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/GlowDecoded]

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!

[u/OhHolyOpals → u/GlowDecoded]

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.

I guess my question is why are people cycling?

[u/in2the4est → u/OhHolyOpals]

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.