Prescription FAQs

Is tretinoin / retinol good for pigmentation?

Tretinoin or retinol are retinoid creams. They are frequently used as a pigment corrector in many different types of creams. They are useful in the rotational phase of pigment fading & range in concentration between 0.05% to 0.5%. The ideal formulation depends on your type of pigment & your skin sensitivity. Here are some facts-

• Best used to maintain pigment clearance
• Better creams for pigment include ascorbic & kojic acid
• Retinol is best combined with other active ingredients
• Tretinoin can be pre-mixed with hydroquinone; ie. TriLuma 

The Melasma Clinic stocks a range of retinols, for recommendations, book a consultation with our team in Brisbane or Sydney. 

Is bakuchiol good for melasma pigmentation?

It’s marginally better than nothing, but its efficacy is pale in comparison to pigment correctors such as arbutin, ascorbic acid, azelaic acid, botanical, HQ & others. If you are into fluffy trends, consider bakuchiol, if you are serious about treating melasma & pigmentation, consider better alternatives. 

Is niacinamide good for melasma / pigmentation?

It is better than nothing, however there are many better alternatives including vitamin C, arbutin, kojic acid, & azelaic acid. 

Niacinamide is best used with other pigment inhibitors & not as a stand alone treatment.  

Is vitamin C / ascorbic acid good for pigmentation and melasma?

Vitamin C rates as one of the better pigment inhibitors as it reduces pigment production by enzyme blockage & it is an antioxidant. It is best used in the morning as vitamin C levels in your epidermis (top part of the skin) remain high for up to 72 hours. 

The best formulations contain L-ascorbic acid. The best concentrations range from 10 to 30%. Though useful as a pigment corrector, it is not that effective as a stand alone treatment for melasma. 

How do I get a prescription for tretinoin?

Tretinoin, also known as Retrieve or Stieva A, is prescribed by a doctor or dermatologist. Your treating clinician will provide you with a prescription based on your condition. Repeat tretinoin prescriptions are provided at the discretion of your treating doctor.

How do I get a prescription for hydroquinone?

Hydroquinone is prescribed by a doctor or dermatologist. Your treating clinician will provide you with a prescription based on your condition. Repeat hydroquinone prescriptions are provided at the discretion of your treating doctor. 

How do I get a prescription for tranexamic acid?

Tranexamic acid orally – tablets require a prescription by a doctor or dermatologist. Your treating clinician will provide you with a prescription based on your condition. Repeat tranexamic acid prescriptions are provided at the discretion of your treating doctor. 

Topical tranexamic acid serum or creams do not require a prescription. 

How long can I be on hydroquinone?

Hydroquinone can not be used long term. Your duration will be determined by your treating physician. This depends on your skin condition, skin color, strength of hydroquinone & phase of pigmentation treatment. 

As a guide, hydroquinone use ranges from 2 weeks to 6 months. 

How long does hydroquinone last for?

Hydroquinone has a variable expiration date as it is prone to degradation, especially to light & heat; hence the expiration date.  

Hint: ignore this date (as it is a legal requirement in Australia to have this). Base the activity of hydroquinone on the color. If it is brown, it is expired, if it is white – cream, it is good. Store or keep your hydroquinone in a fridge for maximal shelf life.

Is Hydroquinone safe?

Hydroquinone has a good safety record if used correctly & under guidance. The most common side effects of hydroquinone are-

1. Irritant contact dermatitis
2. Tachyphylaxis (stops working)
3. Exogenous ochronosis (paradoxical pigment)

Your treating physician will guide you through the use & rotation of HQ. Hydroquinone can not be used if you are pregnant, however it can be used with guidance if you are breastfeeding.

How do I get a repeat prescription?

Your treating clinician will provide you with a repeat prescription based on your condition & discretion of your doctor. 

Repeat tretinoin prescriptions are provided at the discretion of your treating doctor, alternatively you can get your GP to prescribe this. Repeat hydroquinone prescriptions are provided at the discretion of your treating doctor. 

How do I get a new prescription if I lose it?

Lost prescriptions reissue will be provided at the discretion of your treating clinicians. As a guide you will monitor your prescriptions in our data system to see the maximal duration of treatment. 

Lost prescriptions of tretinoin can be issued by a general practitioner. Lost prescriptions for hydroquinone and or tranexamic acid will require a review of your clinical records. 

Can my GP issue repeat prescriptions?

