Cosmelan 2

What is Cosmelan 2?

Cosmelan 2 is a topical depigmentation treatment designed to reduce hyperpigmentation, melasma, & dark spots on the skin. It is part of the Cosmelan Depigmentation Method, which typically involves an in-office peel (Cosmelan 1) followed by at-home maintenance with Cosmelan 2. 

How good is it for pigment & what types of pigment can Cosmelan 2 treat?

Cosmelan can potentially treat the following types of pigmentation. 

• Melasma
• Post inflammatory hyperpigmentation
• Sun & age related pigmentation
• Dark circles; some forms
• Perioral pigmentation
• Underarm dark pigmentation

*Results are highly variable, depending on the cause of hyperpigmentation. This product is best used after initial chemical peels or lasers. 

What is the difference between Cosmelan 2 & the Cosmelan Peel?

The Cosmelan 2 is a home based cream used after the Cosmelan Peel. The peel is an in-office procedure designed to ‘lift off’ pigmentation & kick start the Cosmelan 2 application.

How long does it take for Cosmelan 2 to work?

The Cosmelan 2 speed of pigment clearance depends on the type of pigmentation. 

• Melasma: 2-4 weeks, faster with Cosmelan Peel or pico lasers as initial treatment. 
• Post inflammatory pigment: 4-16 weeks.
• Skin lightening & brightening: 4-8 weeks.

*Cosmelan 2 does not work for deep dermal pigmentation or resistant melasma. 

**Ideally Cosmelan 2 & other creams are employed together with pico laser & medical therapy for best results. 

What ingredients are found in Cosmelan 2?

The cream contains active ingredients like azelaic acid, kojic acid, phytic acid, niacinamide,  retinyl palmitate & ascorbic acid, which work synergistically to inhibit melanin production, promote skin renewal, and brighten the complexion. 

Cosmelan 2 is used to maintain the results of the initial treatment and to prevent the reappearance of pigmentation issues. Regular use helps to achieve a more even skin tone and minimize the recurrence of dark spots.

Can Cosmelan 2 be used without the peel?

Yes, but the results are nowhere as good compared to a pretreatment peel or laser. For optimal results, pre-treatment to remove pigmentation gives the fastest & best outcomes. 

As a stand alone cream, you can expect pigmentation to fade by 10 to 30%, usually after two or three months. You will only need to use it two or three times per week at that stage.

During the summer months or when your skin is exposed to more sun than usual, your pigmentation may rebound. In this case, using the Cosmelan 2 cream daily again is best.

What is the best treatment for melasma pigmentation?

It’s not Cosmelan 2, however this product is very useful in the maintenance phase of melasma treatment. Here’s the summary-

Phase 1 (pigment removal): pico laser & medical therapy, alternatively novel peels such as Vi Precision or Cosmelan peel. This removes most pigmentation in the shortest possible time.

Phase 2 (maintenance): this is where Cosmelan 2, Melanopro Peels &  other pigment correctors come into play. 

How long does Cosmelan 2 Cream last?

The Cosmelan 2 cream contains 30 grams, which is a small amount (& super expensive). Using it 1-3 times daily 30 grams will last between 2 to 4 months.

What are the side effects of Cosmelan 2?

Tolerated by most Cosmelan 2 is generally safe in most skin types, bar sensitive skin. Side effects include-

• Peeling (prolonged peeling is abnormal)
• Prolonged redness (transient & mild redness is normal)
• Stinging (transient stinging & irritation is normal)
• Persistent swelling

Side effects are more commonly seen in patients with sensitive skin; namely eczema, dermatitis & rosacea. In these patients, we do not recommend Cosmelan 2, use azelaic acid or niacinamide instead. 

Is Cosmelan 2 or the Cosmelan peel worth it?

The Cosmelan peel is widely recognized as one of the most popular treatments for hyperpigmentation/melasma, offering up to a 90% reduction (best case not average) in unwanted pigmentation, however it works in only 60% of melasma cases. 

The downside is prolonged recovery of up to 14 days. In this regard, pico lasers & other peels may be a better option for busy patients. 

How does Cosmelan 2 compare with the Melanopro peel system?

Both are good solutions with pros & cons. 

