By Aimee Kvandal, NP
Melasma is often the culprit of hyperpigmentation (skin discoloration) and is typically seen on the forehead, cheeks, nose, chin, and upper lip. It is medically benign but people who suffer from Melasma are frequently searching for an answer to help improve their Melasma permanently. Unfortunately, there is no known cure BUT there are treatments that can help diminish the appearance of Melasma and help you feel more comfortable in your skin. At beyond | AESTHETICS in Camarillo and Ventura, we offer several treatments for melasma.
Topical Treatment for Melasma
Hydroquinone (HQ) is the most frequently prescribed depigmenting agent worldwide and it has remained the gold standard for the treatment of melasma, particularly epidermal type melasma. Variably good results are obtained in most of the patients treated with HQ. The depigmenting effects of the HQ treatment become evident after 5-7 weeks. Treatment should be continued for at least six months. The first 3 months HQ is applied twice a day, following the below schedule and the following 3 months the patient should follow the below wean off schedule. HQ should not be abruptly stopped due to certain side effects such as paradoxical postinflammatory hypermelanosis. Irritation is the most common complication; other adverse effects include erythema, stinging, irritant and allergic contact dermatitis, nail discoloration, transient hypochromia, and paradoxical postinflammatory hypermelanosis.
Application: After washing your face, apply a thin layer of Hydroquinone to your whole face twice daily for the next 3 months. Then follow the below schedule for the next 3 months. This whole application process will be a total of 6 months.
AM Routine for the first 3 Months
- Cleanse your face using Epionce Cleanser for your skin type
- Hydroquinone (1-2 Pumps)
- Moisturize with Epionce Moisturizer for your skin type
- Sunscreen (SPF 30 or more) Epionce SPF or Epionce Tinted SPF
PM Routine for the first 3 Months
- Cleanse your face using Epionce Cleanser for your skin type
- Hydroquinone (1-2 Pumps if you can tolerate 2x per day)
- Moisturize with Epionce Moisturizer for your skin type
Results: You should start to see results in 5-7 weeks with the above application schedule. Hydroquinone cream is usually well tolerated. However, some users may experience minor and temporary skin irritations including mild itching or stinging and reddening of the skin. If these do not subside within 1-2 weeks, stop using the cream.
A very important consideration patients should be aware of before starting HQ is that the HQ “Bleaching” effects are reversible, therefore, hyper-pigmentation usually returns after discontinued use in 1-2 months. It is also very important to wean off HQ slowly and gradually. implement our Epionce MelanoLyte Skin Brightening System and be consistent with using this system for best results. Below is the schedule to wean off HQ.
Weaning off Hydroquinone Schedule
You should never stop using Hydroquinone products abruptly but rather wean off them slowly to prevent side effects such as paradoxical postinflammatory.
Use HQ twice a day for 3 months then start to wean off HQ by following these instructions:
Month 4: The first 2 weeks of this month:
Apply HQ the first 4 days of each week by adhering to the above HQ AM/PM schedule.
The remainder of the week use Non-Hydroquinone products.
Example: Epionce MelanoLyte Skin Brightening System- Continue to wash your face with an Epionce facial cleanser for your skin type then: Apply MelanoLyte Tx AM and PM; Prior to PM application of MelanoLyte Tx, apply MelanoLyte Serum. Also consider adding Epionce Intensive Nourishing Cream or Renewal Facial product for your skin type and of course apply your Epionce sunscreen daily and re-apply when needed.
Month 4: The last 2 weeks of this month:
Apply HQ the first 3 days of each week by adhering to the above HQ AM/PM schedule.
The remainder of the week use Non-Hydroquinone products.
Example: Epionce MelanoLyte Skin Brightening System- Continue to wash your face with an Epionce facial cleanser for your skin type then: Apply MelanoLyte Tx AM and PM; Prior to PM application of MelanoLyte Tx, apply MelanoLyte Serum. Also consider adding Epionce Intensive Nourishing Cream or Renewal Facial product for your skin type and of course APPLY your Epionce sunscreen daily and re-apply when needed.