Yes, but it is at the discretion of your treating practitioner. Most GPs will re-issue scripts for topical vitamin A such as tretinoin. Medications such as hydroquinone & tranexamic acid, are more complex as they are often used at intervals. 

+Is prescription skin care better than over the counter?

Yes, but it depends on the context. As a guide, prescriptive retinoids, hydroquinone, and tranexamic acid are more potent compared to non-prescriptive medications. 

How do I store Hydroquinone?

In a fridge away from light & heat. This will prolong the shelf life of this cream. Though our HQ has a labeled shelf life, this is only used as a guide. 

A better guide is to look at the color of the cream. It should be white to cream coloured. If it has turned brown, it has oxidized & you will require another prescription. 

How do I apply hydroquinone?

Application depends on a). Your skin sensitivities b). The concentration of hydroquinone & c). Added ingredients with hydroquinone (HQ) (eg. tretinoin, steroid). There are two ways to use it, 

1. Apply a small amount every alternate night, increase as tolerated. Only apply to dark areas (eg. melasma prone areas of the cheeks, forehead, upper lip). 
2. Short contact, apply nightly, leave on for 20 minutes, wash off, increase application time by 15 minutes every week. Once you can tolerate 90 minutes of application without irritation, you can leave it on overnight. 

Your treating clinician will guide you through the application process, start date & importantly stop date. Our protocols are set in stone. 

Hydroquinone and tretinoin mix, is it good or effective?

This combination can be useful in the management of melasma pigmentation, however the rate limiting aspect is skin irritation, from both hydroquinone & tretinoin. Here is the solution-

1. Use both formulations individually, ie. HQ as a standalone, similarly with tretinoin .
2. Start with HQ as titrated; small amount, apply 3 nights a week, increase as tolerated.
3. Do this for 4-8 weeks before introducing tretinoin. 
4. Start tretinoin 3 nights per week, increase as tolerated. You can mix this with HQ.
5. Titrate accordingly (common sense). 
6. The above constitutes the depigmentation phase of melasma / pigment reduction. 
7. From there your allocated clinician will guide you through the off cycle, during which you use tretinoin as a stand alone (without HQ). 

Tretinoin & high strength hydroquinone are scripted items, you do require a consultation with a clinician. 

What can I mix / go well with hydroquinone?

Unless you are an expert in skin care (beyond Reddit or Google searches/Blogs), the default answer is no. We don’t want you to throw away your skin care, just put it aside during your pigmentation treatments by us. 

Your treating nurse or dermal therapist will advise you on when & what to add to your routine. The real answer is that mixing another skin care ingredient with hydroquinone is possible, however it largely depends on –

• The concentration of hydroquinone you are applying
• The active ingredient you want to mix
• Your skin sensitivity
• How you do it & your ability to understand skin irritation & how to deal with it

A simple mix is retinol or a retinoid with hydroquinone as tolerated & titrated. Do this 4 weeks after tolerating HQ nightly. If you can not tolerate HQ, don’t mix. 

*Your treating therapist will guide you through the timings & active ingredients based on the factors above. 

Does hydroquinone cause cancer?

The safety profile of hydroquinone, a widely employed agent for skin lightening, has been subject to scrutiny due to potential carcinogenicity (cancer) concerns. While hydroquinone demonstrates efficacy in managing hyperpigmentation disorders like melasma & post inflammatory hyperpigmentation, its utilization has been associated with regulatory restrictions in various nations owing to safety apprehensions. Hydroquinone is obtainable over-the-counter in concentrations up to 2%, with higher strengths accessible via prescription.

Research findings on the carcinogenic potential of hydroquinone have been inconclusive, with some investigations indicating a plausible linkage between hydroquinone exposure and certain skin cancer, while others fail to establish a significant association. The apprehension stems from hydroquinone’s metabolic conversion to benzoquinone. This compound may increase the rate of cancers in animal models

Given these concerns, judicious use of hydroquinone under professional supervision is recommended. Recommendations include limiting its duration of use to short-term periods, typically no more than 5-6 months, as prolonged or excessive application heightens the risk of adverse effects. Concurrent use of sunscreens is advocated to counteract heightened photosensitivity induced by hydroquinone, namely as pigment reduces, the protective mechanisms of UV attenuation is diminished. This point however, is mute, as melasma patients will undoubtedly apply copious amounts of sunscreens.  

