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Mon Apr 19, 2010 10:20 pm  |
A little more about combination therapy, how it works, and results of clinical studies
"Combination Therapy
Combination therapy is more effective than single agents used alone. The etiology of melasma is not completely understood, thus, therapies that can act at different stages of pigmentation can produce better clinical results than a single therapy acting at a single stage.[6]
The addition of tretinoin eliminates pigment and increases keratinocyte proliferation by preventing the oxidation of HQ and improving epidermal penetration. Further, adding topical corticosteroids reduces the irritative effects of hypopigmenting agents, and inhibits melanin synthesis by decreasing cellular metabolism.[6] This combination, HQ 5%, tretinoin 0.1%, and dexamethasone 0.1%, was first introduced in 1975 and termed the Kligman formula after its inventor. It has been the most extensively used combination therapy for melasma worldwide.[34]
More recently, results from a multicenter, randomized, double-blind control trial demonstrated that a new combination of HQ 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (Tri-Luma®, Galderma) proved better than any combination of two of the above agents, with 77% of patients showing complete or nearly complete clearing. Clinically significant improvement was noted as early as 4 weeks with maximum results at 8 weeks. The most common adverse effects were mild local irritation, erythema, and skin peeling.[35] The mixture should be applied to the entire affected area to avoid blotchiness. The recent 2006 consensus of the Pigmentary Disorders Academy (PDA), a group of international dermatologists and leaders in pigmentary disorders who receive sponsorship from Galderma, supported the use of triple therapy.
The PDA consensus suggested that first-line therapy for melasma should consist of fixed topical therapies and only when triple combination therapy is unavailable or patients have a sensitivity to the ingredients, should dual ingredients or single agents be considered.[6]" |
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mitra
New Member
 
Joined: 17 Apr 2010
Posts: 7
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Tue Apr 20, 2010 1:06 am |
| Quote: |
[quote="kims"]Hi Moosej,
Here's my routine:
A.M.
Obagi Cleanser C-RX
Obagi Vit C with 4% Hydroquinone
Clear
Sunscreen NIA24
P.M.
Cleanser
CP's Super CP serum
Clear
Exfoderm Forte
Blender/Retin a 0.05%
Eyes -- Alternating with MD Forte and Skinmedica TNS Eyes
I hope I haven't forgotten anything |
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Tue Apr 20, 2010 10:40 pm |
Hey u all.....everyone out there who is using obagi for the first time and need assurance from one more person after rileygirl and Kims...thats me  hahahaha...
Okay so just wnated to assure u all muy friends that obagi is worth trying...Kims do i sound happy ??? yes i am...this is the 4th consecutive day and my skin is as good as it was 4 days ago..actualy by this i mean that my skin was always reverting back to bad skin in the initial 12 weeks,,but since i have started my 13th week,,,there is a big difference thta i have noticed,,,my skin started to look sort of beautiful all of a sudden,,,my blotchiness etc etc was already gone during the 12 weeks but there is something that wasnt here on my face for these 12 weeks and it is here now and i dont really know what it is thats maiking my skin more vibrant and somehwta prettier...Rileygirl and Kims always told me that the big diffenrece i ll see would be probably after the 12th week,,and God they were absolutley right...During all these 12 weeks i was wondering if it was worth trying obagi,,,somedays i was happy with my skin and the other day i would think,,,my skin doesnt look that good ,should i stoop using obagi,,,but i never stopped it...Now this is my 13th week,,,for the past few days,,,i have noticed my skin is not getitng bad at all during the whole day ,,,and then not even the next day and it hasnt happened to me in the last 12 weeks...so this 13th week has proven to be magical for me...i m really happy with the results and even i got the WOW feeling that i was wating for all these 12 weeks,,,,for the past 4 to 5 days,,,,that Wow feeling is there and specially when i see myself in the mirror,,,,that moment of WOW that i was always waiting for is probably not only a moment,,,its going to last for years,, i hope so,,,i know sunscreen is a must,,,,i wont forget it ever...
So for everyone out there,,,who gets doubtful at times,like the way i used to,,,i assure u,,,Obagi is not a wastage of money,,,and u r not going to get NOTHING form it,,,u might think for many weeks of initial use that may be its not worth it,,,but at the end,,,i m telling u its really worth it...u lll be soo happy at the end...Kims and Riley r right and so i m now
Best Of Luck all of Yaaaaaaaaa !!! |
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Tue Apr 20, 2010 10:43 pm |
One more thing i wanna add is that i used to drink only 2 to 3 glasses of water everyday,,,just forget it,,,,but for the past 5 days i m also making sure to drink 8 glasses a day,,,i m sure this also has to do alot with the results,,,,,may be obagi gave me this beautiful skin even before the 13th week but it was nt showing that much cuz i was dehydrated...what do u guys say ???????
