Topicals (proven brighteners) Vitamin C serum in the morning Niacinamide for tone and barrier Retinoid at night (started cautiously) Targeted pigmentation actives (alpha arbutin, tranexamic acid, kojic acid, azelaic acid) where indicated Hydroquinone in a planned, cycled course for melasma where appropriate, under supervision In-clinic A planned course of chemical peels (mandelic, glycolic, salicylic depending on skin type) For melasma specifically, sometimes specialty lasers or microneedling-RF in selected cases Lifestyle Sleep, hydration, antioxidants in diet Iron and vitamin D corrected if deficient Stop the at-home over-acid-stacking that brings most patients to dull, sensitised skin in the first place And, optionally glutathione If, after a foundation is in place, a patient still wants to try IV glutathione, we discuss honestly: Pharmaceutical-grade product, sourced and stored properly Medical supervision
If youre wondering if you can eat your way to better glutathione levels, you absolutely can
Accurate diagnosis before initiating treatment is essential particularly because certain conditions that resemble eczema, such as rosacea, may worsen with topical steroids
Similarly, there may be limited instances in which a drug or biological satisfies the definition of a Part D rebatable drug but is not a COD under the MDRP
