Small pin-prick sized popped blood vessels on face. 28 year old female. Can 10% hydroquinone or tretinion cause this?

Question

I am developing small popped blood vessels on my face & they will not stop forming! I recently got the Cosmelan peel which is an intense peel for melasma. The maintenance cream is a whopping 10% hydroquinone and 0.1% tretinion paste! I have been using it for a month+. I read hydroquinone thins the skin, especially this percentage. I am receiving a KTP laser treatment to zap these spots. Doc said it might be hormonal? Should I discontinue the maintenance cream? Is it too harsh, thinning the skin?

Jeff Angobaldo, MD · Answer

Thank you for your question.   I would recommend to start using triluma morning and night six weeks prior to laser treatment. Fractional treatment is very effective for suppressing discoloration and evening out skintone.  Skinpen which is a microneedling device that would also be beneficial for getting rid of melasma.  The microneedling treatment helps to wake up your natural growth factors, shrink your pores, fade discoloration and acne scars, and help increase collagen and elastin production. You would do a treatment every 4 weeks and stay out of the sun as much as possible and always wear spf 50 broad sprectrum.  Always consult with your physician first before starting a treatment

Michele S. Green, MD · Answer

I am so happy that you had the Cosmelan treatment since I find it so effective to treat melasma.  I have seen redness or some irritation but not broken blood vessels. Please post photos of your face to help you.  You can always stop Cosmelan II for a while and you should use their Vitamin K cream and I prescribe a Vitamin C serum from my office as well to help with the redness. Best, Dr. Green

Davin Lim, MBBS, FACD - Account Suspended · Answer

See a dermatologist for the red dots, a diagnosis will be helpful, and yes a vascular laser like KTP can help. Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours.Picosure is not the only answer, though I do believe that in the correct hands it does clear up up to 80% of epidermal - mixed melasma in 3 sessions. 
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
  
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

David E. Berman, MD (retired) · Answer

you can get a fantastic improvement in your irregular pigmentation on your face with the incredible Picosure laser which fires 1,000 times faster than other lasers so that it does not cause redness. you should plan 3 treatments, each spaced one month apart. for those red blood vessels and spider veins, you can get superb results with the any of the vascular lasers such as the Cynosure Elite laser which has an alexandrite laser within it. david berman md

Beverly Johnson, MD (retired) · Answer

I think that this is one reason NOT to use high potency HQ. It is very irritating so strong steroids are added to the product to make it LESS irritating. The side effect of strong steroid is a gradual destruction of the epidermis---it gets thinner and so the vessels are exposed that are in the deeper levels ( called "atrophy") . The thinner skin is also more susceptible to sun damage , and blood vessels are  part of that scenario. I would strongly recommend NOT using HQ at that high concentration since the steroid induced changes don't go away .Be Safe,Dr Beverly Johnson

Small pin-prick sized popped blood vessels on face. 28 year old female. Can 10% hydroquinone or tretinion cause this?

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