Melasma cure and dermarolling

[Lisa]

I´ve had melasma for several years. Today the melasma is almost gone due to a cutan liquid I got from my doctor and also trying to avoid the sun (that´s the worst part). The liquid containt hydrochinone (instead of hydroquinone), tretinon and vit c, so today there is only a shadow, only visible to me, instead of the brown mask, I had when I started treatment. I guess the trick to get rid of melasma is patience.

But here is my question, I read somewhere in this forum that you can only dermaroll with a needle less than 0.5 mm, because of the risk of inflamation? Is that so, I have just bought a 0.5 mm and I have no inflamation on my skin, isn´t safe to use the 0.5 dermaroller? And do you recommend that I apply the vit c serum first and then dermarolling or should I wait till after to apply the vit c serum?

[SarahVaughter]

You are lucky! It is hard to get rid of Melasma. The cause of Melasma is not fully understood and that is why they cannot treat the cause, they only treat the symptoms.

Since inflammation seems to be a factor in Melasma, anything that can cause skin inflammation or irritation has to be used with caution.  Acid peels often help suppress Melasma but in certain individuals it makes Melasma worse. The same goes for Tretinoin and the same for laser treatments etc. In many cases it helped, in some cases it made it worse.  That is why I am cautious recommending dermarollers for Melasma without warning that a test patch is absolutely necessary.

  Dermarolling causes a short lasting inflammation.  The inflammation after dermarolling with short needles subsides much quicker or there is no inflammation at all and that is why it is safer in case of Melasma. You can use longer needles but whatever length you use, do a test patch first.  Do not roll very frequently - give your skin time to regenerate.

  Melasma tends to reoccur. It is rarely cured, it merely is controlled. You must absolutely avoid sun and use a high factor sunscreen.  Since Melasma seems to be affected by both UVB and UVA light, you must use a

sunscreen - also in winter or on cloudy days. UVA ( they penetrate to the dermis)  levels are high year-round and it is not blocked by window panes. UVB is highest in summer. Try to avoid extreme temperatures (very hot or cold).  Do not rub your skin, do not go to the sauna etc.

  At the beginning, use very diluted vit. C to see how your skin reacts. Vit. C was successfully used in medical studies to improve Melasma but again, it could in some individuals irritate the skin and you have to be careful. Apply it in the evening because vit. C is sensitive to light. I am not sure if combining it with dermarolling is a good idea in your case. It is a good idea when you have no Melasma or if you have stubborn dermal Melasma (to bring the vit. C or other lightening products to the dermis) but since your Melamsa has disappeared, you should probably not risk any potential skin irritation from dermarolling (certainly not without testing it on a small skin area). Apply diluted vit. C to help keeping your Melasma away. Vit. C, just like most lightening agents, can't affect the existing pigment much, it can only reduce the formation of new pigment. That is why it sometimes takes months to see effects.

 Since dermarollers speed up the skin's turnover it should improve Melasma by speeding up the sloughing off of skin including the pigmented skin. A short-needled dermaroller is useful for Melasma in the epidermis.  A long-needled dermaroller could be an interesting option for dermal Melasma. The turnover of the epidermis is much quicker than the turnover of the dermis and ablative methods can't easily reach the depth of the dermis due to the risk of scar formation, so a dermaroller that can reach the dermis (> 0.5 mm) could be theoretically very useful for deep Melasma. However I'm not very keen on recommending it for Melasma because it causes short-term inflammation and it is likely that Melasma will reoccur and dermarolling will have to be repeated over and over for maintenance. If you decide to try it, do a test patch first.

 

Because inflammation seems to play a certain causative role in melasma and dermarolling might make it worse, I would be cautious using long needles (longer than 0.2 mm) due to the fact that they induce inflammation. There is not enough data available yet to make an informed judgment about using long needles on melasma



A MORE DETAILED EXPLANATION OF MELASMA

  Inflammation is our body's response to conditions when the area has to be cleared of bacteria, virii, fungi, damaged cells due to injury, sunburn, etc. The area temporarily gets red (increased blood flow), warm and tender/painful. The body initiates processes to remove unwanted elements from the area, remove debris (damaged skin cells etc.) and trigger new cell growth.  This is a normal, necessary reaction which purpose is to heal and renew the tissue. It only becomes a problem when the inflammation becomes chronic. The cause of chronic inflammation is not fully understood. The prevailing opinion is that it is a result of our immune system attacking our own healthy cells. Others claim that there must be a causative agent (such as bacteria, virii or something we still don’t know about) that causes our immune system constantly attacking it. It is a very complicated subject.

