Should I stop dermarolling for my melasma?

[Tina]

Dear Sarah

I’ve read all about the melasma and I know how difficult it is to treat it.

I use my dermaroller (0,2mm) for about a month . I just use it once a week very diligent. Because my skin is extremly sensitive my face is really red afterwards and it burns after the treatment. Then I spritz thermal water and I use skin lightening serum with kojic acid etc. and then I use a vitamin c serum. ( it burns a bit). Thats it.

Next morning I follow my usual routine which is cleansing, thermal water, sometimes the C serum and of course hight sunprotection SPF50 every day.

I use SPF 50 since 2008 (when my melasma started) and tried many things to get rid of my melasma. Nothing worked.

Since 2 weeks I found out that the melasma or the hyperpigmentation got more and the already existing melasma got darker.

I have new pigmentation around my cheeks, forehead and eyes that was there never before.

Directly under my eyebrow I have a scar. So I rolled over there too and around this area I got a little hypopigmentation. Oh my... :scared:

Sarah, you said that any skin inflammation or irritation could make the melasma worse. So in my case it seems so that the dermaroller makes it worse. Or is it agood sign that the melasma is now more noticable but with patience and rolling it gets better?

Or I have deep epidermal melasma and I need longer needles?

I have no idea what is right. I don’t want any more melasma. And I am really scared to continue rolling and rolling  and end up with melasma all over my face. And maybe some hypopigmentation

Like almost every woman with this condition, I feel very ugly and uncomfortable with this and I go never out without makeup.

What should I do?

Please help me Sarah.

Thank you very much.

Tina

[SarahVaughter]

Unfortunately, many things can worsen Melasma. Strong wind, coldness, heat, massage, creams, acid peels, dermarolling etc. However, it is highly individual. Not everybody reacts the same. Acid peels, dermarolling, laser treatments etc. often improve Melasma but in some unfortunate cases, it worsens Melasma (the skin produces more melanin pigment as a reaction to the treatment). What improves Melasma in one person can make it worse in another. Always do a test patch.

It will be difficult to find out what caused the worsening of your Melasma. Theoretically, it could have been the vit. C in spite of the fact that ascorbic acid (vit. C) has been successfully used in improving Melasma because it is a mild inhibitor of melanin (see the studies below).  It could also have been the dermaroller. I think you should stop both the vit. C and the dermaroller and use only Hydroquinone cream.



A double-blind randomized trial of 5% ascorbic acid vs. 4% hydroquinone in melasma

Liliana Elizabeth Espinal-Perez MD, Benjamin Moncada MD*, Juan Pablo Castanedo-Cazares MD



Abstract

Background Melasma is an acquired treatment-resistant hyperpigmentation of the skin.

Methods Sixteen women with idiopathic melasma were included in our trial. After randomization by another clinician, they were instructed to use, at night, 5% ascorbic acid cream on one side of the face and 4% hydroquinone cream on the other side, for 16 weeks. Sunscreen was applied daily throughoutthe period of observation. They were evaluated every month by colorimetry, digital photography, and regular color slides. Subjective evaluation by each patient was also taken into account.

Results The best subjective improvement was observed on the hydroquinone side with 93% good and excellent results, compared with 62.5% on the ascorbic acid side (P < 0.05); however, colorimetric measures showed no statistical differences. Side-effects were present in 68.7% (11/16) with hydroquinone vs. 6.2% (1/16) with ascorbic acid.

Conclusion Although hydroquinone showed a better response, ascorbic acid may play a role in the therapy of melasma as it is almost devoid of side-effects; it could be used alone or in combination therapy.

 

A Randomized, Double-Blind, Placebo-Controlled Trial of Vitamin C Iontophoresis in Melasma

Huh C-H, Seo K-I, Park J-Y, Lim J-G, Eun H-C, Park K-C

         

Abstract

Background Vitamin C is known to both inhibit melanin formation and reduce oxidized melanin. However, vitamin C does not easily penetrate the skin. In this study, vitamin C iontophoresis was employed in order to enhance vitamin C penetration.

Objective: The purpose of this study was to evaluate the efficacy of vitamin C iontophoresis for melasma patients. Methods: Twenty-nine females with melasma were enrolled. For iontophoresis, a vitamin C solution was applied to one side of the face, while distilled water was applied to the other side as a control. The L (luminance) value was measured by a colorimeter to obtain an objective pigmentation parameter.

Results: Twelve weeks after iontophoresis, the colorimeter of the treated site showed a significant decrease in the L value (from 4.60 to 2.78, p = 0.002), compared to that of the control site (from 4.45 to 3.87, p = 0.142).

Conclusion: Vitamin C iontophoresis may be an effective treatment modality for melasma.



Related subject:

https://http://forums.owndoc.com/dermarolling-microneedling/How-to-treat-dermal-melasma

[Tina]

Hello Sarah

Thank you so much for your answer. I really appreciate it.

this is bad news. I thought I could continue my rolling. Even if the melasma got more I thought I did something against it. You know what I mean. Maybe it's called frustration....

Alright about hydrochinone. I also want to order the infadolan or the tretinoin from your site. Can you recommend a good hydrochinone crem, gel or serum. Could be also something with 2% because of my hypersensitiv skin. Can I mix it with the tretinoin. Even if I don't should use the roller I would try the infadolan around my eyes?

After few month with hydrochinon I shouldn't try the dermaroller again, did I understand that right?

Just another short question which you can answer with yes or no: BPO (Benzolperoxyd) against acne can make the melasma worse right?

And AHA 10% cream twice a week or so could it make it worse too in my case?

Thank you Sarah for your advice and help.

Greetings

Tina

[SarahVaughter]

>Alright about hydrochinone. I also want to order the infadolan or the tretinoin from

>your site. Can you recommend a good hydrochinone crem, gel or serum. Could be

>also something with 2% because of my hypersensitiv skin. Can I mix it with the

>tretinoin. Even if I don't should use the roller I would try the infadolan around my

>eyes?

Yes you can apply Infadolan around your eyes.

You can mix hydroquinine with Tretinoin but Tretinoin is acidic (it is Retinoic acid). The acidic form is the most potent and the most effective but it is also the most irritating. There are many studies where Tretinoin has been successfully used to improve Melasma but again, it can theoretically also worsen Melasma in certain prone individuals. You should try it on a small portion of your face first.

>After few month with hydrochinon I shouldn't try the dermaroller again, did I

>understand that right?

No I do not think you should. It seems that in your case, melanocytes produce more melanin as a reaction to dermarolling, unfortunately.

>Just another short question which you can answer with yes or no: BPO

>(Benzolperoxyd) against acne can make the melasma worse right?

Anything that can irritate the skin (wind, acids etc) or any mechanical or other intervention (massage etc) can theoretically worsen Melasma but it is individual.

Basically any type of "activity" to the skin can in some cases provoke melanocytes into producing more melanin in Melasma sufferers. The worst thing for Melama is sun exposure. Melasma is a very frustrating skin condition.

>And AHA 10% cream twice a week or so could it make it worse too in my case?

Acids usually improve Melasma but in some unfortunate cases, it provokes the skin into producing more melanin. That is all I can say. 10% AHA is a weak acid and is should be OK but nothing is 100% sure with Melasma.