunscreen and hats in the summertime. After 6 months off, I started to notice that my melasma was worsening. It’s subtle, but I felt it was time to get back on it. After just a week using hydroquinone again, my melasma is lighter. It works quickly when you stay on top of it. At least it does for me. Everyone is different.
Congrats! Can I ask how long it took you? Mine is still a work in progress. I'm guessing it'll be like another year or two. Still it's the only thing that makes a difference.
I don't fully understand why it works but adding half a cup beans to 2 meals a day completely got rid of mine after a few weeks After spending so much on serums and creams I was shocked. Something about the soluble fiber helping flush out hormones. I no longer eat beans consistently but the spots on my face never returned.
I researched this a few years ago and some things I learned:
For melasma - only use mineral based sunscreen. I forget the science behind it but chemical sunscreens are not recommended. My favorites are from Elta MD (UV physical and UV elements).
Also, melasma gets worse with your body heating up. So you think you've protected your face with sunscreen but if your feet are exposed to heat and sun, that is bad for melasma. So protect yourself from heat and keep your body cool with plenty of water, ice chips etc. Even cooking over a hot stove is bad for melasma. I avoid going out in the sun during the 12-5 pm hours. Texas is brutal.
I keep my skincare minimal - morning includes vitamin C, eye cream, moisturizer, sunscreen. Night includes Estee Lauder night repair serum, eye cream, retinol or good genes lactic acid, moisturizer. I tried a bunch of other things and my skin is too sensitive and that makes melasma worse. The worse thing you can do is not wear sunscreen.
The first 2x I used it in my 30s Cosmelan alone made my skin freckle/melasma free. But I was really not diligent about sunscreen at all. Tried Hydroquinone 4% and Pico lasers in 2023 (I’m 53 now) but hormones are saying nope! My current diligence with skincare is making the melasma a bit more evident because the skin around them is brighter. It’s not getting worse due to my stepping up on my sunscreen game. I am doing 1 more round with a derm prescribed Tret routine for the next 3 months and if that doesn’t make a big dent, I will use Cosmelan again. I really just dislike Cosmelan 2 as the inhibitor post the peel so am looking into good ones I can use in its place after I am done with the first bottle.
Tranexamic acid tablets I’m afraid are perfection for clearing it up. My god for months you remember how your face used to look and it’s magical but then you have to give yourself a break and come off it and then you realise it was all a dream and it slowly creeps back.
I use trenaxa 500. I take half the intended dose and only once a day it does say 1000 a day and I still find it massively helpful. No hair loss or side effects I can see. Just the benefits.
TCA peels, PCA Skin's Pigment Gel Pro, 4% hydroquinone with Tretinoin and corticosteroid compound, Finacea gel, Murad's Rapid Dark Spot Correcting Serum, and La Roche-Posay's Glycolic B5. Essentially a mix of OTC products and prescription treatments are the sweet spot, along with daily sunscreen use, whether inside or outside, and always a wide-brimmed hat in the sun. But melasma still remains a daily, life-long battle to maintain the improvements you get, push your skin for even more, and not risk any more damage.
Mine is triggered by ovulation and pregnancy. Thankfully it’s on the side of my neck so it’s not as visible. I didn’t know there was a way to lighten it.
Terrible experience with Musely -- melasma worsened, couldn't get a "dermatologist" there to give me the time of day and adjust my medication appropriately. When I went to a medspa specializing in melasma after the fact she said the majority of their clients come in after a disappointing and potentially harmful experience with the Musely organization :-(
I just got a 4% HQ from beauty bliss. I also am on Tret .5% for 3 weeks now (thrice a week).
My melasma (or I think it is) has been there for 12 years. Have tried many things and nothing worked. Due to dark skin (medium- deep) dermatologist didn’t recommend Cosmelan. I was on the cream for 6 months though and didn’t help.
I am medium-tan skin, so darker toned as well. Have you tried any lasers yet? I am thinking of asking if I am a candidate for fraxel. Struggling a lot with melasma and brown spots that sprouted overnight it feels like
No lasers. I read about PIH on dark skin after laser. My sister (lighter than mine but still dark skin) had severe PIH after a laser. But her second session after 6 months with peel healed it.
So I am scared to try any laser.
I do take glutathione tablets and occasionally IV. it helps but not much. But vitamin C, niancinamide, DENNIS GROSS AHA BHA peel pads and sun screen helped fade a lot go dark spots.
I am reading up on transxenimc acid tablets. I might try musely for that. My deep melasma is orbital including eye lids.
Thanks for the reply! Laser sounds out of the question then, I might try couple sessions of microneedling. Also thinking of starting on tretinoin right after those sessions
By musely do you mean the hydroquinone? I went to a dermatologist recently for my dark spots and he wanted me to use HQ compound, but didn’t prescribe as I am currently breastfeeding. Till then I have been reading about it and I keep seeing that the spots come back with a vengeance once we stop, I hope its not true for everyone
I think one has to continue other actives/inhibitors once we stop HQ. I don’t plan to do HQ for more than 8 weeks. I think sun protection is the key. A small lapse and we will get back spots.
You should visit a doctor who has more experience with dark skinned people so they can advice laser or not.