  One of the problem with Melasma is that there seems to be a mild chronic inflammation or at least a significant increase in the number and size of dermal blood vessels in Melasma affected areas – this was confirmed for example in this study: https://http://www.norseld.com/articles/vascular%20feature.pdf

  Whether the increased number of blood vessels has an effect on the overproduction of Melanin pigment in Melasma is unknown. Melanin is normally present in our skin and makes up our skin tone but in Melasma, Melanin is overproduced in certain areas (Melasma's brown spots are caused by the over production of Melanin). Melanin is induced by sun exposure as a form of natural sun protection (Melanin absorbs harmful UV and transforms it into harmless heat). Unfortunately, Melanin production can also be triggered in some individuals as a result of skin irritation, inflammation, acne, injury (even a minor one such as bug bite), exposure to high temperatures etc. It doesn't mean that anybody with "ordinary" hyperpigmentation has Melasma. Melasma, just like stretch marks, seems to be tightly connected to hormonal causes. Melasma often appears in pregnancy or in women on hormonal contraception or hormonal replacement.  It only means that people with Melasma have to be careful with everything that could potentially trigger Melanin production. Some of the procedures that help Melasma can also potentially trigger melanin in susceptive individuals.

  Another problem with Melasma is that in can occur in the epidermis - then you are lucky and you can significantly improve it for example with acid peels.

  Or it also affects the dermis, which is the deeper skin layer. Dermal Melasma is simply too deep to be removed. Normally, there is no melanin in the dermis. It was found that the basal membrane (the membrane between the epidermis and the dermis) is damaged in dermal Melasma sufferers and that facilitates the migration of melanocytes and Melanin into the dermis where they constantly cause hyperpigmentation.

  You have several options to treat Melasma:

- Mechanical removal of Melasma by dermabrasion, acid peels, ablative lasers etc.

This removes or partially removes the existing pigment but does not prevent the overproduction of new pigment. That is why it has a high reoccurrence rate. Moreover, it can irritate the skin, cause inflammation and in case of ablative lasers, it heats up the skin. This can potentially make the condition worse.

- Non-ablative lasers or IPL - the light from the laser or Intense Pulse Light is absorbed by concentrated Melanin in the skin or by Hemoglobin in the blood, that heats it up and the pigmented cells or enlarged blood vessels get destroyed. High re-occurrence and it can potentially make it worse.

- Melanin production inhibitors used on and off for a long time (permanent maintenance)

Currently, the most successful Melasma treatment products are those that reduce Melanin production (skin lightening products) such as Hydroquinone (Hydrochinon) , Arbutin, Kojic acid or vit. C, often in combination with products that speed up the skin's turnover and even out skin tones, such as Tretinoin (Retinoic Acid) and sometimes in combination with anti-inflammatory such as corticosteroids, vit. C, Tea Tree oil etc. Each of these products has its pros and cons.

                                                     You can use a 0.2 mm dermaroller to enhance the penetration of hydroquinone to the dermis but do not do it for a prolonged time. The best protocol is   3 month on, 1 month off



  The reason why Melasma is so difficult to control is because when you manage to remove it mechanically, it frequently re-appears. When you stop using Melanin inhibitors, it can reappear. It commonly requires life long maintenance. Nevertheless, it sometimes emerges in pregnancy or when on hormonal contraception and it completely disappears when the hormonal influence is no longer present.  In some cases the Melasma persists.

The problem with long lasting hyperpigmentation in Melasma, café-au-lait  spots and other melanin related pigmentation is that the root cause of  the pigmentation is unknown.  It is caused by local overproduction of  skin pigment melanin by pigment producing cells (melanocytes) but nobody  knows why melanocytes produce an excessive amount of melanin in certain  places. Thus, you cannot treat the cause but only the symptoms. That is  why fighting hyperpigmentation is so difficult.

   You will manage to lighten your spot with melanin inhibitors, however  it is likely that your melanocytes will keep on producing excessive  amounts of melanocytes in that area. The reoccurrence of the  hyperpigmentation does not always happen, however it is not uncommon.

There is a new skin lightening topical called Elure that works in a different way than hydroquinone.

   Elure contains an enzyme (  lignin peroxidase) that breaks down existing pigment. Hydroquinone prevents formation of a new pigment.

   The results with Elure were disappointing in many cases and successful  in a few. I don't want to comment on its efficacy because I truly can't  say anything else about it except that it's extremely expensive.

[Lisa]

Thanks for your kind answer, it is securing to have such a honest person to guide one:-) I am also very happy to get rid of the mask, it was very "painful" to have, it was the only thing I looked at, when I saw my self in the mirror. I have made many mistakes in my skin regimes, during these years. The worst mistake I have made, was putting concentrated vit c oil (from aromatherapy) on the mask, and then going out in the sun, trying to swicth out the skin:-( I was tottally black on the mask, it was terrible. But I forgot before, to tell about my rosehip oil, that is really so good for the skin, this oil together with the serum from the doctor and really trying to avoid the sun (50 or 60 SPF every day and hat in the summer), has been the recipe to get rid of my melasma.

