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Suggest treatment for melasma on the face

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Posted on Fri, 29 Jul 2016
Question: Hello Doctor,
I am writing to you on a follow up question to my recent issue with melesma that I have on my face. I have pasted our recent conversation on this below. Sorry for the long read, but here is my next question after going through your prescribed treatment.
Q: The pigmentation on my face has reduced by 40% but not completely healed. I applied Clearz for about 2.5 months. It seems that when I was applying I could see better results but as I stopped the pigmentation has re-appeared with a 40% reduction. What do you recommend I do next?
I have also kept myself protected from sunlight by applying photoblock (spf50) regularly, even when at home.
Here's our previous conversations on this for better context:
Hello Doctor. I am 35 years old and I have observed that my skin is pretty sensitive to sunlight. There is a a small area on my face where I have developed some pigmentation, I have attached a picture to give you more insight.

After consulting a dermatologist a few months ago I have implemented the following methods to reduce the pigmentation.
1. I apply photobloc (spf 50) every day three times, even when I am at home to prevent exposure to uv rays.
2. As per the dermat's recommendation I apply Kojivit plus every alternate days in the night before sleep, and on other days I apply Ban a tan cream in the night before going to bed.

I have done this for about three months now but I am not seeing any visible changes. I am afraid that the pigmentation is becoming more prominent.
Can you please recommend what I should do to completely get rid of this?

Asked by Me , Thu, 17 Mar 2016

Doctor's reply to your question above...
Brief Answer:
I suggest a kligman formula based cream for initiation of treatment

Detailed Answer:
Hello. Thank you for writing to us

I am dr.kakkar(dermatologist). I have gone through your query and i have also reviewed the image.

You seem to have Melasma, a condition which presents with asymptomatic brown patches on sun exposed skin of face.
You may use a cream triple drug combination i.e based on Kligman formula e.g tretinoin+hydrquinone+hydrocortisone in addition to the sunscreen. This formula/combination is preferred for initiation of treatment in melasma and usually produces good results in most patients in about 2-3 months. Thereafter this combination cream based on kligman formula is changed to a milder preparation like kojivit or ban-a-tan (those which you are currently using) for maintenance of improvement. Sunscreen use is a must for these to be effective.
Creams based on kligman formula/ modified kligman formula are prescription products and should be used under supervision of a dermatologist because they can cause irritation. In any case these creams should not be used longer than 2-3months because they are steroid based. However these creams based on kligman formula are effective for initiation of treatment in melasma because of dramatic and excellent impoivement in melasma.

Regards
Replied by Dr. Kakkar S. , Thu, 17 Mar 2016

Thanks Doctor. Could you please provide me with the name of the cream and the dosage?

Doctor's reply to your question above...
Brief Answer:
Sunscreen during the day and depigmenting cream at night

Detailed Answer:
Hi.
You may use Sebamed sunscreen spf 50 during the day. Reapply every 2-3 hours. At night you may use Clearz XXXXXXX Or Lumacip plus or Triglow M cream, only at the pigmented patch. All these creams are based on kligman's formula. However, you should not use these creams for more than 2-3 months. Once the initial response has been achieved with one of these creams should be substituted by an safer alternative like kojivit or ban a tan cream (those which you are already using now)

There is no laser treatment that works for melasma.

Regards
Replied by Dr. Kakkar S. , Sat, 19 Mar 2016
doctor
Answered by Dr. Asmeet Kaur Sawhney (7 hours later)
Brief Answer:
Start oral therapy, chemical peels

Detailed Answer:
Hi
Thanks for being at healthcaremagic
I am Dr Asmeet Kaur Sawhney, a dermatologist.
I have gone through your history and according to me the medicines recommended to you were fine.
Have you used clearz or clearz XXXXXXX cream?
If even after applying it for 2.5 months the pigmentation has reduced by only 40 percent I would recommend you to take oral therapy as well.
It has been seen that oral tranxaemic acid in the dose of 250 mg 2-3 times in a day for 3-4 months is effective in the treatment of melasma.
Besides this you can also consider going for chemical peels. Glycolic acid, TCA peeels and jessner's peels are effective in the treatment of melasma.
Multiple sessions are required after intervals of every 2-3 weeks.
6-8 sittings may be required.
Regards
Dr Asmeet

Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (31 hours later)
Thanks Doctor. I had used clearx XXXXXXX cream. Should I continue to use this or move towards using safer options like Kojivit or Ban-a-tan? I am worried that using steroids for prolonged periods could have bad effect on my health. Please advice.

For oral therapy how could I get access to oral tranxaemic acid? is there a cream that you could recommend?

And for chemical peels should I go to a dermatologist for treatment or can I use any cream at home that contains Glycolic acid?
doctor
Answered by Dr. Asmeet Kaur Sawhney (35 minutes later)
Brief Answer:
Use Kojivit plus and ban a XXXXXXX cream, avoid steroid based creams

Detailed Answer:
Hi
I think you should go for kojivit plus cream and ban a XXXXXXX cream as these don't have the side effects of creams based on kligman's formula like clearz XXXXXXX cream.
Using creams based on steroids for prolonged periods and unsupervised can lead to redness, thinning of skin, pimples, increased hair growth and dialatation of blood vessels.
Oral tranxaemic acid is available in the market as tablets like tablet inmela 250 mg or tablet tranaxa 250 mg .
It can be started as 250 mg twice daily.
For chemical peeling you should definitely consult a dermatologist and get it done from a dermatologist under proper supervision.
Regards
Dr Asmeet
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Asmeet Kaur Sawhney (26 minutes later)
Thanks Doctor. Is there any side effects while using tablets that have Oral tranxaemic acid? also how long do you recommend I take them for?

Can I continue to use Kojivit plus and ban a tan cream for as long as I am seeing good results?
doctor
Answered by Dr. Asmeet Kaur Sawhney (13 minutes later)
Brief Answer:
Tranxaemic acid safe except in persons with bleeding & clotting diseases,

Detailed Answer:
Oral tranxaemic acid tablets are safe to use except in persons having history of any bleeding or clotting disorders.
They need to be continued for atleast 3-4 months depending on the response.
Yes kojivit plus and ban a XXXXXXX cream can be used till the time you get satisfactory results.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Asmeet Kaur Sawhney

Dermatologist

Practicing since :2007

Answered : 5006 Questions

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Suggest treatment for melasma on the face

Brief Answer: Start oral therapy, chemical peels Detailed Answer: Hi Thanks for being at healthcaremagic I am Dr Asmeet Kaur Sawhney, a dermatologist. I have gone through your history and according to me the medicines recommended to you were fine. Have you used clearz or clearz XXXXXXX cream? If even after applying it for 2.5 months the pigmentation has reduced by only 40 percent I would recommend you to take oral therapy as well. It has been seen that oral tranxaemic acid in the dose of 250 mg 2-3 times in a day for 3-4 months is effective in the treatment of melasma. Besides this you can also consider going for chemical peels. Glycolic acid, TCA peeels and jessner's peels are effective in the treatment of melasma. Multiple sessions are required after intervals of every 2-3 weeks. 6-8 sittings may be required. Regards Dr Asmeet