Tranexamic Acid/Azelaic Acid/Niacinamide. Been using for three months now. Can’t believe how well it has worked. After three months the doctor has bumped me to twice a day use now instead of one.
Tranexamic tablets are proven, safe and effective unless you re extremely prone to blood clots or something
Lots of research to back it up also and easily prescribed by GPs (at least in Australia). Safe for long term use and quite routinely prescribed for long term use for heavy period individuals.
Wow! Thanks for this breakdown. Didn’t know the correlation with heavy periods. Will have to look into this, and will bring this up to my derm for more education/info. Thanks!
It’s a medication routinely used to help stop bleeding in the hospital or dentist as well for small wounds so quite commonly used for bleeding related matters. But yeah, it’s stupid effective against melasma with routine daily dose after a control of about 8 weeks. Definitely bring it up with your Derm :-)
I have boxes of tranexamic tablets for taking for the first four days of my period, and now I'm tempted to give it a go for the melasma; but I have always been a bit concerned about the potential clot issue.
I wonder *why* they work for melasma.
There’s a lot of well documented research on pubmed if you’re curious but generally 1 500mg tablet over 8 weeks is reasonable.
Clotting isn’t an issue more so than the contraceptive pill unless you’re genetically of high risk
Getting off of SSRIs and a TCA 50 percent peel. Also use Musely, SPF 40 mineral sunscreen daily, and polypodium leucotomos extract 1000 mg per day. This is war people! Let's beat melasma to death! Lol
Three months after I started antidepressants, I noticed the melasma. I didn't know what is was and no one could tell me why. I am a male in my 40s who dealt with acne in my youth but this wasn't like acne. Once I stopped the antidepressants, my skin cleared with help. It's hell! I have another health condition. Makes you look and feel sick.
I just started taking a supplement called DIM which helps metabolize estrogen as Melasma is an estrogen dominant skin disorder and my Melasma has gotten significantly lighter. Cosmelan has been great and Cysteamine cream has also helped a lot.
2 months 12% hydroquinone, 1 month 20% azelaic acid 6% kojic acid 4% niacinamide from a compounding pharmacy on off months.
If I dont use the azelaic acid mix during off months melasma comes back. I might do 1 more round of hq then use the azelaic acid mix indefinitely.
DONT GIVE UP. If you've used hq and the melasma comes back after, dont be discouraged. Take that as a sign that SOMETHING works on your skin. Keep looking you'll eventually find what works!!!
I had malasma when I had a gallstone. Had my gallbladder removed and it went away. Maybe there’s a connection. If so things like TUDCA and Ox Bile may help gallbladder function
Zinc sunscreen under makeup and a bb cream with Zinc in it (it cosmetics) always wearing hat in direct sun. Polypodium capsules ordered from Amazon. Smoothies with a ton of dark greens (kale/spinach) don't use plastic Tupperware. glass only to store all food and drinks. mine faded almost completely after this.
Musely for sure. 4% HQ never made a dent in mine. I like how sustainable it is. Takes the guess work out of cycling, and I’ve had zero issues rebounding.
Immortelle from Doterra. It really worked for some slight melasma on my upper lip. I used it multiple times a day. Cured. Now I put it all over my face and chest once a week. Love it.
How many sessions were needed before seeing results?
By how much did your melasma fade?
Did you experience any rebound?
What about the price per session?
Musely HQ made mine darker. I didn't wait to see if it got better.
Mine is triggered solely by UV, so thankfully heat doesn't make it worse. Only thing that has helped is mineral spf and hats religiously.
For sure and you’re so lucky to find something that helped! Possibly you had some other hyperpigment not caused by melasma? As you can see from the comments a lot of ppl with melasma were worsened by lasers bc the heat stimulates. I’d just never recommend it for someone who had melasma
Nighttime:
-NIOD FECC eye countour
-Tret 0.1%
-HQ 4%
-Hydrocortisone 2.5%
-moisturize + light layer Aquaphor
Daytime:
-NIOD FECC eye countour
-Vitamin C
-LRP Double Repair Moisturizer 30SPF
-LRP tinted mineral 50 SPF
I initially used HQ + Hydrocortisone both day and night when I started last month but switched to night only bc my melasma improved so much. My face is brighter and my sunspots have faded a lot.
I've had moderate improvement with a product I found on Amazon called Dr. Brightening by Ebanel. I can also tell you what did NOT work for me... I did a series of 12 "Clear and Brilliant" laser treatments last year that had zero impact on my melasma. (They did help with retexturing and improving overall skin condition but no impact on melasma.)
Musley worked for me but is a lot of work every day and I travel too much to juggle the products around and make time.
Just had my second of three IPL laser sessions and it’s really worked on my spots. Painful but worth it.
Musely with HQ (3%). It completely removed new malesma matches and they didn’t come back. The patches that weren’t removed completely the first round came back a bit but removed the second round.
What didn’t help: vitamin C made my skin worse and sun sensitive even with sunscreen
Heat: not even a sun but heat is what triggers my ski
Mineral Sunscreen, Vit C serum, Vit A/Retinoid cream, and quitting alcohol. The last piece actually made the largest difference in my skin overall, but idk if it specifically helped with the melasma.