Melanopro improves skin texture more than Cosmelan, with less irritation & costs. 

Cosmelan is great for pigmentation, costs more & has more skin irritation. The optimal treatment depends on your skin sensitivities & budget. 

Can you do Cosmelan at home?

Cosmelan Peel is a professional-grade treatment that must be administered by a board-certified dermatologist or another qualified medical professional. The process begins with the application of the Cosmelan 1 mask, a potent chemical peel specifically designed to address hyperpigmentation & melasma. This initial step must be performed in a clinical setting under the supervision of a clinician. 

Following this in-office treatment, patients are provided with a comprehensive home care regimen, including products like Cosmelan 2 cream and Hydra-Vital Factor K moisturizer from Mesoestetic. These products should be used consistently for your prescribed time period. 

What is an example of Cosmelan 2 skin care routine for treating melasma?

A simple melasma skincare routine is as follows: 

AM: Niacinamide 10% or ascorbic acid 20% prior to application of sunscreen SPF 50+ tinted. 

Midday: Sunscreen reapplication, lotion, stick or spray.

PM: Cosmelan 2 application. 

Note: The greatest traction of any melasma skincare routine is the correct application of sunscreen. This has a much greater impact on melasma than any marketing objective of any skin care ingredient. 

The addition of antioxidants in the morning can be useful, however the rate limiting factor is your skin’s irritation threshold. As Cosmelan 2 is an irritant, addition of an acidic compound such as ascorbic acid may lead to skin irritation.  

Does Cosmelan 2 make you peel?

One of the possible side effects of Cosmelan 2 cream is peeling in the treated area. The Cosmelan treatment works by speeding up skin cell turnover, which can result in mild peeling, dryness, redness, or irritation. To counter these effects and ensure the skin stays hydrated and protected, our clinic recommends specific skincare products for at-home use.

Mesoestetic’s Melan Recovery and Hydra-Vital Factor K moisturizers are specially formulated to provide intense nourishment during the Cosmelan treatment. If you experience persistent side effects or discomfort, it is advisable to pause the use of Cosmelan 2 cream until the irritation subsides. Continuing to use Cosmelan 2 while the skin is peeling and irritated can be counterproductive and may worsen hyperpigmentation.

Here is what to do if you experience significant discomfort or peeling. 

• Stop application of Cosmelan 2
• Use Hydra-Vital Factor K 3-4 times a day, or La Roche Posay Cicaplast cream
• Wait till skin is COMPLETELY normal (1 to 6 days)
• Restart at half the applied amount every 2nd to 3rd day
• Increase as tolerated

Can Cosmelan 2 be used in pregnancy?

It’s advisable to avoid using Cosmelan 2 cream during pregnancy due to the presence of Vitamin A (Retinol- retinyl palmitate). Vitamin A is known for its skin-renewing benefits, but when applied topically, it can be absorbed into the bloodstream in small amounts. This absorption poses an infinitely small risk of harm to the fetus during pregnancy. 

For safer skincare options during pregnancy or breastfeeding, it’s recommended to choose products that do not contain Vitamin A. Dr Davin Lim recommends the following ingredients that are safe in pregnancy –

• Azelaic acid: 10-20%
• Ascorbic acid: 10-15%
• Niacinamide: 10% 
• Licorice root extract: variable 
• Glycolic acid: 4-18% AHA serums

Why is Cosmelan 2 so expensive?

It’s all about guarded company secrets by the maker of Cosmelan; Mesoestitic. Unlike medical chemical peels that can be compounded (eg. TCA, Jessner, Phenol, Croton Oil, Glycolic, Retinoic), Cosmelan & Dermamelan are classed as novel peels. Their ingredients are guarded (acknowledging that a ‘loose’ ingredient list exists), & their formulations are even a bigger secret (percentage, base, excipients etc). 

A secret formulation allows the Cosmelan peel to be marketed to raise company profits, as compared to medical chemical peels whereby the aim is to share information about formulations & propel the knowledge of melasma treatments via controlled studies. Cosmelan & Mesoestetic are all about the dollar. Cosmelan formulations are not expensive to manufacture (cost approximately $4 to $8 USD including packaging), the expense is due to the marketing of the product. 

