Melasma treatments can vary depending on the degree of severity and patient factors like willingness to take oral medication. The problem with calculating the exact cost for treatment arises because melasma is a recurring problem. It has both UV and hormonal triggers but recurrence can be prevented/ reduced with religious use of sunblock.
Treatments can range from
oral medication - Tranexamic acid (TXA) has been shown to reduce the appearance of melasma when taken over a period of 3 months. The contraindications for its use include hypersensitivity, cardiovascular disease and coagulopathy.
3 months supply or 100 tablets/ bottle would set you back 160 to 250 dollars
Crystal tomato - Patients who are unsuitable for TXA can consider Crystal Tomato.
In a trial conducted at National Skin Centre, there was significant improvement in melasma severity scores after 84 days of supplement vs placebo.
The main ingredients are carotenoids and can be taken just once a day. It is safe for pregnancy or even breastfeeding mothers. It retails in clinics at 140 to 160 dollars a box which will last 1 month.
Topicals - my focus will be on medical grade creams and not OTC
Depigmentation creams - Triluma
Combination cream containing Tretinoin 0.05%, Fluocinolone acetonide 0.01% and Hydroquinone 4%. Hydroquinone and Tretinoin interrupt the synthesis of melanin, Tretinoin also exfoliates the skin and fluocinolone suppresses synthetic function of melanocytes plus it also helps with the irritation caused by the first 2 agents.
Price ranges from 150 to 200 dollars/ tube 15g depending on the clinic
This has to be stored in a fridge 2-8 °C and is not recommend for long term use ( > 8 weeks)
Cyspera/Cysteamine cream
Active ingredient Cysteamine, which inhibits melanin synthesis by inhibition of Tyrosinase. This has the benefit of being steroid and hydroquinone free. There is less irritation compared to triluma/ hydroquinone when used strictly for 15 mins a day and it can be used on a longer term basis for maintenance as well.
Average cost 230 to 260 dollars / tube
- Lasers - There are many different lasers that can be used from Q-switch Nd:Yag to pro-yellow lasers. They are usually done once a month. Cost varies largely depending on the type of laser used and the number of sessions required.
Hope this information is helpful to you!
The treatment of melasma should be decided based on the skin type of patient and type of melasma ( epidermal/ dermal/ mixed and ?vascular), rather than the absolute cost.
Dr Mark