So I will start very carefully, with dermarolling with the 0.5 mm two times a week over the summer. And then first try the 1.5 in the fall. The vit c serum will I use the days in between.

I will keep you posted on my experiences:-)

[Julie]

Lisa;1616 wrote: I´ve had melasma for several years. Today the melasma is almost gone due to a cutan liquid I got from my doctor and also trying to avoid the sun (that´s the worst part). The liquid containt hydrochinone (instead of hydroquinone), tretinon and vit c, so today there is only a shadow, only visible to me, instead of the brown mask, I had when I started treatment. I guess the trick to get rid of melasma is patience.

But here is my question, I read somewhere in this forum that you can only dermaroll with a needle less than 0.5 mm, because of the risk of inflamation? Is that so, I have just bought a 0.5 mm and I have no inflamation on my skin, isn´t safe to use the 0.5 dermaroller? And do you recommend that I apply the vit c serum first and then dermarolling or should I wait till after to apply the vit c serum?

 

Hi Lisa,

I was curious about that cutan liquid you used. I have melasma also and saw on another forum where someone used a compound prescription that seems similar to the one you described. Could you post more information on this cutan liquid? The ingredients and the prescription strength (%) of each one. Is it a compound prescription or is Cutan the brand name? Thanks so much.

Julie

[Lisa]

Yes off course:-)

Here goes:

Hydrochinon USP 16 gram

Tretinoin 200 miligram

Natriummetabisulfit 200 miligram

Ascorbic acid 200 miligram

Ethanol, Waterfree 85,5 gram

Propylenglycol 112 gram

It has to be kept cool in the refrigerator.

You will peel sometimes from the liquid, but mostly in the beginning. Be very carefully witrh the sun and always only put it on at night.The good part is that is very helps, I have hydrochinon in instead of hydroquinone, I have heaerd so many bad things about that, but I should really persuade the doctor to leave out the hydroquinone.

Hope you will get a good result too:-)

[Julie]

Thanks so much for the information Lisa.  Hydrochinon and hydroquinone are the same thing right? I looked it up and it seems that it is the same medicine but named differently in Europe. (I'm in the U.S.) Anyway the three main ingredients in the prescription I have are tretinoin, ascorbic acid and hydroquinone, I am going to take a copy of the compound prescription I saw and your list to my dermatologist and see what she suggests.  I have heard that hydroquinone can be bad for you if used long-term but I hopefully won't need it too long.

I have one more question, I hope you don't mind. How long before you saw results after you started using the Cutan liquid?

Thanks,

Julie

[SarahVaughter]

Yes,  Hydrochinon is just a different name for the same substance (Hydroquinone)  .  Hydrochinon = Hydroquinone.

   

  Hydroquinone is banned in some European countries or it is prescription-only.

   

  I think the main problem is that people overuse it. They use high concentrations for a very long time. In the US, 2 % hydroquinone is OTC.

[Lisa]

I am sorry to say but it took some time, but as long as it is getting better all the time, it is not so bad. My mask was very bad, people was asking me what was going on with my face and these date where you can´t see a thing, it is just amazing to get rid of it. But really be careful with the sun, what you have been figthing for in mounths, you can ruin in 10 min in the sun without sunscreen or hat. If you want to be extra nice one day, you can just use "tan in a can" :-)

[felucci]

i read that hydroquinone is dangerous to the skin and some other posters in different forums agree with me. so it's right to conclude that skin lightening creams like Metaderm that has no hydroquinone content is safe? metaderm, btw, can be used for melasma.

[SarahVaughter]

The main lightening ingredient of Metaderm is Alpha Arbutin.

   

  Arbutin is a naturally occurring Beta-D-glucopyranoside of hydroquinone.

   

  Currently there are not enough studies to be sure one way or the other.

   

  The main problem is that people overuse hydroquinone. They use it for too long.

[sachalynxx]

hi lisa,
i have found your posts about malasma.  can you give me the name of product your doctor prescribed to you?  i have tried many things to no avail and hoping your product may help.  thanks

[SarahVaughter]

In 2011, there has been a study about enhancing the penetration of skin depigmenting products by dermaneedling (needle length of 0.5 mm and 0.13 mm) with successful results:
Skin Needling to Enhance Depigmenting Serum Penetration in the Treatment of Melasma:

https://http://forums.owndoc.com/dermarolling-microneedling/dermaroller-for-melasma/

You can try a 0.5 mm regular dermaroller (up to three times a week) to enhance the penetration of a Hydroquinone cream. The best protocol is 3 month on, 1 month off and so on.