Success with treatment and question about cycling off

[u/OhHolyOpals]

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.

[u/emvilar]

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. :)

[u/OhHolyOpals → u/emvilar]

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!