Tri-Luma

TRI-LUMA cream is used to treat melasma. It contains a potent depigmenting agent, tretinoin & a corticosteroid preparation.  A retinoid is formulated with hydroquinone to amplify the results of individual ingredients whilst steroids reduce the skin irritation from tretinoin & hydroquinone. This cream is effective for melasma, however its use should not extend beyond 8 to 12 weeks.

Benefits

skin lightener

When to use

PM

Works with

Vitamin C

Caution with

Irritation

Treatment science score melasma clinic

What is Triluma?

Think of TriLuma as your melasma premix cocktail consisting of fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05%. 3 ingredients in the one convenient tube so you don’t need to guess how much of each ingredient to use.

what is triluma

What is it good for?

Disorders of pigmentation, especially melasma & post inflammatory hyperpigmentation. 

triluma for pigment and melasma

How to use it?

Start slowly, namely every other night. Increase application if there is no skin irritation.
Do not mix with other ingredients (initially). 

How long does it take before working?

TriLuma takes 3-4 weeks before seeing results. Most patients will achieve a 30% to 60% reduction in pigmentation. It remains as one of the most potent pigment inhibitors ever produced.

triluma results

How to reduce skin irritation from TriLuma?

Start 2-3 nights per week, increase as tolerated. Start with 1 ⁄ 2 pea size amount, dilute it in moisturizer, then reduce the moisturizer bit in the subsequent weeks. 

Tips

  • Moisturize after application
  • Do not exfoliate before
  • Be careful of combinations (refer below)
  • If you cannot tolerate this formulation you can try short contact therapy, namely apply for 15 minutes then wash off. Much akin to Cyspera. 
  • Consider stand-alone formulations of each active ingredient. It is much easier to titrate.

triluma

What happens if my melasma does not respond to Triluma?

Our specialists will discuss the use of other medications & employing physical therapies such as pico lasers or Cosmelan peels. 

What should not be mixed with TriLuma?

An easy rule to remember is no acids, bar azelaic acid. For advanced users, it goes something like this-

  • Low irritant potential: Azelaic acid, niacinamide, green tea, vitamin E.
  • High irritant potential: Glycolic, lactic, & salicylic acid, ascorbic acid (vitamin C), hydroquinone, kojic acid, retinoic acid. As TriLuma has a retinoid, be careful not to double up on things. 

can i use triluma

Can I apply TriLuma to other areas?

TriLuma can be applied to the neck, chest, & decollete areas. Neck areas are more sensitive compared to the face, so start slowly. TriLuma can also be used to treat pigmentation in other areas.

How long can I use TriLuma for?

Guides state 8 weeks, however new studies suggest up to & beyond 4-5 months. Some as long as 6. Be guided by your clinician as to the timings of rotational therapies. 

how long can i use triluma

What are the side effects of TriLuma?

The two most important (but rare) side effects are exogenous ochronosis (pigment getting worse), & tachyphylaxis (TriLuma stops working). Provided you follow the protocols beset upon your treating physician, these events are rare. 

Other side effects include-

  • Burning, redness, flaky skin
  • Irritated & sensitive skin
  • Allergy to medication

Can this be used in pregnancy?

TriLuma contains both hydroquinone & a generation one retinoid. Retinoids are not compatible with pregnancy. They have been shown to cause birth defects in rats at super high doses. 

Compatible pigment correctors include: niacinamide, ascorbic acid, azelaic acid, AHAs, flavonoids, & botanicals such as licorice root extract. Pregnancy associated melasma can be safely treated with glycolic acid peels & pico lasers.

Is TriLuma better than hydroquinone itself?

Yes and no. Yes, if you can tolerate it, no if you get skin irritation. More ingredients do not mean a better outcome. In our experience it is far easier titrating a retinoid with HQ, compared to a do it all formulation. 

Retinoids work in conjunction with tyrosinase inhibitors to reduce pigment output, however they also help repair sun damage (elastosis), increase epidermal turnover & potentiate absorption of hydroquinone.

TriLuma vs tretinoin, which is better?

Tretinoin can be used as a stand-alone treatment for melasma, however the efficacy is less than a mixture of HQ & tretinoin, hence in the context of pigment reducing, TriLuma is better. 

Tretinoin is used during the ‘off phase’ or maintenance phase of melasma management.

tretinoin vs triluma

Is Cysteamine or Cyspera as good as TriLuma?

It depends on the marketing material you read & the rigged research papers. Cyspera has a ‘hit’ rate of 77 to 90%, as marketed by the company (which is good at marketing). Conversely dermatologists know that TriLuma is better than Cyspera as a depigmenting agent, however Cyspera is useful as an agent during the maintenance phase of melasma. 

TriLuma vs tranexamic acid cream, which is better?

Answer: TriLuma, however t.acid serums are better tolerated. Tranexamic acid orally however is a different story. 

How do I recommence TriLuma after peels or lasers?

Be guided by your clinician as to the timing. Post pico lasers, you can recommence within 1-3 days. For chemical peels, it is recommended you wait 1-10 days, depending on the peeling agent.

YouTube video

Will my skin purge from TriLuma?

Possibly as this has a retinoid, but this is short lived. You can reduce the chances of purging by-

  • Slow titration of cream- apply twice a week, increase as tolerated
  • Dilution of cream ½ with moisturizer

Skin purging is short lived, 1-3 weeks, so hang tight.  

Where do I get a prescription?

You can source this online as it is not available in Australia. We can compound the same formulation if required. However, this is not our preferred pigment corrector for the reasons given above. 

*Pharmacies in India & Canada stock TriLuma. & or imitations of this product.

A Summary | Davin’s viewpoint on TriLuma for melasma & pigmentation

Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney

A useful topical for melasma & post inflammatory hyperpigmentation, Triluma is limited by skin irritancy, availability & costs. The combination of a topical retinoid with a highly irritating pigment corrector, whilst novel, does not make sense to me. Additionally, the use of a CS mixed with the above, again whilst novel, may lead to long term complications including skin thinning & or more commonly, perioral dermatitis.

My preferred combinations are stand alone, namely HQ, & a topical retinoid of choice. This allows the dermatologist to titrate the dosing application & treatment area. This means if skin irritation ensures, we can omit one of the actives (HQ or the retinoid). This enables the patient to build up tolerance over time.

We rotate TriLuma with other pigment correctors at the 3–4-month mark, depending on your clinical scenario.