How to improve the discoloration and hyperpigmentation when using Retin-A 0.05%

Question

I have been using Retin a 0.05% for more than a month and recently my skins appear to have some melasma and redness like the result of sunburn although I use sunscreen every day. My skin looks so dark and the cheeks have some dark marks like hyper pigmentation. My acne has improved significantly but these side effects scare me a lot. Please help me. Will the erythema and hyperpigmentation disappear? What should I do to improve my the hyperpigmentation during the time using it?﻿ Thanks a lot.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Hratch Karamanoukian, MD, FACS · Answer

There are other options to the Obagi product line. An important component of melasma care is wide spectrum UV protection and sunblock as well as avoidance of sun exposure. I recommend Spectrase.
I recommend lower potency hydroquinone combined with non HQ product called Melarase. It is also beneficial to use an oral supplement called Pigmentation Relief Complex (see link) or Scler-X. 
Best
H Karamanoukian MD FACS

Emil A. Tanghetti, MD · Answer

You may want to consider adding a hydroquinone product to your treatment routine to address the areas of dark pigmentation that is concerning you. At our facility, we utilize the Obagi line for our hydroquinone products and they work very well for treating the type of brown pigmentation you describe. As always, you should be very diligent with your sunscreen use to prevent any future pigmentation and to protect your investments in your skin that you are making right now! I would suggest a consultation with a dermatologist to confirm that you are an appropriate candidate for adding a hydroquinone to your current treatment protocol. Good luck!

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