The bleaching effect of HQ may be enhanced with a combination of other agents such as topical retinoids or topical corticosteroids. Combination therapy aims to increase efficacy, minimise side-effects, and shorten the duration of treatment. Combination formulae may contain two or three bleaching agents.

Tretinoin Tretinoin (retinoic acid) is the most commonly used topical retinoid for the treatment of melasma. It acts by removing melanin via keratinocyte shedding, enhances the penetration, and prevents the oxidation of HQ. It also reduces the risk of skin atrophy associated with the application of a topical corticosteroid as part of a combination bleaching formula31. Tretinoin is recommended at a concentration of 0.01–0.1%, and better results are obtained when it is used in a combination formula with HQ31,32.

Azelaic acid is a dicarboxyl acid derived from Pityrosporum ovale (Malassezia ovalis). It acts by inhibiting tyrosinase and selectively affects hyperactive melanocytes without acting on normal melanocytes. Also, it possesses an anti‑inflammatory and cytotoxic action on melanocytes. It is an off-label treatment for melasma. Twice daily, long-term application is needed, often more than 3 months. It is very well tolerated24,27. Azelaic acid (15% gel, 20% cream) has been studied compared to HQ for the treatment of melasma.

Kojic acid Kojic acid is the second most effective non-prescription bleaching agent. It is a fungal metabolic product (Aspergillus, Penicillium), which inhibits tyrosinase acitivity. It may cause sensitisation and allergic contact dermatitis. Also, it has been found to be mutagenic in cell culture studies23. Sun exposure should be avoided during use of kojic acid. It may be used alone at a concentration of 1–4% twice daily or as combination treatment together with glycolic acid 5%

Hydroquinone Hydroquinone (HQ) has been used for over 50 years for the treatment of melasma. It is considered to be the most efficacious bleaching agent. It inhibitis tyrosinase activity, and therefore inhibits the conversion of tyrosine to melanin and increases the degradation of melanosomes. It is active only in epidermal melanoyctes that have tyrosinase activity, while it is inactive for dermal melanophages

Melasma: Avoidance of precipitating factors UV and visible light can initiate or aggravate melasma. The regular use of broad spectrum (UVA, UVB) sunscreens is necessary both for preventing melasma and for enhancing the effectiveness of topical therapies17. Women with melasma receiving oral contraceptives (OC) should discontinue them if possible and choose another method of contraception. However, melasma may persist despite OC discontinuation1

Skin colour is influenced by a variety of factors, such as melanin, capillary blood flow, and collagen in the dermis. For the most part, however, the colour of the skin is controlled by the pigmentary system and is primarily determined by the quantity, type and distribution of melanin within the skin. The synthesis of melanin is a complex multi-step process, catalysed by at least one or a number of enzymes, the most prominent of which is tyrosinase.

Melasma is a common acquired disorder of skin pigmentation. It occurs typically as symmetrical, irregular, light-grey to dark-brown macules and patches primarily in females with darker skin types, at puberty or later in life. It involves sun-exposed areas, such as the face and arms. Patients with epidermal type melasma show an excellent response to therapy, patients with mixed type show a good response, while patients with dermal melasma show a poor response to therapy

Course of 3 treatments Time: 3 x 20 minute appointments Cost: from € 300 Ouch factor: 2-3 out of 10 (micro injections) Longevity: a 6-8 month top up required (not whole course)

Shed the dull complexions of winter and supercharge your skin for springtime. Book in for a consultation to find out more +35312692255 WWW.AILESBURYCLINIC.IE Reboot the areas such as eyes, neck and décolletage with Redermalization ™ a safe and effective antiaging treatment.

Shane’s Birthday Bash - a few memories credits Tom Honan Dr Patrick Treacy www.ailesburyclinic.ie #icon #johnnydepp #nickcave #sineadoconnor #music

Banish stretch marks for good with medical micro-needling and stretch mark serum😁The micro needles penetrate through to the dermis to essentially traumatise the skin and as a result stimulate the production of collagen and elastin through the body's natural healing process. There is little to no downtime with this procedure. To book a consultation call 01 2692255 or email aestheticnurse@ailesburyclinic.ie

Nurse Ciara beating the Monday blues with some pink fluffiness! #aestheticmedicine #aestheticnurse #cutiepie #wewantherskin