The ASDS association in the US has come up with this statement, which is current as of 2024. There have been no reported incidences of cancer from topical application of hydroquinone in humans. Though health concerns are related to oral ingestion of hydroquinone, concerns over topical toxicity and carcinogenesis have been raised but not validated when the product is used correctly as directed under the supervision of an appropriately trained, licensed physician.

HQ alternatives can be prescribed if you are concerned by your own research. Fluffy natural or organic ingredients include azelaic acid, ascorbic acid (vitamin C), licorice root, bearberry extracts & niacinamide. Whilst they can be useful in the maintenance phase of melasma, these ingredients provide marginal benefits in the de-pigmentation phase. If HQ is not used as part of your INITIAL melasma treatment plan, the chances of treatments working falls dramatically. 

The most important safety aspect of hydroquinone is the duration of treatment. As a guide you can use it for a period of up to 3-6 months. The exact duration will be discussed by your skincare expert as they take into account; 

• Concentration of HQ
• Cycle or phase of depigmentation/ maintenance
• Other pigment correctors that you may be using
• Adjunctive prescribed medications
• Laser settings

Can I mix vitamin C with hydroquinone?

Best not to mix both vitamin C & hydroquinone as both can be irritating to skin. However there are exceptions- 

1. Use vitamin C in the morning. You can start titrating vitamin C after 2-4 weeks of HQ use at night. 
2. In some cases we add vitamin C in your HQ to stabilize the latter. The concentration added will not cause skin irritation. 

 

Can I use hydroquinone if I have sensitive skin?

HQ is not contraindicated if you have sensitive skin, providing you give it some thought. Here is how to use it-

1. Use a tiny amount of HQ, for example ½ pea size amount, dilute with your moisturizer. Apply 2-3 nights a week & modulate the application based on your skin irritation. 
2. Try short contact HQ. Apply for 15 minutes, then wash off. Increase by 15 minutes ‘on’ application daily. If you can tolerate 90 minutes, try leaving it on overnight. Start slowly, & use common sense. If you get irritation even if you leave it on for 15 minutes, leave it on for 10 minutes, then increase as tolerated. Hydroquinone application is not a race, some can tolerate only 2 to 3 nights per week, others nightly, & some twice a day application. Everyone is different. 

*If you are using other skin care products such as AHA, retinol, retinoids, & acids, we suggest reducing the ones that do not contribute to your skin care goals. 

If you think you have an allergic reaction, ask this AI bot how to differentiate between allergies & irritant reactions- we have programmed this in as well. If you can not find the answers, speak with your allocated nurse or dermal clinician. 

What is Triluma & how good is it?

TriLuma ranks as one of the most overrated & downright silly prescriptions out there. Hear me out (Dr Davin Lim programmed this) !!! 

Firstly, HQ or hydroquinone is highly irritating. Why combine tretinoin if this is the case? Sure, prescribe a steroid to counteract the process (suppress melanocytes my ASS).  It is far better to use a stand alone formation of HQ & tretinoin & titrate accordingly. This means you can use HQ more often (which is good), & if your skin tolerates it, add tretinoin. If you are using TriLuma & you have skin irritation, you’re in a compromised situation because you can’t stop one ingredient & continue with the other. It is called a marketing exercise. 

Where can I get TriLuma?

Google search TriLuma. You can get this from India or Canada online. Alternatively, if you know someone overseas you can obtain a prescription. 

Compounded equivalents of TriLuma can be obtained from Australia if you search hard enough. Our clinicians MAY prescribe this, providing your condition is appropriate. 

How do I know if I am allergic to hydroquinone?

Conduct a test spot or ROAT (repeat open application test). Apply a small amount of hydroquinone on your inner arm or behind your ear. If you react, you most likely will have an allergic reaction (even to the very smallest amounts). 

A patch test by a medical dermatologist can determine if you are truly allergic to hydroquinone. Irritant reactions are super common, allergic reactions are much rarer – less than 1%.

Irritant reactions means that you can potentially use hydroquinone, allergic reactions means that you can not. 

How do I deal with skin irritation from hydroquinone – Triluma or what happens if I am sensitive to hydroquinone?

Just about everyone will be sensitive to hydroquinone, so you’re not unique. It depends on the concentration of hydroquinone and how sensitive your skin is. Here is how to deal with it-

Option one (preferred). Use less, use less frequently. 

