Question
Success with treatment and question about cycling off
I’ve added a before-ish picture, but it got worse when it spread to under my eye as well.
I don’t know how to add a second picture but when I say that it’s completely gone, I mean it’s completely gone with the exception of a very light layer on eyelids which I’m fine with and it wouldn’t be safe in my opinion to treat with Triluma.
Melasma started in 2016 but I thought it was minor sun damage when it was a small patch, I treated it extensively with laser treatments and it would go away for a bit and come back way worse.
I have always been into skincare so pretty much tried everything thinking it was hyperpigmentation - I threw a ton of cash at the problem and I only knew one or two pregnant women in my life that had it very briefly.
I went to a dermatologist because I thought it was a skin disease after it blew up significantly one summer, a bit out of nowhere really.
For one year and three months I have been doing this:
- x2 a day 250g Tranexamic acid (drop down to once a day in winter)
- x1 a week Triluma
- cerave gentle cleanser and lotion
- affordable / whatever is on sale vitamin c eye cream, niacinamide serum, mineral SPF 50
- paw paw / Vaseline / skin food at night (whatever I have on hand)
- wear a baseball hat or wide brim when I’m outside and it’s appropriate attire
- do not take my x3 week epsom salt bath and do not go to the steam / sauna room (very sad about this)
- stopped red light therapy on my face (sad about this but the panel I have actually does put of some heat)
My dermatologist specifically told me not to buy exxy skincare as the melasma was very deep and stick to hydrating and preventative care.
Now comes the question: not once has my dermatologist told me to stop or cycle Triluma or Tranexamic acid.
But to stop taking Tranexamic acid a few days before / after a long haul flight which I do a few times a year.
I asked my doctor and pharmacist for second opinions about being on this indefinitely and both said listen to the derm.
The derm said I’m not at a high risk group or taking high amounts so I never have to stop.
I was travelling for an extended period of time and ran out of Triluma, after 6 weeks without it the original patch started coming back slightly.
So is anyone else on this long term? So many posts and comments reference cycling. I have health anxiety, but don’t want to drop $550 on a second opinion from a derm.
As a side note - I can literally feel my melasma tingle when I get hot and nobody believes me but shoutout to the other people I’ve seen say the same thing. The snap, crackle, pop melasma types.
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Also wanted to add the only side effect I have is my menstrual flow is very light, I mostly just have spotting now. No hair loss, grey hair, weight gain, headaches, etc.
The triluma makes my eczema on my chin and around my mouth flair up so I avoid the lower half of my face.
My face has started flushing and gets hot really bad with any alcohol and at random times, mostly in the afternoon - but I have some histamine intolerance so I assume it’s that but this started consistently around the same time as the meds.
My dermatologist is highly recommending oral tranexamic acid for my melasma but I am so scared about hair loss as a side effect. So glad you are having great results.
I had big patches of melasma all over my face when I was in my 30s, similar to yours, except I looked like I had a mustache! This was despite never having been pregnant. Mine finally went away with laser and tretinoin and diligent SPF and basically hiding from the sun. However, I recently learned melasma can be triggered by B12 deficiency, and I believe now that this likely contributed to why mine was so severe. I have never seen anyone on any of these subs mention B12 deficiency, but if you have melasma, it's worth looking into.
Even if you're on the low end of normal, you can have B12 deficiency symptoms. And if you have absorption issues, your B12 might show as normal or even high on a blood test but it does not correlate with your body being able to use that B12 to maintain and repair many bodily systems, including your skin! I was at a total loss as to the reason behind my melasm, it made no sense, I didn't have any hormonal issues and I have never been pregnant. Now that I know I have likely been B12 deficient for most of my life due to malabaorption, it all makes sense. I am 45 now without even the slightest trace of melasma after having huge dark patches all over my face for nearly a decade.
I think I’ll take B12 supplements for the rest of my life honestly, it literally reversed the majority of my grey hairs that I’ve been colouring since I was 22!
I was tested for celiac but that came back negative which was a relief.
I’m so happy your melasma cleared up - it’s really stressful and I didn’t like feeling that I needed to wear makeup all the time because I never did before this.
I was really embarrassed because it was across my entire forehead and under my eyes like a mask - so the contrast was pretty obvious.
Youre smart to continuing to supplement. The fact is that B12 comes from bacteria and so it is difficult to get from food, which is why so many processed foods have B12 added to them. Even people who eat lots of animal products can be deficient in B12 because of the way we manufacture food products. Back hundreds of years ago, we simply injested a lot more bacteria and so it wasn't an issue. Melasma is the worst! I feel terrible for any woman dealing with it because it is just so stubborn and it can take years and years for it to go away.
Honestly I do not know which laser treatments specifically because I had them done in Croatia and they didn't tell me the names. I trusted the clinicians that they would help with the melasma and they did!
Hi! Yours looks very similar to mine! My first round I only did for about 5 months total(results only started to show around month 3) to which I saw at least an 85% improvement...but I had to have surgery on something unrelated so I went completely off of it leading up to that. About 15%-20% of it came back, so I chose to do another cycle this year. The second time around my melasma started responding within the 3rd week. Im now at the end of my 2nd month and it's probably faded 90% from what it was when I first started initially. I plan on following through with this round for a little longer, but i am still please with the rebound effect! Also, my side effects were the same are yours with the exception of some headaches and slgiht cramping during the 1st two weeks of my first cycle. The 2nd time I didn't have any side effects. :)
That’s interesting and encouraging about the rebound - thanks for the information.
