I have used Hydroquinone 4% with Tretinoin 0.025% for Melasma but I am facing side effects should I keep using it or?

Question

I have been prescribed by my dermatologist a week ago to use Hydroquinone 4% with 0.025% Tretinoin for my Melasma problem, but after using the combination my skin turned red, bit swelled, very dry even some of my skin peeled off with burning effect.When I spotted my skin turned black I have stopped the treatment.Is it normal to have these effects. My Dermatologist in out of country right now what should I do?

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Michele S. Green, MD · Answer

There are some patients who have the opposite effects from these creams and are unable to tolerate them.  You should discontinue these creams for now and possibly use a hydrocortisone cream twice a day to help ameliorate the condition.  Please consult an expert in Melasma to help treat your condition. Best, Dr. Green

Abdulla Fakhro, MD, FACS · Answer

Hello Mj Shaikh, it is not uncommon to have these side effects from your regimen. How are you using the combination? Normally whenever we recommend the combination of hydroquinone and tretinoin creams we urge patients to alternate them at night. It is best if you apply the hydroquinone only on the melasma and then wash your hands, apply tretinoin cream all over your face.  if you are not having issues then you can increase treatment at night and also begin to use hydroquinone in the AM. 
Here's where it gets a bit challenging, you need to observe diligent sun care, something with an spf of at least 50 or so. Using many of the cleanser on the markets to wash your face at night (make sure you dont try new products that you could be sensitive to) 
In the past, I have noticed that some dermatologists will often prescribe some topical steroids when patients have a lot redness. When your doctor returns, ask him or her for advice regarding this. 
This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion.The information provided should not be relied upon as a substitute for consultations with a qualified health professional.

John Tanqueray, MBBCh · Answer

Side-effects of redness, dryness, flaking and sometimes soreness and cracking will occur and are to be expected on a regime like this. Melasma is a difficult condition to treat and usually requires more aggressive regime like this. It will not harm your skin to continue, but if you are experiencing any cracking of the skin it is best to back off. You will get better results and more rapid improvement if you can persevere. The side-effects will usually subside after about 6 weeks of use. If you have an important event in the meantime you can reduce or stop applying the creams for a few days and things will settle.Good luck.

David E. Berman, MD (retired) · Answer

If you have skin types 1-4, you should consider the Picosure laser. You should plan at least 3 treatments, spaced a month apart. I would not start these treatments until you rest your skin and the irritation and inflammation resolve. You may also benefit from pre-treatment with HQ. The Picosure laser has little to no downtime since it fires 1,000 faster than other lasers.david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes - vvv common to have these side effects with HQ and Tretinoin - especially in combination. This is why I prefer stand alone creams. Simple method to titrate. Stop everything , use a moisturiser only for 4 days, then dilute half pea size active, pea size moisturiser, apply to brown areas 2-3 nights a week. Increase as tolerated. Dilution decreases if your skin can tolerate it. If not, OK to use 2-4 times per week. Any problems swap to Meladerm. Melasma is a very common cause of skin pigmentation. It 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. This forms the foundation of all treatments. 
  
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams or Meladerm. I start my patients on laser (low dose Q switch or Picosure) as this has shown to decrease pigment production. Another laser I use is the Clear and Brilliant in the 1927 Permea setting combined with creams. IPL should never be used to treat mixed melasma as it often worsens the condition (this is termed ‘Rebound Melasma’)
  
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.

I have used Hydroquinone 4% with Tretinoin 0.025% for Melasma but I am facing side effects should I keep using it or?

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