💥SPECIAL OFFER ALERT!! Ailesbury clinic are now offering our range of chemical peels at some amazing prices. The Perfect peel now €350 and all our TCA peels now €250!!! Don't miss out on glowing skin, just in time before winter! #chemicalpeel #tcapeel #perfectpeel #aestheticnurse #aestheticmedicine #teamailesbury

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The aging process is inevitable, and we will all feel these effects of loss of elastin at some stage. However, we here at Ailesbury we have some tricks up our sleeve to prevent and correct against the signs of aging. Pop in for a consultation and find out how you can get the most from your skin. We stock a range of skin care brands and have a huge range of non-invasive treatments to help make the most from your skin. ☎️012692255 #lovetheskinyourein #teamailesbury #skincare #aging #noninvasive #aestheticmedicine #aestheticnurse

One of our favorite clients has just launched her new photography website, and can we just say, "WOW". Check this talented girl out!! #photography #loveourclients www.michelleconnor.ie

💥NEW GALWAY DATE ALERT: Ailesbury clinic's Dr.Olga O'Drisicoll will be taking a new date in our Galway clinic this Friday the 21st of July for all your dermal fillers and anti-wrinkle injections. To book you apt phone 01 2692255. Further dates for bellissimo Galway to be announced soon! #aestheticmedicine #dermalfillers #antiwrinkle @bellissimogalway

So delighted to be taking bookings for the perfect peel!! Make a free consultation with one of our nurses and give your skin the glow it deserves. We are obsessed with these peels and think you will be too! @theperfectpeel "The Perfect Peel is a revolutionary peel that will transform your skin into looking younger, healthier and clearer in just one week. The Perfect Peel can be used on all skin types and requires no pre-peel skin preparation. The process takes less than 15 minutes and is virtually pain free." "Improve the overall tone and texture of your skin Lighten and brighten your skin Remove or reduce sun damage and age spots Reduce pore size and soften fine lines and wrinkles Reduce or eliminate Hyperpigmentation and acne scars Improve acne skin conditions and Melasma Stimulate the production of collagen resulting in firmer skin Slow down the aging process and prevent wrinkles" ☎️ 012692255 🖥nurserio@ailesburyclinic.ie / aestheticnurse@ailesburyclinic.ie #perfectpeel...

Pop into Ailesbury clinic for this seasons must have...glowing skin! Book a free consultation with one of our nurses and get a tailor made skin treatment plan for your skins wants and needs. We offer a wide range of medical grade and cosmeceutical skin care brands, chemical peels, Skin rejuvenation, IPL, hair removal, radio frequency fat removal and skin tightening, dermal fillers, PRP, dermal rollers, and much much more! #lovetheskinyourein #teamailesbury #aestheticnurse #aestheticmedicine #chemicalpeels #perfectpeel #tcapeel #dermalroller #prp #dermalfillers #lipfillers

One less problem! 👄 Call: 012692255 to book in for your dream lips today! #lipfillers #teamailesbury #aestheticnurse #poutgame #poutstrong

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Now in stock! Pop in and pick up your holy grail today. @skinceuticals Broad action anti-oxidant and high protection SPF. Book a free consultation with one of our nurses ad tailor your package to get the best results for your skin. #glowyourownway #lovetheskinyourein #aestheticmedicine #aestheticnurse #skincare #healthyglow #skinceuticals #teamailesbury

We love our customers!!! Our very happy customer @shelmccabe after her treatment at Ailesbury, looking AMAZING!! Book in today for a free consultation with one of our nurses. We will tailor make an individual treatment plan for you to get the most from your skin. We offer a range of peels, lasers, IPL, radio frequency, PRP, dermal roller, skin care products, dermal filler, anti wrinkle injections and much much more. #glowyourownway #happycustomer #wow #beautifulinsideandout #teamailesbury #ailesburyclinic #aestheticmedicine #aestheticnurse #lovetheskinyourein #glowing

Medical miconeedling is used to stimulate the production of new collagen using the skins ability to heal itself. Puncturing the dermis with microscopic needles stimulates fibroblast cells to produce new collagen. This procedure is used to improve skin tone and texture, treating the appearance of ageing, acne scarring, pore size, stretch marks and pigmentation. It is combined with a specific topical serum to target your skin issue. A course of 3 is recommended 😸#microneedling #dermaroller #serum #acnescarringtreatment #antiaging #antiwrinkle #pigmentation #pigmentationtreatments #finelines #wrinkles #skinrejuvenation #glowingskin #skincare #stretchmarks #stretchmarkremoval #stretchmarktreatments #reduceporesize #reducepores