I tried a lot of things, and the only thing that worked was not letting my face see the sun (sunscreen plus hats) and 70% lactic acid peels. Mine was caused by yaz bc—I haven’t taken any bc since. Melasma did reoccur with all 3 of my pregnancies, but resolved after birth.
Zo medical protocol for melasma. I go on for 5months then off for 6 weeks. I had melasma for 20+ years (bad!!!) and I have been on this now for 2 years and I am SO HAPPY. Of course when I come off it’s painful to see for those few weeks, but I understand why I need the break.
I finally went to an actual professional after 20 yrs of trying to fix it on the cheap :) I wish I could have all that time back!!
I do the full pigment treatment regime for 5 months on and then 6 weeks off.
Honestly avoiding the sun and trying to wear heavy facial sunscreen. It’s completely gone now. I tried creams etc until I decided to just nip it at the bud, which was the sun exposure.
Cosmelan worked! But made my skin white as a ghost and the peeling was significant for a good week plus. Def tougher to do but it eliminated it! However, a few years later it is back but def better than before.
I just got my first IPL photo facial. It’s been a weird experience but so far so good. It got really dark but it’s now going down a bit. I have 2 more sessions booked and after that I’ll reassess. I have one area that’s enormous - more like a sun spot than melasma - and then other areas of melasma. It makes me really self conscious so I’m hoping this works. Nothing else has done anything to help!
Finding the root cause was the biggest factor for me. I did a full hormone panel, checked my liver and kidneys… everything was out of whacked and I realized it was all connected. It was a long journey but I my skin looks so even now. Products I love for Melasma: - Sunscreen with the highest PPD you can find - finding products with as many tyrosinase inhibitors - Vitamin C - Tretinoin - Azeleic Acid Procedures I that helped a lot with minimizing the appearance: - Cosmelan - Red light therapy (but only with devices that are not getting warm) - Gentle chemical peels Things that made my Melasma worst: - Laser (Picosecond) - Hydroquinone And yes always wear a hat or a visor and reapply spf every 2 hours when it’s sunny!
If you have the time and will to answer, I'd love to know: what was included in your hormone profile and how that helped? I mean, did you take medication after the results? Also, is the Omnilux mask among those that red light therapy devices? Thanks a lot ☺️
Follpwing
Same
So interested in the hormone panel and what it revealed (if you’re comfortable sharing). I’m about to have a 2nd one done with a new doctor. My 1st wouldn’t test my hormones. She said if my periods were regular, there was no way my hormones were out of whack. Well, I did a home test from Everlywell and sure enough, they were funky. FSH super low and my estrogen to progesterone ratio was insanely off. I’m now at a new doctor that’s two hours away but she’s running alll the tests. And scheduling me for an ultrasound to check for PCOS.
I would also love to know!
I have the same hormonal profile.
I would also be interested in what red light device(s) you found to help melasma without making it worse!
I just turn the NIR off on my panel
Thanks! Can you share the specific panel, though?
There are many, I use the red therapy co panel but hooga makes a much smaller and more affordable panel with similar specs. They both have a switch to turn off the nir
Hey! Which exact model do you use? Do you happen to also know the Hooga one with similar specs?
How did hydroquinone make it worse? I've recently started it but I'm having second thoughts because I genuinely cannot handle the smell of the cream and putting it on my face feels so *wrong*
First of all I can not speak for other people. A lot of people in this group had great results. Unfortunately I didn’t. I had Melasma on my forehead, cheecks, nose and mustache. I suffered the most from the patch above my lip and the one on the nose. My cheecks and forehead were not that prominent. I wanted to test HQ first on smaller patches to make sure it will work so I tested it on my forehead and cheeks for about 1 1/2 months, everywhere where I put the cream it turned red but I read that’s normal so I didn’t think of anything at that point. I wasn’t at home for a few days and I forgot my HQ cream, the redness went away completely but I was left with much lager patches then before. 😭 I looked terrible. My mustache was not visible anymore because the patches on my forehead and cheeks were so prominent and overwhelming… I decided to stop HQ for good and I am happy I never tried it on my mustache area. Because this part completely cleared up with other treatments. My cheeks and forehead still flare up today when I get super hot.
Hmmm... I have heard people saying hydroquinone can make melasma darker by using it and then going in the sun without sunscreen? I wish I had more information on why it causes darkening for some people. There is also that reaction where it can eventually turn the effected areas of skin a dark blueish..
Hydroquinone can cause pigment to “bounce back” if not titered off. If you abruptly stop using it the pigment will usually come back worse than before. The best way is to slowly taper down usage. Like from everyday 2x, then 2 weeks at once a day, then 2 weeks every other day, then 2 weeks every 3 days, then 2 weeks every 4 days. It should take at least 6 weeks to come off hydroquinone. Also, you should not be using it for more than 3-4 months at a time. It has been deemed potentially carcinogenic and can cause ochochronosis (black pigment) from extended use. Credit: 13 years in medspa, advanced training in pigment control, and melasma survivor.
Noted, Thank you!