Month 5: The first 2 weeks of this month:
Apply HQ the first 2 days of each week by adhering to the above HQ AM/PM schedule.
The remainder of the week uses Non-Hydroquinone products.
Example: Epionce MelanoLyte Skin Brightening System- Continue to wash your face with an Epionce facial cleanser for your skin type then: Apply MelanoLyte Tx AM and PM; Prior to PM application of MelanoLyte Tx, apply MelanoLyte Serum. Also consider adding Epionce Intensive Nourishing Cream or Renewal Facial product for your skin type and of course apply your Epionce sunscreen daily and re-apply when needed.
Month 5: The last 2 weeks of this month:
Apply HQ 1 day of each week by adhering to the above HQ AM/PM schedule.
The remainder of the week use Non-Hydroquinone products.
Example: Epionce MelanoLyte Skin Brightening System- Continue to wash your face with an Epionce facial cleanser for your skin type then: Apply MelanoLyte Tx AM and PM; Prior to PM application of MelanoLyte Tx, apply MelanoLyte Serum. Also consider adding Epionce Intensive Nourishing Cream or Renewal Facial product for your skin type and of course APPLY your Epionce sunscreen daily and re-apply when needed.
Month 6:
You should now be only using the Epionce MelanoLyte Skin Brightening System. This system works best with the Epionce Cleanser for your skin type, MelanoLyte Serum, Intensive Nourishing Cream or Renewal Facial product for your skin type and of course apply your Epionce sunscreen daily and re-apply when needed.
Other Treatments for Melasma
There are several treatment options for patients who decide that Hydroquinone is not right for them:
Chemical peels
Treatments such as TCA, glycolic, and VI Peels can help all types of Melasma depending on the strength of the peel. For the epidermal type, sometimes a series of light to moderate peels in conjunction with light microdermabrasion may be enough to lighten the hyperpigmentation. However, with dermal or mixed types, a much stronger chemical peel is necessary to reach the pigment in the dermis. There is risk involved with stronger chemical peels, such as darkening of pigment. We recommend a series of VI Peels as it’s one of the few peels that is able to penetrate to the dermis with low risk of making hyperpigmentation worse.
Microneedling
Although the exact pathophysiology of how microneedling helps with hyperpigmentation is not completely understood, the assumption is that controlled injury to the skin creates cellular modifications necessary to lighten skin.
Dermasweep
Dermasweep combination therapies are excellent for epidermal and mixed types of Melasma. Two different infusion solutions are layered on top of one another to create the right amount of exfoliation and penetration of skin lightening products. Generally, patients will need 6 treatments spaced 2 weeks apart followed by maintenance treatments as needed.
Laser treatments
Treatments like HALO may be used to treat melasma. BBL/IPL laser treatments should be used with CAUTION. Some places offer “mini IPL” or “low level IPL” for Melasma which may be beneficial for epidermal melasma, but buyer beware as IPL treatments can cause hyperpigmentation to no longer respond or be very difficult to respond to any treatments.
Contact us to discuss which treatments or skin care routines may be right for you!
NOTES & REFERENCES
1Bandyopadhyay D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303-9. doi: 10.4103/0019-5154.57602. PMID: 20101327; PMCID: PMC2807702.
2For the Epionce Professional
Training Handbook A Guide For Using Epionce Effectively in Practice
https://www.epionce.com/professional-portal-login/
3Lima Ede A. Microneedling in facial recalcitrant melasma: report of a series of 22 cases. An Bras Dermatol. 2015 Nov-Dec;90(6):919-21. doi: 10.1590/abd1806-4841.20154748. PMID: 26734882; PMCID: PMC4689089.
4Melasma: the bright side of treating dark spots
by beyond | AESTHETICS | July 13, 2017 | Discoloration & Pigment
https://www.seewhatsbeyond.com/discoloration-pigment/melasma-bright-side-treating-dark-spots/