Before Obagi,,i would drink like 12 glasses a day of water with no change in my dirty looking skin  |
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Tue Apr 20, 2010 10:52 pm |
| Yes maheen, drinking water makes a huge difference. I was traveling last week and could not drink water often but I'm back home and for the past two days I am drinking water regularly and such a difference it does in a couple of days. Also, when your skin is very bad, try a carrot, beets and apple juice also for a couple of days only or twice a week and yogurt in the morning for breakfast. |
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Wed Apr 21, 2010 4:14 am |
I was looking around on internet to find cheaper places to buy individual Obagi products and came across some interesting instructions for the Blender.
"Care must be taken to apply Obagi Blender prior to the tretinoin and must be applied in a specified proportion."
Is this correct? I was always under the impression that you mixed the 2 together then applied? |
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Wed Apr 21, 2010 5:19 am |
| its_kristy wrote: |
I was looking around on internet to find cheaper places to buy individual Obagi products and came across some interesting instructions for the Blender.
"Care must be taken to apply Obagi Blender prior to the tretinoin and must be applied in a specified proportion."
Is this correct? I was always under the impression that you mixed the 2 together then applied? |
Not, it's not correct. You mix the Retin A and Blender before applying. |
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Wed Apr 21, 2010 9:16 am |
| I have a question about the application/massaging of the products in. Is the massaging aspect of the application an essential part of the regimen? My face burns and stings when the product hits my face and the friction of rubbing in the products for several minutes makes it even worse. Is there any harm in applying the product on my face and letting it naturally absorb into the skin for a minute or so then rubbing what little is left into my skin? |
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Wed Apr 21, 2010 9:36 am |
| its_kristy wrote: |
| I have a question about the application/massaging of the products in. Is the massaging aspect of the application an essential part of the regimen? My face burns and stings when the product hits my face and the friction of rubbing in the products for several minutes makes it even worse. Is there any harm in applying the product on my face and letting it naturally absorb into the skin for a minute or so then rubbing what little is left into my skin? |
The rubbing is actually a big part of it. You want to rub the products in completely for them to get down into the skin where they can work.
ZO Skin Health (Obagi's over-the-counter line) recommends this massage. FUYguy who used to post here (worked for ZO Skin Health) had this to say about the massaging in of the products. Hopefully it will help you.
"massaging in with all of our products as there is additional stimulation benefit from the increased vaso-capillary activity."
"Dr. Obagi is an advocate for stimulating the skin—though physical (massage) or cellular activation (retinol). Anytime you stimulate the skin cells, you re-energize/rejuvenate them." |
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Wed Apr 21, 2010 10:21 am |
thank u Margarett,,,i ll definitely try that once i m off my diet trying to lose lost of pounds i have gained during my first pregnancy,,,so far lost only 20 pounds another 30 left...aaaaaahhhhh..
thanks buddy |
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Wed Apr 21, 2010 10:27 am |
Maheen,
I can tell that you're very excited about your progress!! I always enjoy reading your posts; they are so full of excitement and passion! I'm sure this is probably how you live your life as well. Good for you!!