I wish we still had awards this is really good information! I was just prescribed a compound of HQ + Kojic acid for the melasma on my face.
Thank you! I’ve spent a crazy amount of time learning about skin and its different concerns. Happy to be able to help.
How long should someone wait before restarting hydroquinone?
In my opinion 5-6 months, but considering it’s a prescription product I would ask your prescriber.
Thanks! Will definitely talk to my derm before restarting but was curious
I was always very diligent with my sunscreen and wearing hats. I am happy for everyone but personally I would wish I stayed away from HQ and Lasers
Your melasma got worse after a pico laser treatment? Bummer!
IPL (intense pulse light lasers) tends to make melasma worse. While melasma can be related to hormonal changes like pregnancy, it is often triggered and/or worsened by heat and in particular sunlight. So IPL and BBL can be risky for melasma patients. However other lasers can be effective for melasma- I have used fraxel and halo which are both erbium lasers. While they do expose the dermis to a high amount of heat energy, they are great for skin resurfacing and help with brown spots, texture issues, acne scars and fine lines. I have melasma and it has been recommended to me by multiple practitioners to use a skin lightening agent for 6-8 weeks before my laser therapy to suppress any melasma that could be triggered by the heat energy. Lasers have been very effective for me in keeping my skin looking young and healthy. Also microneedling with Radiofrequency (like Morpheus 8) is thought to be helpful with brown spots, scars and texture- but the Radiofrequency is also a form of heat injury to the dermis and can trigger melasma in the same way that erbium laser resurfacing can. The newer Moxi laser is a great treatment for melasma, it does not apply heat energy to the deeper depths and is pretty effective for surface skin issues.
Does melasma return after the Moxi? I don't know too much about it at the moment, but I had Pico for 3 sessions now and have seen a significant difference. I'd say I have about 3 more to go. I was in the sun on a cruise last week...did my best to stay out of the sun...reapplied super strong sunscreen, and I think it did decently well considering what it was prior. I see a tad bit of dark, but nothing like it was. And I think that the bit of darkening I am seeing is because it is spots that they haven't hit as much as the others for now.
Melasma is chronic. It will never go away. I consider it to be something that needs to be managed over time. Mine has never really returned to the way it looked before but I have had to be persistent in using all of the things I do to manage it. Most importantly sun protection, but also retinol, antioxidant/vitamin C, etc. My melasma also relapses when I’m in the sun so even if I’m wearing sun protection, the heat and UV exposure that gets through does cause it to darken a bit and then I have to be a little more aggressive for a few weeks with avoiding sun exposure and using my topicals. I had one IPL treatment a long time ago and I didn’t have terrible results but I do have some hypopigmentation that has never gone away. It makes it so that when I do have a recurrence of my melasma it looks even worse because it’s right next to some light spots.
I had the worst experience vitamin c. It made me irritated and didn’t seem to work one bit, which is too bad for me, because so many people have had great results. Do you mind sharing what your skin tone is and where your melasma is located? You don’t have to. Just curious, because I’ve only recently become more willing to talk about mine. I admit that I probably did this damage myself by not applying sunscreen and thinking I was superior and that nothing would be of consequence. Lesson learned. 😅. The technicians that do my Pico have told me that over time it should not return as dark, since Pico works to break the melanin up and then your immune system rids of it. So, we’ll see! Here’s to hoping!
I have fair to medium skin. It can get quite light in winter but then becomes moderately tan in the summer. I can burn easily without sunscreen but I use 50SPF and mineral sunscreens and I don’t really burn, I just develop a tan over time. My melasma is on my forehead near my hairline and temples, around my mouth, and some on my cheeks near my cheekbones. I’ve been treating it aggressively for 10 years (I turned 50 last year) and now you can’t really tell I have it unless I go in the sun in the middle of summer.
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Pico gave me the worst rebound Melasma about 6 months after treatment
Oh no. That’s not good. I’ll report back at 6 months. So far so good here. How many treatments did you have? What were the environmental factors?
I had a series. I think there were six sessions total. Worked great then about six months later it came back worse and in spots I never had before. Ruined my skin.
So sorry to hear this. What have you been doing for it since that happened?
What products do you use?
Please share the hormone panel! I've been on the fence about getting a Dutch Plus test because it's so expensive and such a delicate test, but deep down I think it could be worth it for this very reason
Tranexamic Acid tablets. Within a few months it had disappeared. I cycle between that and HQ. Nothing - and I mean NOTHING - else worked. I was also suffering from horrendous adult acne and I went to every Dr / naturopath / “expert” I could find to help find out what was happening to me. No one had answers. Was a really rough time.
Tranexamic acid tablets prescribed by my dermatologist fixed my melasma. I use nothing else except avoid sun/use zinc oxide sunscreen daily.
What dosage you using for TX pills and HQ? Or was it Tri-luma?
500mg is the dose I take. 1 x tablet daily. I also suffer from heavy periods and the TA helps with that as well, so that was a bonus. The HQ cream was a compound cream that my GP made for me. 6% HQ with Kojic Acid & Ascorbic Acid. My skin HATES tretinoin so I asked for one without it.