•     Apply half the normal amount you would apply, mix with any plain moisturizer. 
•     Apply every second night. 
•     Slowly increase to 4-5 nights per week as tolerated.
•     Use more HQ as time goes by (as tolerated)
•     Use less HQ if you experience skin irritation. 
•     If you still cannot tolerate a small amount, go to option two (below).

Option two (less preferred), short contact therapy. 

•     Leave on for 15 minutes, then wash off. 
•     Add an extra 5 minutes per day as tolerated, then wash off. 
•     Build up to a maximum of 45 minutes application daily or longer if tolerated.

Hydroquinone application is not a race, some can tolerate only 2 to 3 nights per week, others nightly, & some twice a day application. Everyone is different. Use common sense, find the medium between application amount & frequency versus that of skin irritation.

*If you are using other skin care products such as AHA, retinol, retinoids, & acids, we suggest reducing the ones that do not contribute to your skin care goals. 

**If you think you have an allergic reaction, ask the bot how to differentiate between allergies & irritant reactions- we have programmed this in as well, acknowledging that in 95% of cases it is an irritant & not an allergic reaction.

What is the best hydroquinone to use?

It depends on your skin condition (melasma vs other types of pigmentation), your innate skin sensitivity (the most important factor), your current skin care routine & your phase of melasma treatment. In general compounded HQ is best as this is a bespoke formulation suited for YOU.

• HQ concentrations range from 2% to 10%.
• Vitamin C is added in concentrations ranging from 0.3% to 2%
• Tretinoin can be added in ranges from 0.02 to 0.2%
• Topical steroids can also be added to the mix. 

Our clinicians will guide you accordingly. 

What are alternatives to hydroquinone?

There are numerous alternatives to hydroquinone, ranked in no particular order-

• Ascorbic acid or vitamin C (10-20%)
• Azelaic acid (15-20%)
• Arbutin (0.5 to 2%)
• Licorice root 
• AHA such as glycolic or lactic acid
• Retinol & retinoids
• Niacinamide
• Kojic acid
• Green tea
• Cysteamine 

The ideal combination of ingredients depends on the type of pigment you are wanting to treat, depth of pigment, your skin color & importantly your skin sensitivity.

How long can I use hydroquinone?

It depends on your application & concentration. Short answer; up to 3-6 months. The exact duration will be discussed by your treating physician/clinician. We take into consideration-

• Concentration
• Cycle or phase of depigmentation/ maintenance
• Your pigment diagnosis
• Other pigment correctors that you may be using
• Adjunctive prescribed medications
• Laser settings

Where can I buy/get hydroquinone?

HQ can be purchased over the counter as Superfade 2%. Higher strengths require a prescription. 

Prior to the use of HQ, you should be aware of the potential side effects, application guidelines as well as duration of use- cycling of this cream. Search this site for more information. 

Can I get hydroquinone from any doctor / my GP?

Yes, however the formulation may differ. Hydroquinone is compounded. A compounded solution is exactly the same as a food recipe, namely there are raw ingredients that are required (think of an omelet, eggs = hydroquinone). The end result of the omelet is highly dependent on the cook.   

We vary the concentration of hydroquinone depending on the patient (number of eggs in the omelet), additionally we may add other ingredients such as additives to prolong the shelf life (antioxidants), ingredients to reduce skin irritation (anti-inflammatory), as well as additives to increase the penetration of various skincare actives. In some cases we add a vitamin A derivative like retinol or a prescription retinoid.  

Is Superfade good?

It is better than nothing. Superfade contains 2% hydroquinone & a mix of salicylic acid. It can fade melasma pigment ever so slightly & can be purchased over the counter. 

Does azelaic acid require a prescription?

You can buy 10-20% azelaic acid over the counter. Examples include Azclear & Paula’s choice. 

Whilst useful as a home remedy, there are far better pigment correctors out there. 

What is the best azelaic acid brand?

We don’t have a favorite brand of azelaic acid. Good brands include Azclear & Paula’s choice. Whilst azelaic acid can be useful for pigment, our clinicians prefer bespoke pigment correctors that are tailor made for patients. 

How do I start azelaic acid?

GIven the low irritancy of azelaic acid, you can use it nightly. Use a pea size amount, apply after a bath – shower – face wash. Apply to the pigmented areas, extending beyond the borders of pigment. You can use it on the whole face, but in the context of pigmentation, this is not necessary. 

