After a noticeable hiatus, Galderma’s Tri-Luma® Cream is available in pharmacies once again. This may be good news for the seven million people with melasma, or brown to gray-brown patches of skin that typically appear on the face. Melasma is a result of over-prodction of the pigment melanin, which gives color to skin, hair, and eyes. Melasma is sometimes called the mask of pregnancy because it tends to occur with the rise of pregnancy-related hormones.
There are many other factors that may increase risk for melasma, including:
- Birth control pills
- Hormone therapy
- Anti-seizure drugs
- Sun exposure
- Family history
Triluma packs a one-two-three punch against melasma. It combines three active ingredients:
• Fluocinolone acetonide 0.01%, a mild corticosteroid that reduces inflammation.
• Hydroquinone 4%, the mother of all depigmenting agents that interrupts the formation and synthesis of melanin to help lighten the skin.
• Tretinoin 0.05%, which works to increase the skin cell turnover rate and exfoliate skin.
Triluma is available only by prescription for moderate-to-severe melasma of the face. It is recommended to be used for up to eight weeks only, and is not a free ride. Side effects may include redness, peeling, burning, dryness, and itching, and since it contains a steroid, prolonged use can have other risks. While some are doing a happy dance that Triluma is back, where has it been? Supplies started to dry up soon after a full recall in late August 2010 due to manufacturing deficits.
New York City dermatologist Joshua Zeichner, MD, explains: “Triluma was off the market for several years because of manufacturing issues. Its return puts a smile on dermatologists’ faces and will brighten the complexions of their patients’,” he says. “With three powerful ingredients packed into one cream, Triluma multitasks to address several causes of dark spots at the same time.”
What Else helps? More Melasma Treatment Options
Triluma is not the only game in town for melasma, and it can also work in concert with other therapies, Zeichner says.
Other options include fractionated lasers, chemical peels, Intense Pulsed Light (IPL) treatments and Silkpeel Dermal Infusion. According to most skincare pros, combo therapy is the master plan to attack melasma on all fronts. Camouflage makeup can also help cover melasma patches during or in lieu of any treatment, but that will only get you so far.
Other melasma dream creams—available only through physicians—include Lumixyl ($120), an alternative to harsh bleaching agents. Lumixyl is a non-irritating, synthetic peptide technology that has been clinically shown to significantly improve the appearance of skin discoloration. Developed by dermatological researchers at Stanford University, the key ingredient is Decapeptide-12, the only peptide shown to measurably aid the skin in restraining tyrosinase, the enzyme that causes overproduction of melanin that contributes to darkening.
Another award-winning melasma antidote is Elure Advanced Skin Brightening Lotion and Elure Advanced Brightening Night Cream ($135). The active ingredient in these products is called Melanozyme™, derived from a tree fungus, that gently yet speedily diminishes discoloration and corrects uneven skin tone by breaking up the melanin in the skin and restoring radiance to the complexion in 28 days.
“TriLuma is the gold standard for prescription products for skin lightening, agrees Omaha-Nebraska based dermatologist Joel Schlessinger MD, the president of LovelySkin.com. “The main drawback at this time is that it has to be refrigerated.” Additionally, it’s limited to an 8-week period of use, he says. “For this reason, there is the need for other methods after the use of TriLuma and that is where I see the main opportunities for products like Elure and Lumixyl,” he says. “Elure offers a ‘step-down’ approach and one that avoids 4% hydroquinone,” he says.
Another alternative hails from ZO Medical, whose Brightenex ($110) was developed for those who prefer to leave the hydroquinone in the pharmacy. Brightenex is a unique formula that uses a microsphere delivery system to target discoloration, and is recommended as a first course in treating hyperpigmentation. A powerhouse blend of retinol, melanin inhibitors, and antioxidants are released to brighten up skin tone quickly while minimizing redness and irritation.
Sun avoidance is the cornerstone for all melasma treatment protocols, says Schlessinger. “It is incredibly important for any individual who is using these products to practice sun avoidance and protection if they are out in the sun,” Schlessinger tells Beauty in the Bag. Makes sense.
“This means every exposure, whether it is a brief one such as going from the car to the store or longer exposures on vacation,” he says. “It goes without saying that no indoor tanning is acceptable and clothing, such as hats and sun protection garments, are essential to any program.”