OTC retinol use and melasma - will it get worse?

Question

Is it likely that an OTC retinol (e.g., Paula's Choice 1% Retinol) may worsen my melasma even if I continue to use sunscreen daily? For how long can retinol products like this be used safely (my main concern is NOT to worsen my melasma).

Jason Emer, MD · Answer

Thank you for your question, 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, and sometimes Erbium (Cool Laser) to get the best results. See an expert for a formal evaluation. Best, Dr. Emer

Jeff Angobaldo, MD · Answer

Thank you for your question.  I would suggest doing a fractional treatment for melasma.  Apply hydroquinone morning and evening two weeks prior to your treatment.  The fractional treatment would help to suppress the discoloration and improve texture of your skin along with shrinking your pores.

Raffy Karamanoukian, MD, FACS · Answer

Melasma is associated with hyperpigmentation caused by a combination of hormones, sun exposure, inflammation, and deposition of melanin pigment. In our office, we specialize in melasma treatments and start with Melapads, Melarase AM, Melarase PM, and Replenish; followed by pulsed dye laser to eliminate inflammatory erythema and light fractional laser.

Best,

Dr. Karamanoukian

Realself100 Surgeon

Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes- retinol can worsen melasma due to skin irritation. If your melanocytes are still active, melanin will be produced. Ideally a tyrosinase inhibitor should be combined. Combination treatments will give you a much higher success rate. 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. 
  
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

OTC retinol use and melasma - will it get worse?

Answers (4)

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