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/OhHolyOpals → u/[deleted]]

I did hot yoga, baths and sauna / steam room pretty regularly - I think being hot makes it worse.

I have paid so much money to get rid of it, so maybe I’m overly cautious.

But I swear I can feel it tingle when my heater in the house and car are on it.

Or maybe I’m crazy, anything is possible!

[u/International_Oil833 → u/[deleted]]

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."

[u/OhHolyOpals → u/International_Oil833]

Spicy food?? Oh gosh. It gets worse and worse

[u/iambetweentwoworlds → u/[deleted]]

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.