You can use it up to twice a day. Duration can be indefinite. If you have any skin irritation, use less, & or less frequently. 

Do I apply azelaic acid to only the pigment or whole face?

Apply to the pigmented areas, extending beyond the borders of pigment. You can use it on the whole face, but in the context of pigmentation, this is not necessary. 

For melasma patients, use it to the pigment areas only. For prevention of post inflammatory hyperpigmentation, apply it to the treated areas. 

How long can I use azelaic acid for?

This is a safe medication, you can use it indefinitely, or as directed by your clinician. It is safe in pregnancy. 

When do I use azelaic acid?

You can use it in the morning or in the evening, or both times. We prefer evening use (PM). 

Are there any side effects of azelaic acid?

Azelaic acid is well tolerated with little to no side effects. It is the ingredient of choice if you have rosacea, acne, sensitive skin or dermatitis. Having said that, you should exert common sense with application. If you develop any irritation, reduce application amount & or frequency. All skin care products should be used as tolerated. 

Can azelaic acid be mixed with retinol or vitamin C or other skin care ingredients?

For beginners who do not understand their skin’s irritant threshold, the answer is no. For more experienced users, you can titrate other skin care ingredients with azelaic acid. Here is a simple tip. 

Start mixing a small amount of azelaic acid with your chosen product two to three times a week. Apply to the affected area/s. Increase your application frequency & amount as tolerated. 

*Pharmacological interactions may occur with some combinations. For further clarification, contact the parent skin care company for more information. The combinations are too complex for us to program this AI bot to answer. 

Azelaic acid doesn’t work, what can I use?

Azelaic acid, in the scheme of pigment correctors, is weak. We use it in two situations. 

1. Prevention or mitigation of post inflammatory hyperpigmentation following procedures. Mitigation can not be seen (by definition). Hence in this role, if pigment is either prevented or reduced in severity, azelaic acid has done its job.
2. Rotational therapy for melasma. In this context if azelaic acid has prevented pigment from returning back, the job is done. 

There are far more active ingredients that we employ, namely arbutin, kojic acid, ascorbic acid, & prescription topicals. Book a real time consultation with our clinical team for pigment diagnosis & a management plan. 

Is azelaic acid safe in pregnancy or breastfeeding?

Azelaic acid is safe in pregnancy & compatible with breastfeeding. It is classified as category A. 

Safe ingredients include: vitamin C or ascorbic acid, vitamin E, licorice root extract, bearberry, novel formulations such as Meladerm, niacinamide. Additionally alpha hydroxy acids such as lactic or glycolic acids are safe. 

Ingredients that should not be used in pregnancy include: retinol, retinoids, hydroquinone & high strength (>1.5/2%) salicylic acid. Check with your pharmacist as to what is compatible with pregnancy .

Is MelaB3 good for treating melasma & or pigmentation?

Mela130 is an over the counter pigment corrector made by La Roche Posay. It is a cost effective over the counter serum readily available in pharmacies in Australia. The key ingredients include –

• Melasyl – a pigment corrector that blocks pigment formation at a cellular level
• Niacinamide or Vitamin B3 at 10%
• Retinyl palmitate
• Hyaluronic acid 
• Cystoseira tamariscifolia: is a novel seaweed extract that can help strengthen skin.

La Roche Posay claims that MelaB3 is more effective than vitamin C (at 7%), hydroquinone at 4%, Tranexamic acid at 1% & kojic acid at 1%. Search the A-Z section of this website for the full list of ingredients & what we really think of MelaB3.

The recommended retail price is $79.95 & can be purchased online or at Chemist Warehouse. 

*The Sydney & Brisbane clinics do not stock MelaB3 as this is an entry level topical. Our clinic customizes skincare ingredients based upon your skin type, sensitivities, type of pigmentation & skin age. 

Is polypodium effective in melasma?

Polypodium leucotomos extract or PLE has been shown to be effective in the management of melasma, however the overall effects are modest at best. Our specialists prescribe polypodium as adjunctive therapy. 

Polypodium leucotomos extract has antioxidant, photoprotective & anti-inflammatory effects, which could potentially lighten melasma. 

What is the best vitamin C serum / brand to use?

Recommended brands are Obagi, Medik8, Synergie, & SkinCeuticals. Just avoid The Ordinary 23% vitamin C, it is less than ordinary. 

Can I add vitamin C to my current skincare routine?

