Our expert says:
Hi Kendri, thank you for the question.
This is a difficult question to answer over the net as one would like to examine the skin before deciding on the best treatment approach.
From your description it seems that you suffer from Melasma and that you received a hydroquinone based topical product (there are various concentrations used).
Melasma is a typically associated with hormonal changes and sun exposure so your best options would be to use a good SPF (50 or higher) that contains zinc oxide and/or titanium dioxide applied several times daily especially during the hotter months; I would also recommend sun avoidance (as much as possible) such as hats, umbrellas, shade, etc. and that you visit your gynaecologist who can make sure that there are no hormonal abnormalities and run through the different low hormone contraceptive options with you.
Melasma is difficult to treat and complete ‘cure’ may be impossible; chances are that with each sun exposure in the summer months the pigmentation will return to some degree.
My typical approach with ‘resistant’ pigmentation is as follows:
1. Topical: SPF (see above), low dose (2%) hydroquinone combined with depigmenting creams such as NeoStrata’s Depigmenting Gel and Pigment Lightening Gel (please note that other manufacturer such as Environ, Nimue, etc. also have depigmenting creams in their ranges), and light glycolic acid peels combined with depigmenting spot peels (such as DermaCeutic’s peel system but other systems are also available)
2. Fractional skin resurfacing: this should only be performed during the winter months
3. Other options: combination of Omnilux and ALA (ALA is absorbed into the pigment cells which are destroyed once the LED light from the Omnilux is used)
I hope the above has helped but ultimately you may need to consider a second opinion.
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