What is a Good Morning and Night Regimen with Retin a and Hydroqinone?

I use retina and a hydroquinone/retina compound from doctor(alternating nights). I take 100 mg of spironalactone daily. Its been a month now, and I do see some progress with the discoloration (i am dark so i hyperpigment). I put clean and clear moisturizer with .5% salicylic A. Should i put it on before or after the sunblock (mornings). what should i use as a facial wash? I'm using Neutrogena oil free acne wash with benzoyle P twice a day. Can i use makeup? How long will until acne is gone? product suggestions also

Doctor Answers 1

Always use Retin-a at night

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When ever you are prescribed a retinoid product, it is always best to use it at night; although some of the newer products are more light stable, many retinol and retinoid compounds are not very stable and can break down in the light. The acne regimen  I prescribe typically depends on your skin sensitivity and type of acne. Topical acne products and especially retinoids can make your skin sensitive, and if you are having problems with irritation its best to use a mild gentle cleanser (I like cetaphil dermacontrol oil free wash). If your skin doesn't tend to have problems with sensitivity and you have inflammatory acne  (painful bumps or pustules) adding in a benzoyl peroxide wash (such as Panoxyl 4% creamy wash) once a day can help. If you have problems with small acne bumps (called comedonal acne) using a facial wash with salicylic acid once a day is typically what I recommend (I like Aveeno clear complexion cream cleanser). I tend to recommend these in the am because again retinoids can be very fragile depending on the formulation. It is always best to apply the acne products prior to applying sunscreen and /or moisturizer, I like mineral sunscreen moisturizers as they are less irritating. You can use make up, but I would make sure to check the bottle to make sure it says "non-comodogenic". At bedtime I usually recommend a mild cleanser such as cetaphil as above, and wait 15-20 minutes after washing your face to apply the retinoid/hydroquinone product. This decreases the chance of irritation.  If you are using spironolactone for acne it is likely that you have a component of hormonal acne. Without seeing your acne it is difficult to say how long it will take to respond to treatment,  however typically in my experience spironolactone takes about 3 months to completely take effect. Many times with acne patients feel that the more products they put on the faster the acne will resolve.My approach has always been "less is more", too many products at once can lead to irritation, which can actually worsen pigmentation.

Stuart Dermatologist

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