In most cases, yes. Here is how to do it-

1. Start with a good formulation of vitamin C 10-15% serum. Obagi, Medik8, SkinCeuticals, Zo Skin are a few good brands. 
2. Apply in the AM before sunscreen. Start slowly, namely 2-3 mornings a week, increase as tolerated.

*Be extremely careful if you are using tretinoin, hydroquinone or if you have sensitive skin. Be guided by your treating clinician at The Melasma Clinic. 

Is Superfade a good cream?

It is better than nothing. Superfade contains hydroquinone & salicylic acid in low concentrations. It is over the counter. Best used for mild cases of pigmentation.  

Can retinol treat pigmentation?

Retinol & retinoids such as tretinoin, Retrieve or Stieva A can be effective in treating pigmentation, however there are much better options. Though retinoids have an effect on the pigment producing cells (melanocytes), their action is weak. 

Our physicians will provide you with far better options, acknowledging that retinoids play a role in the maintenance of melasma. 

How to add retinol, tretinoin or a retinoid to my skin care routine?

This should only be attempted if you understand your skin’s irritation threshold, namely how sensitive your skin is to addition of ingredients & how to pull back on topicals if you develop any irritation. We suggest you stick with your primary ingredient for at least 4-8 weeks before adding retinol or retinoids. 

Here is an in depth guide-

1. Exert common sense. Don’t attempt this if you have rosacea or sensitive skin. Chances are you will flare up your skin. 
2. Start every second night, ½ pea size amount of retinol or retinoid with your main ingredient. 
3. Increase the frequency of use first (add an extra night every week). 
4. Then increase the amount (usually over 2-3 months). 
5. Reduce amount & frequency if you develop any skin irritation, ie. redness, scale, burning, stinging, rash etc. 

What is the best retinol or retinoid brand?

Be guided by your clinician. It depends on many factors including your type of pigmentation, your skin’s sensitivity & current topical – ingredient use. 

Prescription retinoids are better than retinol, however they are tricky to use, especially if you are on pigment correctors such as ascorbic acid, hydroquinone or cysteamine. Speak to your allocated laser technician as to the timing of introduction. We will generally introduce you to other ingredients at session 2-4 of your laser program (not sooner). 

Can I use vitamin C with retinol or retinoids?

For the average beginner, no, but for experts, maybe. If you understand your skin’s threshold for skin irritation, you can gradually add retinol or retinoids to your routine. 

Here is a quick hack for better pigment removal –

AM: Vitamin C (with or without vitamin E, ferulic acid)

PM: Retinol 

*In the context of melasma pigment, there are far better options than retinol. Our clinicians at The Melasma Clinic will prescribe you optimal skin care based upon your skin sensitivities & pigment type, often combined with lasers & peels for superior results.

Is Cysteamine or Cyspera any good?

Cyspera or Cysteamine can be used to treat melasma pigmentation. It is most useful during the maintenance phase of melasma, however we do prescribe it in patients who are intolerant to other pigment correctors. The upside of Cyspera is that it can be used long term.

*Cyspera can also be used to treat post inflammatory hyperpigmentation & dark acne marks. It is best used in conjunction with pigment lasers.

How to apply Cysteamine?

Cyspera & cysteamine application can be tricky, however if you exert some common sense it is uneventful  There are two application cycles, phases and this will affect the number of applications. 

• Intense Phase – During this phase apply Cyspera once per day for 3 to 4 months
• Maintenance Phase – Once you hit your maintenance phase, you will only need to apply your cream once a day only two times a week. Optimal results are typically seen around 8 to 12 weeks of use. 

Cyspera is best used in the rotational phase of melasma therapy, our clinical team can guide you as to the timing. This how to use the cream-

• You will want to apply your cream to dry, non-washed skin. Only apply to areas of hyperpigmentation.
• Apply a thin layer. You may feel a warm sensation or tingling for up to 20 minutes. Leave the cream on for 15 minutes then wash off. 
• Remove the cream by washing the area with a gentle cleanser, pat dry.
• End by moisturizing the area as this maintains skin hydration & barrier function. 
• Here is the common sense bit- if you can tolerate Cyspera, leave it on for longer, if you can not, remove it before the 15 minutes is up.

What are the side effects of Cyspera or Cysteamine?

Side effects are common with Cyspera, hence the short contact application time of 15 minutes. Modify application time based upon your skin sensitivities. Side effects include-

• Warmth, tingling, & redness that should clear up within 20 to 30 minutes.
• Possible skin irritation & peeling skin, with prolonged redness.