Is Cosmelan 2 better than hydroquinone?

No, but it’s more complex than that. HQ is hard to use (properly), as it requires management under a physician who knows pigment. Cosmelan 2 is a simple treatment that can be prescribed by non-professionals – dermatologists. 

Hydroquinone has long term issues such as tachyphylaxis & exogenous ochronosis. 

*Cosmelan 2 MD contains Caprylic/Capric Triglyceride, hydroquinone, Kojic acid, and Retinyl Palmitate, zero HQ. 

Is Cosmelan 2 safe for darker skin types?

Yes, it is safe (however side effects such as skin irritation is universally seen, regardless of skin color). Your clinician will guide you through the appropriate application process pertaining to your skin color & pigment goals.

Is Cosmelan 2 better than Cyspera?

Cyspera at least has some clinical studies behind it (published not white paper). Cysteamine, the active ingredient in Cyspera, is a useful pigment corrector, however, like Cosmelan, it can be irritating. Here are our thoughts on Cyspera vs Cosmelan 2 (we prescribe both). 

• Both are useful in the rotational phase of melasma
• Cyspera is more irritating than Cosmelan 2, hence short contact therapy indicated
• Cyspera is less expensive than Cosmelan
• Efficacy is about equal
• Both can be safely used long term

How does the Cosmelan peel &  Cosmelan 2 work?

Cosmelan Peel Mask serves as the initial phase of the Cosmelan depigmentation treatment. It must be applied by a healthcare professional in a clinical environment, such as at The Melasma Clinic in Sydney. During your appointment, our clinicians will instruct you on the duration you need to wear the mask, which can vary from 2 to 9 hours, depending on your skin tone, type, & the severity of your melasma. You will remove the Cosmelan 1 Mask at home using a gentle facial cleanser. 

The second part of the Cosmelan treatment involves a homecare regimen, including the use of Cosmelan 2 cream. This cream, which contains a combination of active ingredients, enhances the effects of the initial mask and helps regulate melanin production. You can start using Cosmelan 2 the day after removing the Cosmelan Peel Mask, provided there are no side effects such as peeling, redness, or dryness. If these side effects occur, it’s advisable to wait until they subside before beginning the use of Cosmelan 2. 

Apply a small amount (about the size of a pea) directly to areas affected by hyperpigmentation and melasma. Use Cosmelan 2 as often as your skin can tolerate it, discontinuing use if irritation occurs. Once irritation subsides, you can safely resume use. Depending on tolerance, Cosmelan 2 can be applied 1-3 times a day or several times a week and does not need to be rinsed off after application.

What is the best treatment for melasma?

It’s definitely not Cosmelan 2, however Cosmelan 2 is a good entry level ‘fire & forget’ solution for melasma that can easily be sold/prescribed with little to no understanding of the condition. 

Melasma is a complex interplay between genetics & environment. The best solution depends on –

• The proportion of epidermal vs dermal pigment
• Vascular involvement
• Sun protection
• Radiation protection (IR) 
• Patient’s (not customer or client as melasma is a medical condition) insights
• Skin sensitivity
• Skin type (color)
• Previous treatment/s
• Geography (number of sessions)
• Expectations 
• Aim for long term remission 

At the Melasma Clinic we employ MANY treatment modalities for melasma; Cosmelan 2, Cosmelan peels, Vi Precision peels, Pico lasers, Thulium lasers, medical prescriptive therapy, oral supplementation, Melanopro peels, vascular modifiers (lasers, PO, injectables) & more. We tailor each treatment according to the above factors for melasma to provide a bespoke, customized approach.

Can Cosmelan worsen melasma pigmentation?

When all homecare instructions are properly followed, Cosmelan treatment will NOT flare up melasma, if it does, it’s your fault. Flare ups can occur if-

1. You don’t have a clue how to use it. This occurs when you continue to use the peel if you experience inflammation. This flare up is called post inflammatory hyperpigmentation. The incidence is inversely proportional to the IQ of the patient. Continued use when inflamed leads to inflammation. This leads to pigment flares. 
2. Poor insight of the patient (most common). Incidental sun exposure, UV radiation, IR radiation (heat- cooking-saunas), can all lead to worsening of melasma pigment. 

