Melasma supplements

What two supplements have the greatest effect on pigmentation & melasma?

The two supplements that have the greatest level of evidence for melasma pigment & skin lightening include glutathione & polypodium extract.

*Best is still relative, namely there are limited studies. Given the banal nature of supplementation, in addition to the low cost, our clinicians advocate supplements in some cases of melasma, pigmentary disorders & skin lightening.

When will I see results?

In some patients, results are seen at 4 weeks, occasionally faster. Best results are seen when oral supplementation is combined with prescriptive skin care, clinical chemical peels, & lasers.

How do I start on supplements?

AM: Glutathione 500 mg + polypodium extract 480 mg.

Midday: Polypodium 480 mg.

Are there any side effects to glutathione supplements?

Topical or oral supplementation in doses up to 500 mg daily are safe, however IV glutathione can potentially damage kidneys & liver. Abdominal pain has also been described. 

How does glutathione work?

The main role of glutathione is to reduce oxidative stress, in turn brightening skin.  Glutathione also reduces pigment production & has anti-aging properties.

What is polypodium extract?

Derived from fern leaves native to South America, Polypodium extract has been a prescribed by dermatologists for the last twenty years, particularly in treating conditions such as melasma and various pigmentation disorders.

This natural ingredient is widely regarded as a safe complement to medically prescribed pigment correctors, offering additional advantages such as photoprotection against UV, HEV blue light, and IR light. Typically administered orally in tablet form, Polypodium extract serves as an oral supplement, often preferred over topical creams due to its enhanced efficacy.

Studies have indicated the potential of Polypodium extract in diminishing melasma pigmentation, including its recurrence, showcasing promising outcomes in clinical settings.

What brand & dose of polypodium do we prescribe?

Polypodium dosage is is 7mg/kg, twice daily. 

The two best known brands are Fernblock & Heliocare. The dose is 480 mg twice daily.

How long can supplements be taken for?

There is no definitive timeline for supplementation. We suggest a trial of 5 months before assessing efficacy. If your skin responds to supplements, you can safely remain on this therapy for as long as you would like pigment to be supressed.

What about Fernblock sunscreens with polypodium?

Polypodium can also be used topically in a sunscreen. This extends the photoprotective role of sunscreens to the visible & IR spectrum as traditional ingredient only protect against UVB & UVA. We endorse Fernblock sunscreens as they have been shown to offer superior protection compared to sunscreens without antioxidants. 

*In practical terms, the higher cost of Fernblock sunscreens may outweigh their marginal benefits over mainstream sunscreens. Heliocare – Fernblock sunscreens are approximately double the cost of leading brands such as La Roche Posay. A 50ml tube should, ideally, last 10 days (2.5 ml application, twice a day. 5 ml daily, hence 50 ml will be finished in 10 days). This means you will be spending an extra $100 monthly on photoprotection, which equates to $1200 per annum. 

Our advice? Learn how to properly use sunscreens in the correct amount (2.5 to 5mls) & frequency (at least twice daily), before worrying about marginal gains with novel ingredients). Though scientifically & statistically significant, in real world applications their advantage may not be clinically significant, especially when 90% of patients underdose their sunscreen.

Can diet help?

Unlikely, however if you would like to try a diet high in antioxidants, you can consume the following-

• High protein pescetarian diet, namely high in fish & fish oil
• Legumes, nuts
• Leafy green vegetables
• Citrus fruits
• Green tea

Though a diet high in antioxidants have minimal impact on pigment, it can improve your cardiac risk factors. Small studies by Professor Adele Green’s group in Brisbane has shown that dietary antioxidants can potentially slow down photoaging.

Can a cream formulation of glutathione be useful?

2% glutathione cream has been shown to be useful in some case of melasma. The effects are marginal at best, with traditional pigment correctors having better outcomes. The advantage of glutathione cream is the high safety profile it has, in comparison to creams such as hydroquinone & cysteamine. 

Oral supplementations are better than creams, given the impartiality of full body application for skin lightening (one tube may last 1-2 days).

What about IV glutathione?

We did employ IV glutathione for a brief period a decade ago, however, do not offer it now because-

1. Results are short acting (1-2 weeks)
2. Repeated IV drips are required, every 1-2 weeks for life.
3. Costs are prohibitive, $900 per session, factor in once every 7 to 14 days, & the annual costs range from $24,000 to $48,000 annually. For life.
4. Side effects are higher with IV glutathione, namely gastrointestinal upset. 
5. Oral supplements are less than a dollar a day.

What are other natural remedies for melasma?

This may not be the best resource for ‘natural remedies’ as we base our treatments on science, not fluff. Natural treatments with the highest scientific value for pigmentation include-

• Azelaic acid
• Ascorbic acid
• Beta arbutin 
• Glycolic acid
• Salicylic acid
• Liquorice root extract, bearberry extract
• Fern extracts

The best formulations depend on the type of pigment.

What treatments can augment & amplify melasma supplements?

The three pillars of melasma treatment include-

Photoprotection: this will give you the biggest traction. Strict & absolute sun protection against UVB, UVA & HEV blue light is the foundation of treatment. 95% of melasma patients will not have this right. Read this website on how to, & what is the best sunscreen for your skin tone. 

Skin care: our clinicians will discuss the best pigment correctors based upon your pigmentation diagnosis & skin sensitivities. We tailor a mix of skin care ingredients such as retinol, retinoids, azelaic acid, ascorbic acid, arbutin, cysteamine, kojic acid, glycolic & lactic acids for each patient. 

Pigment removal with lasers or novel chemical peels. The latest generation of Pico lasers can markedly improve melasma within a few treatment sessions, whilst novel chemical peels can quickly, effectively & safely remove melasma pigment in most patients. The ideal peel type & laser program depends on your skin tone & pigment diagnosis.

Are supplements better than skincare?

In general, prescriptive skincare ingredients are better than oral supplements including polypodium & glutathione. Supplements, as the name suggest, is designed to supplement skin care, peels & lasers. Combination therapy provides the best outcomes.

What other pigmentary disorders can supplements be useful?

Supplements with polypodium & glutathione can potentially be helpful in other pigmentary disorders including-  

• Ashy dermatosis
• Lichen planus
• Drug eruptions (photosensitive)
• Endocrine pigmentary disorders
• Vitiligo

What other vitamins can treat melasma?

Apart from polypodium & glutathione, there are no other supplements that we recommend. Placebo however, maybe sought after by some patients. If this is the case, consider- 

• Vitamin C (as antioxidants) 
• Vitamin E & fish oil (antioxidants) 
• Green tea (taste good, acts as overall antioxidant for the body & skin)

*Antioxidant diet & supplements may also reduce the risk of coronary disease & in some cases actinic damage (Green A. et al publication).