Side effects are not an issue if you exert common sense. Our clinicians will guide you accordingly.  Cyspera has removed the smell of sulfur, which commonly occurs with compounded cysteamine creams. 

Where can I get Cyspera?

The Melasma Clinic can assist in procurement of Cyspera (it will be undergoing importation review in 2024-2025). For now, it can be intermittently sourced by us, alternatively visit the Cyspera website for stockists internationally. 

Is Cyspera better than Hydroquinone?

It depends on the papers you read. The company that is behind Cyspera says yes, however real world application is no. The advantage of Cyspera-cysteamine over hydroquinone is that the former has no long term side effects (such as tachyphylaxis- rebound or paradoxical darkening of melasma pigment – ochronosis). 

Our clinicians may prescribe this topical to you during the rotational phase of melasma. The maintenance phase is when you are taken off specific pigment correctors & weaned off lasers. 

Is MelaB3 any good/effective?

MelaB3 is an over the counter commercial pigment corrector that can (according to La Roche Posay); 

• Treat skin discolorations, including sunspots, age spots, post-acne marks (or post-inflammatory hyperpigmentation)
• Has the potential to reduce melasma pigmentation
• Improve skin luminosity to reveal brighter skin
• Works with in 2 weeks

It has 2 active ingredients, namely Melasyl™: a novel ingredient that visibly reduces dark marks & skin pigmentation. Niacinamide: A form of vitamin B3, niacinamide is a skin vitamin employed  in dermatology. It is anti-inflammatory & has very weak pigment suppression. 

We occasionally prescribe MelaB3 during the maintenance phase of melasma. There are far better pigment correctors on the market as compared to MelaB3. 

Do I need to wear sunscreen if I am indoors / if I don’t go outside?

Yes, here is the reason. Firstly, unless you are in Covid isolation, most people venture outside for daily living. Examples include hanging clothes, going to the shops, & going to the letter box. These are normal duties that normal people do. Most of these activities are not planned in advance. Secondly, if you can see light (outside), you are getting UV & visible light radiation. 

Secondly, if we are treating melasma, every single bit of light & radiation counts, hence the simple solution is twice a day sunscreen. It takes you 10 seconds to apply, which is one quarter the time it took to explain this. Just do it. 

How to know if I am allergic to sunscreen?

Sunscreen allergies are super rare, however skin irritation is much more common, especially if you suffer from rosacea or dermatitis. Here is how to sort it out-

1. Use only physical blockers (eg. Invisible Zinc). Look for zinc oxide or titanium dioxide. 
2. Undertake a test patch. Apply a small amount of sunscreen in front of your ear on one side. See if you react to this before a full face application. 

If you still have ‘allergies’ to sunscreen, visit a medical dermatologist for allergy patch testing & or photopatch testing. In Sydney, visit the Skin Hospital in Darlinghurst or at Westmead. Brisbane patients can be reviewed by medical dermatologists at Cutis Dermatology. 

*Dr Davin Lim is a procedural dermatologist. He does not manage skin rashes or allergies. 

Which is better, zinc oxide or titanium dioxide?

Both are good, however titanium dioxide as pigmentary grade has the edge as it can attenuate visible light, which is important for treating melasma. Most people will not be impressed or compliant with pigmentary grade titanium dioxide as it leaves an unacceptable white sheen. 

If you are serious about pigmentation, here are our hints-

1. Don’t worry-care about ingredients, just look for SPF 50.
2. Ideally a tinted sunscreen in your skin shade, if not augment with mineral make up. 
3. Use the correct amount, ie. 2 finger lengths or one teaspoon. 
4. Reapply, ideally every 2-3 hours, practically at least twice a day

Do I need to use sunscreen with zinc or titanium dioxide?

No, just as long as you protect against UVB (easy), longwave UVA (harder) & VL or HEV blue light. You can use organic sunscreens or ‘chemical sunscreens’ that are SPF 30 or above, providing you use the correct amount of sunscreen, namely 2 finger lengths or one teaspoon. 

For VL protection you only have two choices, firstly iron oxide (inactive ingredients in tinted sunscreen or via mineral make-up), or pigmentary titanium dioxide.

Can I use BB cream instead of sunscreen?