Also, congrats on losing 20lbs of "baby weight!" |
_________________
50 Is definitely NOT nifty!! |
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Wed Apr 21, 2010 12:31 pm |
| I am new here and I am finishing my first week of Obagi Nu Derm. I am using cleanser, toner, Phiten, clear, exfoderm forte & healthy skin SPF 35 in the morning and cleanser, toner, clear, blender/tretinoin at night. My first week was crazy! My face started peeling on day 2 and it has been peeling like crazy since and very red and sore. When I put the products on I burn bad. I was told to do blender/tret every other day. Has anyone done it this way or is it best to suck it up and deal with the pain? Right now my whole face is peeling and makeup makes it look worse, which means a lot of embarassing moments for me when I leave the house! I have never used anything like this before. I have only used a cleanser and moisturizer with microderm every now and then. My skin is hating me right now! I was prescribed this to get rid of some dark spots on my upper lip, cheek and jaw and can honestly say the spots on my jaw are fading considerably already:) I guess I am here for support... this is painful and I am getting a little frustrated:( |
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Wed Apr 21, 2010 12:43 pm |
Using Phloretin CF - not phiten... wow not even close  |
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Wed Apr 21, 2010 12:53 pm |
Hi Juls0603,
Many, many of us have gone through the very same "face issues" with Obagi and we all know how uncomfortable it can be. I would definitely follow your derm's instructions about using the Blender/Tretinoin every other night. Peeling and redness are all normal reactions and to what extent varies from person to person. However, it's great that you're already seeing some fading!! |
_________________
50 Is definitely NOT nifty!! |
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Wed Apr 21, 2010 12:54 pm |
| juls0630 wrote: |
| I am new here and I am finishing my first week of Obagi Nu Derm. I am using cleanser, toner, Phiten, clear, exfoderm forte & healthy skin SPF 35 in the morning and cleanser, toner, clear, blender/tretinoin at night. My first week was crazy! My face started peeling on day 2 and it has been peeling like crazy since and very red and sore. When I put the products on I burn bad. I was told to do blender/tret every other day. Has anyone done it this way or is it best to suck it up and deal with the pain? Right now my whole face is peeling and makeup makes it look worse, which means a lot of embarassing moments for me when I leave the house! I have never used anything like this before. I have only used a cleanser and moisturizer with microderm every now and then. My skin is hating me right now! I was prescribed this to get rid of some dark spots on my upper lip, cheek and jaw and can honestly say the spots on my jaw are fading considerably already:) I guess I am here for support... this is painful and I am getting a little frustrated:( |
Stick with it. It is very hard at first for a lot of people, but you will be very happy. Definitely listen to the instructions you have been given. If you have any raw spots, don't apply the products to those areas, and use a diaper rash cream to heal the spots. You can put Aquaphor on your lips and in the corners of your mouth so they don't crack. Just stick it out! It is all part of the process. |
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Wed Apr 21, 2010 1:03 pm |
OH I am definitely sticking it out.. for the money I spent. THank you for the words of encouragement. It really helps having someone who has done this before. I do not know anyone else who has and everyone that knows thinks I am crazy for doing it!
I took last night off with the blender/tret and today I am peeling worse, but not as sore, which helps. My husband works out of town and is coming home tomorrow and seeing me for the first time since starting this.. YIKES! I hope he is not too scared! I have been warning him. I will just have to put a push up bra on and hope his eyes don't go any higher
Wish me luck! |
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Wed Apr 21, 2010 1:12 pm |
| Also girls, be very careful when washing your face with the Cleanser, don't rub it off with the towel, just gently touch your face with the towel, very gently to dry it. I was rubbing it and had a bad case of flare up, now I am just drying it gently and have not had any peeling or redness in this 4 past days at all and I changed the Retin-A from 01% to 0.25%. |
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Wed Apr 21, 2010 2:14 pm |
| juls0630 wrote: |
I will just have to put a push up bra on and hope his eyes don't go any higher
Wish me luck! |
LOL! I'm sure if you do that, he won't even notice your skin flaking off!
Good luck, juls. You will be fine. You should be done with the worst of it in 6 weeks!! |
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Wed Apr 21, 2010 3:55 pm |
| kims wrote: |
Hi Mitra,
I was on maintenance, but the routine that you saw is for my Nuderm Round 2 where I'm using all the products again for a minimum of six weeks.
Obagi suggests that you do this yearly.
You do not have to take a break after each six week cycle -- just continue your normal routine.
Also, I liked the Obagi sunscreen fine, but I had the opportunity to try NIA24 and just stuck with it. I prefer a physical sunscreen.
After your 18 weeks, you'll probably need to "tweak" your maintenance plan somewhat. The idea is to use the least amount of products but still maintain your results. |
kims, what do u mean by "tweaking" the maintenance plan? Use less products than before? |
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Wed Apr 21, 2010 4:58 pm |
Kim, how are you doing on round 2 of Nuderm?
Maheen, I am so happy for your satisfaction with Nuderm!
For me, I like that my face looks brighter now and has a bit more tone to it. I am still looking for a product that will help tighten the pores though. My acne scars seem to be more visible too, not sure if it still the dryness or the because of the exfoliation that it is more visible.
Juls, hang in there, it is really bad the first few weeks with the peeling and redness. It will eventually subside. |
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Wed Apr 21, 2010 6:42 pm |
RussianSunshine,
I meant that you have to figure out what works best for you and since you're on "maintenance" you shouldn't need to be using the products as frequently. I think the Obagi web site gives a routine for maintenance -- I need to go back and check this out for sure.
Also, you can add other skincare products into your new routine as well.
When I was doing maintenance, I mainly used Clear, Blender/RA from the Nuderm line. I rarely used the Exfoderm Forte. |
_________________
50 Is definitely NOT nifty!! |
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