Melasma treatment in Kochi,
on the IJDVL protocol.

Recurrence after melasma treatment reaches 58.8% at one year per a longitudinal IJDVL study (some studies report up to 81%), without structured maintenance therapy. The recurrence drivers are continued UV/visible-light exposure (especially morning commute and screen time), hormonal triggers (combined oral contraceptives, pregnancy), and discontinuation of topical therapy. DermaVue's structured maintenance combines reduced-frequency topicals + monthly/quarterly laser top-ups + mandatory iron-oxide SPF 50 for 12-18 months after initial clearance.

Hydroquinone is safe and effective when used in 4-month courses with 2-month breaks under dermatologist monitoring. Open-ended unsupervised use (common with parlour-prescribed creams) carries a small but documented risk of exogenous ochronosis, paradoxical darkening that's harder to reverse than the original melasma. DermaVue uses the triple combination cream (hydroquinone + tretinoin + fluocinolone) on a structured pulse protocol with dermatologist follow-up, then rotates to alternatives (cysteamine, niacinamide, kojic acid, azelaic acid) during break periods.

Melasma is a chronic hormone-and-UV-driven pigmentary disorder with characteristic symmetric facial patterns (malar, central facial, mandibular). Post-inflammatory hyperpigmentation (PIH) is reactive, it follows a specific inflammatory event (acne lesion, eczema flare, contact dermatitis, laser burn). Dermoscopy and Wood's lamp distinguish them: melasma typically shows a reticular pigment network with hormone-pattern distribution; PIH shows localised pigment at the previous inflammatory site. Treatment differs: melasma needs the full TCC + laser + maintenance protocol; PIH often resolves with azelaic acid + SPF + time.

Yes, but ONLY at low fluence (0.5-1 J/cm²) with a 10 mm spot size and multiple passes, repeated every 2 weeks. The high-fluence Western protocols cause paradoxical mottled hypopigmentation in Fitzpatrick IV-VI skin and should not be used. The IJDVL low-fluence protocol DermaVue follows has been published with consistent safety data for South Asian skin, achieving 53% MASI reduction in trial cohorts when combined with triple combination cream priming.

Oral tranexamic acid 250 mg twice daily for 8-12 weeks reduces serum melanin precursors and produces meaningful MASI reduction in trial cohorts. DermaVue prescribes it as an adjunct after a venous thromboembolism (VTE) risk screen, patients with personal or family history of clots, current OCP use, or smoking should not take it. Most patients tolerate it well; transient GI symptoms are the commonest minor side effect.

The standard IJDVL protocol is 6-8 sessions of low-fluence Q-switched Nd:YAG at 2-week intervals, about 3-4 months of active treatment. Maintenance top-ups continue monthly to quarterly for 12-18 months after initial clearance. Dermal-pattern melasma (versus epidermal) responds more slowly and may need additional sessions. Wood's lamp at the first consultation classifies the type and predicts the realistic timeline.

Clinical clearance is achievable for the majority of epidermal-pattern melasma patients with the full IJDVL protocol (TCC priming + low-fluence Q-switched laser + tranexamic acid + photoprotection). What's not achievable is permanent cure, the genetic and hormonal drivers remain, so without structured maintenance, recurrence at 12 months is common. DermaVue's framing is: clearance is achievable, maintenance is mandatory, the result is stable manageable skin not permanent cure.

Iron-oxide-tinted SPF 50 broad-spectrum sunscreen, daily, reapplied every 2-3 hours of sun exposure. The iron oxide is critical, UV-only sunscreens leave melasma vulnerable to visible-light-driven pigment activation (which screen time and indoor lighting also contribute to). DermaVue recommends specific brands at the consultation; budget reasonable choices are widely available.

Yes, pregnancy melasma (chloasma) is one of the commonest variants, affecting 50-70% of pregnant women in Indian cohorts. It typically appears in the second trimester and may persist post-partum. Treatment during pregnancy is limited to SPF 50 + iron oxide + topical azelaic acid (the only pigment-lightener safe in pregnancy). The full protocol, TCC, laser, tranexamic acid, starts post-partum and post-lactation.

₹300 consultation. Triple combination cream is ₹1,800-3,600 for a 3-month course. Q-switched Nd:YAG laser toning is ₹4,500-15,000 per session (a 6-8 session course is ₹27,000-1,20,000 total). Oral tranexamic acid is ₹600-1,800 for a 3-month course. Iron-oxide SPF 50 sunscreen is ₹900-1,800 for 3 months. Maintenance after initial clearance is structured at lower frequency to keep recurring costs predictable.