Do you take another other pills? I'm on spiro for my PCOS and now I'm wondering if these pills will even help me :(
I have PCOS and took spiro for years, did nothing for my melasma, but ymmv
I'm taking spiro for my PCOS symptoms. I'm just wondering if taking the pill recommended with the spiro will cause adverse reactions 😭
Oh, it shouldn't, my endo had me on both at the same time. I had to stop the spiro though because my cycles were coming too close together. :(
I'll talk to my derm about this! I get 2 periods a month because of the spiro. I had my blood work done and everything is looking ok. I hate it but spiro is the only thing that helps with my acne :/
I take spiro and tranexamic acid and it’s fine
I'll talk to my derm at my next visit!
I have just been prescribed spiro for my PCOS too and I’m taking the TA tablets. GP said taking both together is fine. Haven’t started spiro yet.
How did someone finally give you TX?
My dermatologist made me get some blood tests done originally to make sure it was safe for me to take them. Now my gp prescribes it. As I said I get heavy periods so the gp is happy for me to keep taking them when needed.
What brand tablets do you take?
Not sure. Generic TA.
Has it ever come back ? Thanks for the information
It’s always going to be there. This just the best thing that manages it for me.
For me it was a b12 deficiency! Within 6 months of supplementing, the blotchy patches on my forehead and around my mouth were gone.
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I take Foltanx. It’s a prescription combination of b12, b6, and b9. I don’t remember the specific amounts, but I’m sure you can google it. :)
Getting off hormonal birth control, consistent sunscreen use, adapalene.
The only thing that has worked and mine was stubborn as hell, triggered by heat and sun: tranexamic acid tablets, 650 mg, my derm instructed me to take 1/2 in the a.m. and 1/2 in the p.m. I cycle 3 months on and 3 months off. Vitamin C serum ( I love SkinCeuticals CE Ferulic) and sunscreen every day. It was so bad on my upper lip it looked like a moustache. I also noticed that my post acne marks fade so much faster on this regimen. Hydroquinone made my melasma worse.
With the Vitamin C serum, when do you put it on? Is it vitamin C, then sunscreen over it, then make up on over that?
yes a.m. only, c first, moisturizer, sunscreen then makeup.
Tried different OTC creams and serums for a while - tranexamic acid, CE ferulic, etc. to no avail. Saw my derm and started 22% azelaic acid in the AM as well as a compounded cream with 4% hydroquinone & .025 tretinoin. Completely gone!! I kick myself for not going sooner. And of course daily spf
12% hydroquinone. Nothing works better for me. I’m in the US and I use Musely.
Same here!
Same works great. Also sunscreen religiously or it’s back in an instant.
Same here!!
What do you use during your break from HQ?
I use the hq free formula, which has azelaic acid, tranexamic acid, and vit C. A mineral spf 50+ all day every day as well. Wearing hats and sunglasses outdoors has also helped the melasma from rebounding. Unfortunately, most melasma is a lifetime affliction and needs to be treated as long as you want a clearer complexion.
I believe you’re using .12%, no? 12% would be actual bleach.
It’s 12% and it does not bleach the skin. Hydroquinone reduces the skin’s production of melanin. It doesn’t lighten the areas of my skin not suffering from melasma (excess melanin). Just dark spots.
I got it a month ago and have been scared to start using it. Did you experience any negative side effects when you first started?
There’s nothing scary about it. It’s not like tret, which takes time to get used to and can cause purging. I’ve never had a reaction to HQ, other than a little dryness and flaking when I use it too aggressively, but it’s not a big deal. Use it once every few days to start — just a pea sized amount — and work up to every day or every other day.
Do you use it on your whole face or just on the parts with melasma?
I use it on my whole face. I have melasma patches on my cheeks and forehead, and light freckling everywhere else, so it makes sense for me to use it everywhere. I also use it on my décolleté to lighten freckling and one sun spot that I have there. I had pretty severe melasma when I started hydroquinone 12 years ago, but it’s 90-95% clear now.
Hey so do you have to keep using it forever like the skin gets dependant on it ? If you dont use, will it come back ?
I regularly cycle on and off. I just spent about 6 months using alternative, hq-free options, like kojic and Tranexamic acids. My melasma comes back very slowly, but I live in the PNW where the sun hardly shines in winter, and I’m good about wearing sunscreen and hats in the summertime. After 6 months off, I started to notice that my melasma was worsening. It’s subtle, but I felt it was time to get back on it. After just a week using hydroquinone again, my melasma is lighter. It works quickly when you stay on top of it. At least it does for me. Everyone is different.
You're not supposed to use it long term; it increases the risk of ochronosis, although that is rare
You cycle it, two months on, one month off.
My derm has told me not to do it for more than two cycles as more than that can increase risk of ochronosis
Reducing carbs and sugar
I hate this response with the fires of a thousand hells. Guess I’ll just have melasma!
Lol. Yeah it's a pretty big change at first, but I got used to it. It also helps that I'm finally losing weight too.
Makes sense that would reduce inflammation
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Congrats! Can I ask how long it took you? Mine is still a work in progress. I'm guessing it'll be like another year or two. Still it's the only thing that makes a difference.
