I have melasma and I have a strong hydroquinone formula (10%) from my derm; it turns my face orange-ish after a while. Why?

Question

My derm gave me a strong (10%) hydroquinone formula to get my melasma under control and then we plan to switch to something less concentrated, but I notice that after I use it for a few weeks my face starts to look really orange. Is this common? Is it because the formula is so strong or could it be interacting with something else? I use a prescription retin-a at night also (seperate formulation) and then just an estee lauder night cream.

Jason Emer, MD · Answer

i suggest cosmelan peels followed by clear and brilliant laser, microneedling/PRP, and skin care with those who have melasma.  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

Dark spots on the skin are caused by sun UV exposure, hormonal load, birth control pills, and genetics. If you’re thinking about dark spot correction or melasma correction, you would be best advised to start with creams that control the production of melanin before starting lasers or chemical peels. I recommend Melarase creams first for pigment correction, followed by a protocol of lasers, chemical peels, exfoliation, IPL, and pulsed dye laser. 
  
 
  
Recommended Creams: Melarase Brightening Kit
  
MelaClenz
  Melapads
  Melarase AM
  Melarase PM
  Replenish Retinoid Cream
   
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Shehla Ebrahim, MD · Answer

Many women suffer from melasma but there is not a treatment available right now that is 100% effective. Lasers can be effective but they are only temporary.I believe the best option is to treat melasma with topical creams, chemical peels and then maintenence with other possible options as needed.If you have a prescription that is turning your skin orange it could be becoming oxidized. Speaking with the pharmacist regarding efficacy is your best option.

David E. Berman, MD (retired) · Answer

The Picosure laser is the best treatment for melasma. you should plan a minimum of 3 treatments, each spaced a month apart. You will need to use a strong sunblock since sun exposure may cause it to return. You should stop any active skin agents, 3 days before your Picosure treatment.david berman md

Davin Lim, MBBS, FACD - Account Suspended · Answer

Sorry, can not give a diagnosis unless a close examination is performed. Possible ocronosis, but this would be grey. Your dermatologist will know upon examination. 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 melasma and I have a strong hydroquinone formula (10%) from my derm; it turns my face orange-ish after a while. Why?

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