Melasma: A Commentary

Abstract

Copyright: © 2015 Khatri KA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. One of my patients, a about 50 year old Hispanic female, with skin type IV, came to discuss treatment options of Melasma. After her skin evaluation, I recommended a TCA peel. She understood the risks and benefits and agreed to proceed with the peel. A 35% TCA peel was performed. She was also using bleaching creams and sunblock. When I saw her for a one month follow up, I was surprised to see that her Melasma was gone and she was very pleased. She came back three years later with Melasma again. She insisted that she wants the “same” treatment as three years ago. I performed another 35% TCA peel. This time when she came back for one month follow up, her melasma was worse than before the peel. I advised her to use TriLuma cream. Her one month follow up showed no improvement. I advised her to continue TriLuma for few more weeks. When she came back for her follow up this time, her Melasma has cleared 90%. I was very pleased but she told me that TriLuma didn’t work and she has been using a Chinese bleaching cream that she found at a Flea market. She showed be the box of the cream but everything was written in Chinese and I could not figure out the ingredients. Few months later while I was on a flight, I asked a fellow passenger sitting next to me who was reading a Chinese newspaper, to read the writings on the box. She told me that there are no ingredients listed but it only shows where this cream was produced. I did some more research to find out the ingredients but failed. I assume it had Mercury.