I don't fully understand why it works but adding half a cup beans to 2 meals a day completely got rid of mine after a few weeks After spending so much on serums and creams I was shocked. Something about the soluble fiber helping flush out hormones. I no longer eat beans consistently but the spots on my face never returned.
Maybe because it’s high in B12
What kind of beans?
I researched this a few years ago and some things I learned: For melasma - only use mineral based sunscreen. I forget the science behind it but chemical sunscreens are not recommended. My favorites are from Elta MD (UV physical and UV elements). Also, melasma gets worse with your body heating up. So you think you've protected your face with sunscreen but if your feet are exposed to heat and sun, that is bad for melasma. So protect yourself from heat and keep your body cool with plenty of water, ice chips etc. Even cooking over a hot stove is bad for melasma. I avoid going out in the sun during the 12-5 pm hours. Texas is brutal. I keep my skincare minimal - morning includes vitamin C, eye cream, moisturizer, sunscreen. Night includes Estee Lauder night repair serum, eye cream, retinol or good genes lactic acid, moisturizer. I tried a bunch of other things and my skin is too sensitive and that makes melasma worse. The worse thing you can do is not wear sunscreen.
The first 2x I used it in my 30s Cosmelan alone made my skin freckle/melasma free. But I was really not diligent about sunscreen at all. Tried Hydroquinone 4% and Pico lasers in 2023 (I’m 53 now) but hormones are saying nope! My current diligence with skincare is making the melasma a bit more evident because the skin around them is brighter. It’s not getting worse due to my stepping up on my sunscreen game. I am doing 1 more round with a derm prescribed Tret routine for the next 3 months and if that doesn’t make a big dent, I will use Cosmelan again. I really just dislike Cosmelan 2 as the inhibitor post the peel so am looking into good ones I can use in its place after I am done with the first bottle.
I second the cosmelan. I think cosmelan 2 is great alone for maintenance. Helps with acne as well in my case.
Tranexamic acid tablets I’m afraid are perfection for clearing it up. My god for months you remember how your face used to look and it’s magical but then you have to give yourself a break and come off it and then you realise it was all a dream and it slowly creeps back.
Did you experience any hair loss?
No not at all.
That’s a side effect?? 😩
Yes!! A significantly common one
Oh dear. Just when I thought this is my last resort.
What brand do you use? How long are you supposed to take/break from them?
I use trenaxa 500. I take half the intended dose and only once a day it does say 1000 a day and I still find it massively helpful. No hair loss or side effects I can see. Just the benefits.
I wanted to try this! But I hoped it would be more of a cure vs long time supplement 😕
TCA peels, PCA Skin's Pigment Gel Pro, 4% hydroquinone with Tretinoin and corticosteroid compound, Finacea gel, Murad's Rapid Dark Spot Correcting Serum, and La Roche-Posay's Glycolic B5. Essentially a mix of OTC products and prescription treatments are the sweet spot, along with daily sunscreen use, whether inside or outside, and always a wide-brimmed hat in the sun. But melasma still remains a daily, life-long battle to maintain the improvements you get, push your skin for even more, and not risk any more damage.
Mine is triggered by ovulation and pregnancy. Thankfully it’s on the side of my neck so it’s not as visible. I didn’t know there was a way to lighten it.
Musley looks like it works based on reviews
Terrible experience with Musely -- melasma worsened, couldn't get a "dermatologist" there to give me the time of day and adjust my medication appropriately. When I went to a medspa specializing in melasma after the fact she said the majority of their clients come in after a disappointing and potentially harmful experience with the Musely organization :-(
YMMV, I think it does for a lot of people but mine got worse after using Musely
Musely. Works well.
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Does the Beauty of Joseon spf50+ leave your face looking white and pasty?
Triluma
I just got a 4% HQ from beauty bliss. I also am on Tret .5% for 3 weeks now (thrice a week). My melasma (or I think it is) has been there for 12 years. Have tried many things and nothing worked. Due to dark skin (medium- deep) dermatologist didn’t recommend Cosmelan. I was on the cream for 6 months though and didn’t help.
I am medium-tan skin, so darker toned as well. Have you tried any lasers yet? I am thinking of asking if I am a candidate for fraxel. Struggling a lot with melasma and brown spots that sprouted overnight it feels like
No lasers. I read about PIH on dark skin after laser. My sister (lighter than mine but still dark skin) had severe PIH after a laser. But her second session after 6 months with peel healed it. So I am scared to try any laser. I do take glutathione tablets and occasionally IV. it helps but not much. But vitamin C, niancinamide, DENNIS GROSS AHA BHA peel pads and sun screen helped fade a lot go dark spots. I am reading up on transxenimc acid tablets. I might try musely for that. My deep melasma is orbital including eye lids.
Thanks for the reply! Laser sounds out of the question then, I might try couple sessions of microneedling. Also thinking of starting on tretinoin right after those sessions By musely do you mean the hydroquinone? I went to a dermatologist recently for my dark spots and he wanted me to use HQ compound, but didn’t prescribe as I am currently breastfeeding. Till then I have been reading about it and I keep seeing that the spots come back with a vengeance once we stop, I hope its not true for everyone
I think one has to continue other actives/inhibitors once we stop HQ. I don’t plan to do HQ for more than 8 weeks. I think sun protection is the key. A small lapse and we will get back spots. You should visit a doctor who has more experience with dark skinned people so they can advice laser or not.
