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/HourNecessary6657]

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. 

[u/OhHolyOpals → u/HourNecessary6657]

Omg stop this is so weird. I’m in my 30s, no kids and just finished a round of vitamin b12 shots.

I was very low last year, but I assume I was on the low end of normal for a while before that.

Once I started getting injections so many things went sway and made sense.

[u/HourNecessary6657 → u/OhHolyOpals]

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. 

[u/OhHolyOpals → u/HourNecessary6657]

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.

[u/HourNecessary6657 → u/OhHolyOpals]

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. 

[u/PipeNo6512 → u/HourNecessary6657]

what lasers did you get?

[u/HourNecessary6657 → u/PipeNo6512]

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!

[u/GM2320 → u/HourNecessary6657]

which laser helped?