We recommend Demelan 3 in 1 Combination Skin Treatment Cream， for Acne Spots， Freckles， Hyperpigmentation， dark discolouration， symptoms， Melasma<br />Demelan is a depigmenting cream with 3 active ingredients， i.e. alpha-arbutin， kojic acid and glycolic acid. Alpha-arbutin is derived from the leaves of bearberry， cranberry or mulberry shrubs. It inhibits the production of melanin and is better tolerated than hydroquinone， an ingredient found in other depigmenting creams. Kojic acid is a by-product in the fermentation process of malting rice and also inhibits the production of melanin. Glycolic acid is a peeling agent that assists the outer skin to shed， which improves the appearance and texture of the skin.<br /> <br />What is hyperpigmentation?<br />Hyperpigmentation， or dark discolouration of the skin， is a common and distressing condition that is difficult to treat， particularly in darker skin. Hyperpigmentation can be divided into two types， i.e. inflammatory and non-inflammatory. Inflammatory hyperpigmentation is caused by various inflammatory skin disorders， e.g. acne， eczema and contact dermatitis. Melasma is a common form of noninflammatory hyperpigmentation. The aim of this leaflet is to provide information on the diagnosis， treatment and prevention of melasma.<br />What is melasma? <br />Melasma is dark skin discolouration (hyperpigmentation) that appears on the sun-exposed areas of the face. It happens when melanocytes in the skin increase their production of a pigment called melanin. Without treatment， melasma can persist for months or years.<br />What are the symptoms?<br />Irregular patches of brown colour are commonly seen over the cheeks， forehead， nose， upper lip or chin， usually in a symmetrical fashion. Although melasma is cosmetic， it is nonetheless a source of stress and embarrassment for the person affected.<br />What causes melasma?<br />Sun exposure is a precipitating factor for melasma.2 Melasma is often associated with the female hormone oestrogen. It is common in pregnant women， women who are taking birth control pills (oral contraceptives) and women taking hormone replacement therapy (HRT) during menopause. Certain medications， such as anti-epileptic drugs， have also been implicated. Melasma of the upper lip is frequently reported in women who wax this area for hair removal.<br /> <br />Treatment<br />A topical depigmenting cream (a cream that reduces pigment) is recommended as first-line treatment. The Pigmentary Disorders Academy (PDA) recommends the use of topical creams with at least THREE active ingredients. As a general recommendation， treatment must be continued for several months before benefits will be seen. Second-line treatments include chemical peels and laser treatments.<br /><br />********************************************************************************************************************************<br />How to use DML?<br />·         Apply small quantities every second day for the first week<br />·         Apply preferably in the evening after the skin cleaning regimen<br />·         Avoid applying to eyelids， external corners of the mouth or nose， or injured or irritated skin<br />·         Avoid prolonged sun exposure while using Demelan<br />·         Use in combination with a broad spectrum sunscreen of at least SPF 15 and continue for a week after discontinuation of Demelan<br /> <br />Tips for successful treatment<br />• Avoiding the sun and using sunscreen are key to preventing melasma and ensuring successful treatment.<br />• Protect your face by wearing a hat when you are outside.<br />• It is advisable to use a broad-spectrum sunscreen that blocks UVA as well as UVB rays with a sun protection factor (SPF) of 30 or higher.<br />• Sunscreens containing physical blockers， e.g. titanium dioxide and zinc oxide are generally preferred over chemical blockers because of their broader protection.<br />• Remember that UVA rays can penetrate ordinary glass， therefore sunscreen needs to be worn even while you are indoors or driving a car.<br />• Speak to your doctor about switching to a non-hormonal form of birth control if you are using hormonal methods.<br /> <br />FAQs about DML<br />·         When should I expect to start seeing results?<br />The lightening effect of the cream is usually observed within 3 – 4 weeks of usage. It may vary from person to person.<br />·         When do I stop using DML?<br />One should stop using Demelan once the hyperpigmented region is of the same skin tone as the surrounding areas. The use of sunscreen should be continued for another week after discontinuation of Demelan.<br />·         Do I apply moisturiser first then Demelan or the other way round?<br />Demelan should be applied first， as the application of moisturiser may create a barrier and not allow contact between DML and site of hyperpimentation.<br />·         Can DML be used during pregnancy and lactation?<br />DML is not recommended during pregnancy and breast feeding as safety has not been established. You may only use it on advise of a doctor. In some cases hyperpigmentation during pregnancy may also be transient. It’s better to wait and see if it goes away first.<br />·         What will happen if I use DML continuously even after my skin has improved?<br />DML can be used for a maximum of 6 weeks， overdose leads to hypopigmentation.<br />·         Can I use other skin peeling agents while I’m on DML?<br />No， adjunct skin peeling agents are not recommended while on DML<br />·         The Package Insert says I must use sunscreen of at least SPF15， but other sources recommend 30， which is the best?<br />Since one of the ingredients i.e. Kojic acid also has sun protection properties， any sunscreen with SPF 15 or above is recommended. The sun protection provided by SPF15 is about 94% whereas that provided by SPF30 is approx. 97%. Sunscreen with SPF 30 is recommended for photosensitive skin， otherwise sunscreen with SPF 15 is effective.<br />·         From what age can it be used， my daughter has Post Inflammatory Hyperpigmentation from acne?<br />It is indicated for individuals above 18 yrs of age only.