Yes, providing the SPF has a minimum of 30, & you use the correct amount, namely 2 finger lengths or one teaspoon. The amount of sun protection depends on the application amount, ie. 2 mg/cm squared. For BB cream it is hard to do as the texture is not the best (though the color match may be better). 

Are nanoparticles in sunscreen unsafe?

There is no evidence that nanoparticles due to zinc oxide or titanium dioxide are unsafe or cause cancer. There is limited evidence of their accumulation in the reticuloendothelial system. The same applies to aluminum found in aluminum cans and the risks associated with Alzhimers. 

If, according to your research, you would like to avoid nanoparticles, you can opt for organic sunscreens or chemical sunscreens that offer higher levels of UVB, UVA protection as well as tinted ones with iron oxide to protect against VL or HEV blue light. If you want to avoid sunscreens all together, you do have the option of going around with a mud mask as this has a very high level of photoprotection. Obviously cosmesis is going to be a problem. 

How to treat melasma naturally?

If you are after natural treatments, you are probably on the wrong website as we approach melasma clinically. There is a vast difference between natural vs clinical as the latter is evidence based medicine & the former is warm & fuzzy. 

For natural treatments, consider-

1. Sunscreen & sun avoidance. If you don’t like the idea of chemicals in sunscreen, use a thick layer of MUD instead. It works, but it may be impractical for everyday use.
2. Try azelaic acid 10-20%. This compound is derived from wheat & rye. 
3. Add vitamin C 10-20% in the morning. 
4. Add lasers (lasers are concentrated beams of light, you can not get more natural than that). 

With these fuzzy treatments, you have a 10-30% chance of fading melasma. With prescribed medical therapy, your chances go up to above 80%. 

For more on natural remedies, consult a naturopathic or holistic healer – skin whisperer over a dermatologist. 

Can I take something internally to help with melasma?

The best hope to date is podophyllum supplementation; twice a day for 12 weeks along with sunscreen. The results are weak, however given the banal nature of plant based supplements, & the low costs, the worst thing that could happen is a placebo option can make you feel better & more positive about your skin. You can shop for podophyllum online, we do not prescribe this compound in our clinics, except as an adjunct in some sunscreens (inactive agent). 

If you are serious about melasma & pigmentation, consult a dermatologist. If you would like to give natural remedies a go, consult a naturopathic practitioner to prescribe you some herbs, berries, vitamins & a smoothie. 

Are there any tests for melasma?

In 98% of cases, melasma can be diagnosed clinically, namely no tests are required apart from a physical exam. 

If you fall into the category of ‘special cases’, a skin biopsy may be required to distinguish melasma from other causes of pigmentation such as Ashy dermatosis, atypical acanthosis nigricans, drug induced pigmentation & others. A dermatologist is involved if this is the case. If your condition is non-procedural (not amenable to lasers), Dr Davin Lim will refer you to a medical dermatologist at The Skin Hospital, Darlinghurst for management. 

Some of the other methods we use to ascertain clinical features include- 

-Dermatoscopic examination to understand the depth & vasculature of melasma. 

-Woods light to teach the traditional techniques to students. 

-Histology, to exclude ochronosis & other causes of pigmentation. 

-Blood tests to look for endocrine dysfunction, eg. thyroid disorders. 

-Skin allergy testing/patch testing to exclude allergies. 

Can skin allergies cause melasma?

No, however in a minority of cases contact dermatitis may mimic melasma or more commonly be associated with melasma.  When we refer to ‘minority’ it means it is very rare. Here is the explanation-

1. Irritant contact dermatitis can occur de novo (usually due to the amount of creams you are using, occasionally occupational exposure). The pattern may mimic melasma. 
2. Irritant contact dermatitis overlays melasma (more common) as you are super sensitive to products like tretinoin & hydroquinone. 
3. Allergic reactions de novo (as above). 
4. Allergic reactions to topicals in melasma patients (rare). The allergies include chemicals in your cream (preservatives, propylene glycol, CS (rare), HQ (rare).

We have programmed this BOT to help you decipher between allergic reactions & irritant reactions & how to troubleshoot, so ask away. The algorithm is very specific. 

* If you are a patient of this clinic our clinicians can guide you. If you are seeing another clinic, let them guide you accordingly. We do not give advice to non-clinic patients. Additionally though our dermatologists are trained to diagnose & manage skin allergies, it is beyond our interest. Patients are referred to medical dermatologists at the Skin Hospital in Darlinghurst.