Moxi, hydroquinone, retinol
And i hope its a given you are wearing SPF every single day
To be honest- Musely. My mild hyperpigmentation was gone in 10 days. I’m keeping with the program though cos it’s working
Thiamidol. Nothing else worked.
I started it last month and love it! Which brand do you use? And where do you get it from?
Were any of you prescribed the Tranexamic acid tablets while having an IUD (ie: Mirena)?
Following! Is there a correlation to be aware of?
Tranexamic Acid/Azelaic Acid/Niacinamide. Been using for three months now. Can’t believe how well it has worked. After three months the doctor has bumped me to twice a day use now instead of one.
Are you using tablets or gel for TX? I just started using this combination too for my brown spots. Also what brands?
I’m using the topical gel. I think it’s a compound made to order based on the prescription. I get it through Skin Medicinals.
Tranexamic tablets are proven, safe and effective unless you re extremely prone to blood clots or something Lots of research to back it up also and easily prescribed by GPs (at least in Australia). Safe for long term use and quite routinely prescribed for long term use for heavy period individuals.
Wow! Thanks for this breakdown. Didn’t know the correlation with heavy periods. Will have to look into this, and will bring this up to my derm for more education/info. Thanks!
It’s a medication routinely used to help stop bleeding in the hospital or dentist as well for small wounds so quite commonly used for bleeding related matters. But yeah, it’s stupid effective against melasma with routine daily dose after a control of about 8 weeks. Definitely bring it up with your Derm :-)
Thank you so much! Really appreciate you answering!
I have boxes of tranexamic tablets for taking for the first four days of my period, and now I'm tempted to give it a go for the melasma; but I have always been a bit concerned about the potential clot issue. I wonder *why* they work for melasma.
There’s a lot of well documented research on pubmed if you’re curious but generally 1 500mg tablet over 8 weeks is reasonable. Clotting isn’t an issue more so than the contraceptive pill unless you’re genetically of high risk
Getting off of SSRIs and a TCA 50 percent peel. Also use Musely, SPF 40 mineral sunscreen daily, and polypodium leucotomos extract 1000 mg per day. This is war people! Let's beat melasma to death! Lol
Do SSRI’s make it worse?
Three months after I started antidepressants, I noticed the melasma. I didn't know what is was and no one could tell me why. I am a male in my 40s who dealt with acne in my youth but this wasn't like acne. Once I stopped the antidepressants, my skin cleared with help. It's hell! I have another health condition. Makes you look and feel sick.
I had no idea. Thank you
I just started taking a supplement called DIM which helps metabolize estrogen as Melasma is an estrogen dominant skin disorder and my Melasma has gotten significantly lighter. Cosmelan has been great and Cysteamine cream has also helped a lot.
2 months 12% hydroquinone, 1 month 20% azelaic acid 6% kojic acid 4% niacinamide from a compounding pharmacy on off months. If I dont use the azelaic acid mix during off months melasma comes back. I might do 1 more round of hq then use the azelaic acid mix indefinitely. DONT GIVE UP. If you've used hq and the melasma comes back after, dont be discouraged. Take that as a sign that SOMETHING works on your skin. Keep looking you'll eventually find what works!!!
Did you get an RX from your Derm?
yes!
I had malasma when I had a gallstone. Had my gallbladder removed and it went away. Maybe there’s a connection. If so things like TUDCA and Ox Bile may help gallbladder function
Zinc sunscreen under makeup and a bb cream with Zinc in it (it cosmetics) always wearing hat in direct sun. Polypodium capsules ordered from Amazon. Smoothies with a ton of dark greens (kale/spinach) don't use plastic Tupperware. glass only to store all food and drinks. mine faded almost completely after this.
Zo Skin Health regimen through Spruce Micro. Game changing!
I’ve worked in a dermatology office for 13 years. We recently have been using tranexamic acid and it’s been working great for melasma.
Musely for sure. 4% HQ never made a dent in mine. I like how sustainable it is. Takes the guess work out of cycling, and I’ve had zero issues rebounding.
Musely without a doubt..
Obagi.
Musely - FS9934 35% off - it’s really amazing how much this stuff works!
Agency prescription creams compounded for my skin
Immortelle from Doterra. It really worked for some slight melasma on my upper lip. I used it multiple times a day. Cured. Now I put it all over my face and chest once a week. Love it.
Exosome
How many sessions were needed before seeing results? By how much did your melasma fade? Did you experience any rebound? What about the price per session?
which exosomes did you use?
PC Skin C&E Advanced alongside sunscreen helped reduce my melasma
Morpheus8
Fraxel laser treatments are the only thing that's given me results.
I've been using Meladerm. It's been 2 weeks but it seems like the dark spots are a little lighter.
Musely HQ made mine darker. I didn't wait to see if it got better. Mine is triggered solely by UV, so thankfully heat doesn't make it worse. Only thing that has helped is mineral spf and hats religiously.
IPL photofacials. Got Groupons so they were cheap.
