Gold Standard Treatment
Triple therapy is when we use hydroquinone, tretinoin and a steroid together in a special (prescribed) combination cream – e.g., “Pigmanorm”, or “Tri-Luma”.
This is the gold standard treatment for stubborn pigmentation.
This is what can be purchased here, if the doctor prescribes it based on your submitted history and photographs.
Risks of triple therapy creams:
In very rare cases, the cream can make things worse – by causing a condition called ochronosis, a blue-black pigmentation of the skin. This would usually happen in people who use it long term – so it’s safest to use it for under 2 months at a time.
If you dab the product on to particular age spots, sometimes it can lighten the skin just around them as well - making a lighter “halo” of skin around each one – so it’s best to spread it over a large area.
IMPORTANT NOTE - The ingredient hydroquinone in the triple therapy cream tends to work best on fair skin tones. If you have a medium-to-dark skin tone, it’s best to see a dermatologist in person rather than using this online service, as the cream may actually worsen hyperpigmentation.
This cream is also unsuitable for sensitive skin, as it is the most powerful treatment available, and thus typically causes light skin peeling and irritation while it is working.
Be patient!
With daily usage, you can reasonably expect
visible results within 2 months. As old skin sheds, and new skin is formed, the hyperpigmented spots fade away.
Other Treatment of Melasma Hyperpigmentation
Limiting sun exposure
Limiting sun exposure is by far the most important treatment, for any kind of pigmentation - even if it has been caused by something else in the first place (e.g., hormones).
This is by wearing a high factor sunblock every day, as well as hats and sunglasses.
Skin lighteners
Skin lighteners are used to fade hyperpigmented areas. This isn’t about making you look pale. Uneven skin colour contributes to an ageing appearance – by using a skin lightener we can even this out, and create the appearance of younger looking skin.
Hydroquinone
Hydroquinone is a very effective lightening agent – that should give results in 2 months.
Before you say – I’d rather keep my tan and not lighten my skin – we are not talking about making you look pale overall. Skin lighteners are for fading hyperpigmented areas which cause uneven skin tone, and reducing brown or dark spots. These brown spots and uneven skin colour are very ageing – and by using a skin lightener we can therefore create the appearance of younger looking skin. Hydroquinone has been in use for more than 50 years for skin lightening, and is considered to be the best ingredient to achieve this, despite a lot of other products since becoming available.
Vitamin A derivatives
Vitamin A derivatives – (e.g., Retinol, Tretinoin) – speed the removal of pigment by accelerating skin cell turnover. If used alone they don’t have much effect on pigmentation - results are much better if used in combination with hydroquinone.
Both Hydroquinone and vitamin A derivatives can dry out and irritate the skin, causing redness.
Steroid creams
Steroid creams (mometasone,fluocinolone or hydrocortisone) can reduce the inflammation which canbe a side effect of both hydroquinone and tretinoin.
Getting the most benefit from treating your Melasma
Wearing sunblock is the best thing you can do for your skin regardless, but this is especially important if you’re going to go to the trouble of treating melasma. The pigmentation is likely to quickly recur if you get UV damage, so you must be obsessive about applying and re-applying your broad-spectrum sunblock every day.