For optimal sun protection, the clinic recommends applying tinted sunscreen, with a minimum SPF of 50. Two finger lengths twice daily regardless of sun exposure. One tube should last less than 3 weeks. 

Is Cosmelan 2 safe?

Does a bear sh*t in the woods? Yes it is safe, providing you know how to use it. As Cosmelan 2 does not contain hydroquinone, it can be used long term, with 2 caveats. 

1. You must modulate the inflammatory response from Cosmelan 2. Refer to previous posts. 
2. It can not be used in pregnancy due to the retinol within Cosmelan 2. 

Are the results from Cosmelan 2 permanent?

No. Nothing in life is permanent, however Cosmelan 2 (if it works) will give patients variable periods of remission, lasting weeks to months. Melasma as you guys know is a genetic condition (modulated by environmental factors), a cream can not change your DNA. 

We employ Cosmelan 2, Melanopro & other agents to extend the remission period following initial pigmentation removal. The exact timing depends on your response, expectations & skin sensitivities. 

Can Cosmelan 2 provide skin lightening?

The Cosmelan 2 is renowned as the world’s leading treatment for depigmentation, delivering both immediate and long-lasting skin-lightening effects. Its effectiveness across all skin types and tones is attributed to its potent active ingredients, which are scientifically proven to reduce excess melanin and inhibit the enzyme tyrosinase, a key player in melanin production. 

Cosmelan treatment is specifically designed to correct hyperpigmentation and achieve a more even skin tone, rather than to lighten one’s natural skin color, however with guidance it can be an effective long term solution following pico lasers. 

We lighten & brighten skin with a program consisting of-

• Pico lasers
• Cosmelan 2 or Melanopro peel 
• Sunscreen (lots)
• Oral glutathione & polypodium supplements

What are other creams that are cheaper than Cosmelan 2 for melasma?

Cheap is not best, however here is a guide of what is out there & our point of view. 

When treating pigmentation, several key ingredients are commonly found in creams and serums. Each of these ingredients works differently to reduce hyperpigmentation, melasma, dark spots, and uneven skin tone:

Superfade 2% Hydroquinone: A skin-lightening agent that inhibits the enzyme tyrosinase, which is essential for melanin production. Hydroquinone is often used in combination with other ingredients for enhanced effects. It’s available in Australia without prescription; just as long as the concentration is under 2%.

Paula’s Choice Niacinamide (Vitamin B3) 10-20%: Reduces the transfer of melanosomes to skin cells, helping to lighten dark spots and even out skin tone. It also has anti-inflammatory properties, making it suitable for sensitive skin. About ⅕ the price of Cosmelan 2, it doesn’t work as well. 

The Ordinary alpha-Arbutin 30ml: A natural derivative of hydroquinone, alpha-arbutin inhibits tyrosinase without the same risks, making it a gentler alternative for skin lightening. It’s $18 & rarely works, but can be considered if you are short of money. 

Melanopro Peel by Dermalogica: is probably the best substitute for the Cosmelan peel. The skin resurfacing cream in our opinion is better than Cosmelan 2. Highly recommended, it has less downtime compared to Cosmelan & is cheaper. 

Azclear Azelaic Acid: Has antimicrobial and anti-inflammatory properties and is effective in treating acne-related pigmentation & melasma. It works by inhibiting tyrosinase and decreasing free radicals, it is $17 & available in most pharmacies. One of our favorite maintenance treatments with much less irritation compared to Cosmelan 2. Azclear has a higher concentration of azelaic acid as compared to Cosmelan 2. 

AHA Elucent Glycolic Acid: An alpha hydroxy acid (AHA) 16% that exfoliates the skin, removing dead skin cells and helping to reduce the appearance of pigmentation over time. Great for pulsed therapy, one of our favorites. Much cheaper than Cosmelan 2, glycolic acid is better than exfoliation as compared to phytic acid in Cosmelan

Tretinoin Retinoids: Vitamin A derivatives that speed up cell turnover, promoting the shedding of pigmented skin cells and the regeneration of new ones. They also enhance the penetration of other active ingredients. Retrieve costs $70 but requires a prescription. It is best used as an anti-aging product not as a pigment reducing agent.