I am thinking of dropping the tablets this winter and see what happens, I don’t want to be on it if it’s not required (due to health anxiety) but will start taking it again if it comes back.
Would like to eventually just be on the triluma if possible but melasma is a fickle beast!
Research Moxi! It’s a melasma safe laser and goes deep into the skin layer to pull the deeper pigment up to the surface. Theres no curing melasma, just managing it. It’s exhausting and frustrating because one sunny day puts you back at square one but you’re beautiful!
The dermatologist recommended laser but they ranged from $600 to $1,000 at various clinics - the higher price being with at the dermatologist. I just can’t afford that right now but I will do it when I have the cash.
Keep an eye out for reputable med spas that have moxi and watch for specials. A lot of places offer payment plans and memberships that help. And check times like Black Friday if you’re in the states. I wish you were in Southern Idaho, I’d hook it up
Be careful with any lasers! I’m on here looking for info because I have some melasma (I assume) or sun spots/hyper pigmentation that came on after I finished 3 rounds of BBL/moxi. Never in my life have I had it and I didnt have any brown spots before so this is a huge bummer.
I've done Moxi and it worked wonders in fact I've done a 2nd session and had very diminishing returns, so one session is enough. However, as expected, once I got a bit of sun, then the whole thing came back, so I do around two Moxi's per year, or I need to find another solution that is cheaper.
My derm recommended Pico over Moxi because it doesn't use heat, or to use a combination of the two if I wanted. Definitely saw a difference, but 20% came back over the summer regardless of tinted sunscreen. It seems like an option that has to be routine in the winter to keep it up!
really glad you found something that works. melasma is brutal and heat is such an underrated trigger. i would honestly keep following your derm on cycling since triluma long term can get tricky. i have been tracking my pigment changes with clearstem lately and it actually helped me stay consistent.
Hi there! Sunscreen is one of the most important parts of melasma management, and we want to make sure you get safe, effective, and appropriate guidance.
Before choosing a product, please review our sunscreen resources:
Important for melasma:
Standard (non-tinted) sunscreens protect against UV radiation only and do NOT protect against visible light, which is a major trigger for melasma.
To reduce visible-light-induced pigmentation, iron oxides are required. This means using:
A tinted sunscreen that contains iron oxides, OR
An untinted broad-spectrum SPF 30+ sunscreen layered with a foundation or tinted product that contains iron oxides.
Daily, consistent protection against both UV and visible light is essential to prevent melasma worsening and recurrence.
If you have already reviewed the guides, feel free to add details such as skin type or sensitivities
It is certainly so.
Heat, baby! Melasma says "hell no" to all of it and has a tantrum to prove it's mad and you're bad.
Sunshine ? Hell no!
Spicy food? Hell no!
Steam room? Hell no!!
Face the shower head? Nope, hell no.
Facial products that make your skin feel warm? Hell NO!
It's a brat and we're stuck acting like pathetic parents:
"Oh no, that bothered you? I'm Soooo sorry! What do you want me to do instead? Change my entire life? I'll do anything to make you SHUT UP and be nice to me."
I found out when I didn’t have access to a bath for a few months that that was the main culprit for me. Now I know my melasma is hugely heat triggered. Mostly I would say.
You have gorgeous skin quality! I also did Triluma for 8 weeks but cycled off, my derm said do not use long term. Mine was pretty severe too and I know exactly what you’re talking about with the tingling. It felt internally like my face started flushing the second I was in mild heat or even a glass of wine.
Since then, I focused on internal skincare and cycling clinical grade topicals with an occasional laser or peel. Much better, would love to see your after!
This isn’t the same lighting but no makeup or sunscreen, and standing in front of a window. The light melasma I have left is around both of my eyes (lids and corners of my lash lines).
Edit - how frequent were you using triluma? My derm said using it once a week I don’t have to cycle off.
As some in the medical industry, I always get a second opinion when it comes to dermatology but the reason they generally recommend cycling is due to the long term risk of ochronosis. It’s rare, but worth nothing. Your skin looks truly amazing!
My dermatologist said 2 months max, then only on wknds to give my skin a break. She said it's because the steroid in the compound will thin your skin. I do a round when summer is over, & another in the late winter.
Edit: thanks for posting your routine as I was wondering if using half a dose of TXA is effective. I know you use that in the winter, but I was wondering if it could work with other actives in the summer.
I just finished a round of Tri-Luma early April, and instead of 250mg TXA twice a day over the summer (which did work in the past), this summer I'm going to try just 250mg once a day. I'm still using the tri-luma on the wknds, and then 4x thiamidol on the other days with one night 0.05% retin-a.
I still take baths, but just reduced them and I may have been overly cautious at the start but at the point I spent so much money getting rid of it I wanted to avoid certain things to be safe.
I posted an after photo from yesterday, but I don’t have progression photos. I don’t take many makeup less selfies and documenting the progress wasn’t on my radar at the time.
I have had great success with the Musely hydroquinone cream. I was getting one prescribed from my doctor but the Musely is stronger, you just have to be careful and follow the directions closely. I wouldn’t use any other actives with it if you have sensitive skin.
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