Do you have to use hydroquinone before and after non-ablative laser resurfacing to get results?

Question

I am attempting to use hydroquinone as preparatory treatment for non-ablative laser resurfacing. After 3 tries with very small amounts (1/2 a pump) 2-3 days between applications I am convinced that the product is giving me allergic contact dermatitis. My face is so red & swollen that I am icing it down. My skin tolerates 0.05% Tretinon daily very well. Is the non-ablative laser still an option for me if my skin cannot tolerate the hydroquinone cream?

Christopher T. Maloney Jr., MD · Answer

Thank you for your question. You do not have to use hydroquinone before a laser procedure to get good results. However it really depends on your skin type. If you are more darkly pigmented, have Asian skin or have melasma, your surgeon may certainly want you on a skin lightener to suppress the melanocytes from activating and causing hyperpigmentation (darkening of the skin). Please address your concern with your doctor and see if Lytera or another product may work. It really will depend on your skin type.

Jason Emer, MD · Answer

I recommend following up with your Doctor performing your treatment about their recommendations to prep for your treatment. PDT therapy and lasers (ProYellow, Excel V, VBeam) can improve any redness and inflammation you're experiencing now. I also recommend adding microneedling/prp along with lasers to get the best outcomes. See an expert. Best, Dr. Emer

Daniel Shapiro, MD · Answer

Thank you for your inquiry regarding  laser. It is ideal if you can use a combination of Retin A and Hydroquinone to prep the skin before any type of laser. However, if your skin is reacting to the Hydroquinone which is a bleaching type product to reduce brown spots ,I recommend to stop it and continue using just the Retin A. I would still plan on doin the non-ablative laser.Good luck

Bryan Ambro, MD · Answer

It certainly does sound as if you are having a reaction to the hydroquinone and I would recommend that you stop it.  In my experience about 5-10% of patients don't tolerate hydroquinone. If your physician feels strongly about pretreating then the are other hydroquinone-free alternatives such as Skin Medica's Lytera.  The only patients that I recommend pretreating with hydroquinone or Lytera are darker skin types or patients with significant melasma. In short,  a non-ablative laser treatment is still an option for you but you need to consult with your physician to come up with a agreed upon pre and post treatment skin care regimen that will give the best result.  Good luck.

Tom Tracey Gallaher, MD · Answer

You should stop using the hydroquinone.  There are other skin lightening products such as Lytera that you might be able to tolerate.  When you have a laser resurfacing, you want to protect your investment so using some retinol or skin lightening product afterwards is to your advantage.

Peter J. Malouf, DO · Answer

Hello,Hydroquinone is useful prior, in order to "turn off" your melanocytes to help prevent hyper pigmentation.I highly recommend it prior to laser resurfacing and many other light or laser based treatmentsDr. Malouf

Gregg Kennedy, MD · Answer

Non-ablative lasers are used to reduce the downtime associated with ablative laser resurfacing procedures.  The trade-off for reduced downtime is reduced perceived result.  Hydroquinone is not required prior to non-ablative laser treatment; certainly, when you are sensitive to the drug, an alternative or no pre-treatment must be chosen.  Talk with your physician about options, and consider the relative advantages of ablative and non-ablative laser treatment, as well.

Cheree Dunbar, MD · Answer

I do not routinely have patients use hydroquinone to prep  for non-ablative, fractional laser procedures.  If hydroquinone seems to be creating an allergic response, then I would definitely avoid it. The main reason to use it would be to reduce the risk of hyperpigmentation.  Patients still get great results without using hydroquinone.  Of course, completing a series of treatments (usually 3) is what gives the best results.

Ralph Massey, MD · Answer

Hydroquinone is NOT a requirement prior to any laser procedure ablative or none ablative. There is little proof it does decrease the incidence or severity of darker pigmentation after these procedure even though many physicians use it in the hope that it may. If you are having a reaction to it you should not use it. There are several alternative topical such as kojic acid. For patients at low risk for pigmentation after the procedure then no topical bleaching prep is needed.
Hope this helps

Drew Varano, MD · Answer

Hydroquinone prep is not a fully required step. It varies among physicians but some like to use it to “prepare” the Skin for a resurfacing treatment by helping decrease/suppress the  melanocyte response . This lessens the probability of PIH (hyperpigmentation) after a Laser session. It is usually used for darker skin types but can be used for any skin type. It also can serve a second purpose in a symbiotic relationship with the laser to improve with pre existing melasma or dyschomia that the resurfacing treatment is trying to improve. If you do have redness or dermatitis from the hydroquinone , you should express that to your physician and an alternative product or no product are options.

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