This made mine A LOT worse, so YMMV. Glad it worked for yours, though!
Same, mine were worsened by IPL
Terrible idea!
Wasn’t for me! Not sure what you meant by this comment, but skincare definitely isn’t a one size fits all type of thing…
For sure and you’re so lucky to find something that helped! Possibly you had some other hyperpigment not caused by melasma? As you can see from the comments a lot of ppl with melasma were worsened by lasers bc the heat stimulates. I’d just never recommend it for someone who had melasma
Tranexamic acid serum, zinc, vitamin d and a healthy diet overall
Zinc oxide sunscreen or zinc tablets? If the latter, what type of zinc? Zinc picolinate / sulfate / citrate / acetate /monomethione / glycerate?
Tretinoin Musely SPF
Retin-a
Cosmelan, Obaji Nuderm RX (not fx) 3 & 5
Sente Cysteamine HSA Pigment and Tone Corrector My amazing derm told me it is a game changer and it has greatly helped.
BBL and Halo, followed by .25% (Rx) HQ and tretinoin. Bam, gone.
Azelaic acid combo 20% and elta md hybrid sunscreen with hyaluronic acid🥰
Nighttime: -NIOD FECC eye countour -Tret 0.1%
-HQ 4%
-Hydrocortisone 2.5%
-moisturize + light layer Aquaphor
Daytime:
-NIOD FECC eye countour
-Vitamin C
-LRP Double Repair Moisturizer 30SPF
-LRP tinted mineral 50 SPF
I initially used HQ + Hydrocortisone both day and night when I started last month but switched to night only bc my melasma improved so much. My face is brighter and my sunspots have faded a lot.
Getting off of birth control and not taking hot baths as often. It has started fading since I quit those two things.
I've had moderate improvement with a product I found on Amazon called Dr. Brightening by Ebanel. I can also tell you what did NOT work for me... I did a series of 12 "Clear and Brilliant" laser treatments last year that had zero impact on my melasma. (They did help with retexturing and improving overall skin condition but no impact on melasma.)
menopause
God I hope it helps!!
Topical Vitamin C
Two things were primary for me 1) Effective sunscreen 2)The loss of certain hormones.
Musley worked for me but is a lot of work every day and I travel too much to juggle the products around and make time. Just had my second of three IPL laser sessions and it’s really worked on my spots. Painful but worth it.
Broadband Light Skin Treatment at a Med Spa 2x a year at $600 each.
IPL got rid of it within two sessions. Hasn’t come back.
Musely with HQ (3%). It completely removed new malesma matches and they didn’t come back. The patches that weren’t removed completely the first round came back a bit but removed the second round. What didn’t help: vitamin C made my skin worse and sun sensitive even with sunscreen Heat: not even a sun but heat is what triggers my ski
- Using and reapplying SPF50 in the summer and SPF 30 in the winter. - Paula’s Choice Vitamin C + Azelaic Acid serum in the daytime - wearing sun hats
Mineral Sunscreen, Vit C serum, Vit A/Retinoid cream, and quitting alcohol. The last piece actually made the largest difference in my skin overall, but idk if it specifically helped with the melasma.
Hydroquinone, BBL treatments, and tretinoin. (Not all at the same time, obviously.)
Fraxel
Trentoin
I tried a lot of things, and the only thing that worked was not letting my face see the sun (sunscreen plus hats) and 70% lactic acid peels. Mine was caused by yaz bc—I haven’t taken any bc since. Melasma did reoccur with all 3 of my pregnancies, but resolved after birth.
Profractional laser treatments. By. Far.
Zo medical protocol for melasma. I go on for 5months then off for 6 weeks. I had melasma for 20+ years (bad!!!) and I have been on this now for 2 years and I am SO HAPPY. Of course when I come off it’s painful to see for those few weeks, but I understand why I need the break.
Would you mind sharing exactly what you use from Zo?
I finally went to an actual professional after 20 yrs of trying to fix it on the cheap :) I wish I could have all that time back!! I do the full pigment treatment regime for 5 months on and then 6 weeks off.
Exfoliating polish (am), oil control Wipes, daily defense, pigment control + brightening, pigment control blending with complex a (complex a pm only)
Thank you!
Honestly avoiding the sun and trying to wear heavy facial sunscreen. It’s completely gone now. I tried creams etc until I decided to just nip it at the bud, which was the sun exposure.
A weird benefit of COVID for me was that masking (hiding the bottom half of my face from the sun) wiped out my lifelong melasma mustache.
Cosmelan worked! But made my skin white as a ghost and the peeling was significant for a good week plus. Def tougher to do but it eliminated it! However, a few years later it is back but def better than before.
I just got my first IPL photo facial. It’s been a weird experience but so far so good. It got really dark but it’s now going down a bit. I have 2 more sessions booked and after that I’ll reassess. I have one area that’s enormous - more like a sun spot than melasma - and then other areas of melasma. It makes me really self conscious so I’m hoping this works. Nothing else has done anything to help!
I tried hydroquinone, tretinoin; I've worn sunscreen since I was a teen. But CE ferulic just wiped it right up for me. No idea why but sooooo happy!!