Prescription treatments take about four to six months to work, natural agents may take longer. However, natural depigmenting agents won’t have any side effects or absorption issues, which is especially important if the patient is pregnant.
Azelaic acid, a naturally occurring hydroxyl carboxylic acid (not a phenol), can also be used. “The products Finacea and Azelex are azelaic acids. It is a little slower in depigmenting, but safer,” she says.
Lemon juice, grapefruit juice, papaya or kiwi juice can be used as natural depigmenting agents. “All you have to do is squeeze juice out of any of these fruits and apply as a compress for 20 minutes to the site every day, and that is a slower acting, natural depigmenting agent,” she says.
While using these products, patients never want to go out in the sun, because they will get phytophotodermatitis. “If a person has the resin from lemons or limes on the skin and then are exposed to the sun, there is a phototoxic reaction,” she says.
Dermatologists also can recommend the natural agent licorice (topical glabridin). “Another depigmenting agent is called Arbutin. It is similar to hydroquinone, but it is from plants.,” she says.
Kojic acid is a commonly used over-the-counter bleaching agent. This is a naturally occurring hydrophilic fungal derivative evolved from certain species of Aspergillus.
Hydroquinone has been banned in England and Japan for fear of ochronosis and hyperpigmentation. For example, now only kojic acid and other natural products are used in Japan.
Today, many patients desire quick, if not immediate, results. To accelerate the depigmenting process, dermatologists can add chemical peels to the regimen.
In addition, intense-pulsed light (IPL) can be added to the mix.
“However, you have to be careful, because intense-pulsed light can sometimes darken and aggravate the melasma,” she says.
The treatment of choice is the fractional IPL, which is specifically indicated for melasma and pigmentary disorders. It can be used in conjunction with the other therapies as well.
“As soon as you have healed from the peels beylikdüzü escort bayan and lasers, you have to resume the combination treatments of hydroquinone or Triluma or some of the natural istanbul escort bayan depigmenting remedies; otherwise, there is a risk of recurrence.
“Sunblock also is critical. Use a UVA and a UVB broad-spectrum to prevent recurrence,” Dr. Torok says.