Resolved question:
Initially I have a few freckles on my cheek. I went to see skin specialist and was given 1) tretinoin cream0.05% (apply every night) 2) elidel pimecrolimus cream 1% (apply every morning & night) and 3)some white cream (without name but apply on the freckles only every night before tretinoin). I applied Vitamin C serum before these 2 creams and moisturizer after the medicines. I also used SPF50 sunblock twice a day.
A month later, i realised my freckles became slightly lighter but the skin surrounding the freckles also lighter. There is a white patch now and having uneven skin tone. Furthermore, there was some pigmentation appeared on my face. My skin is fair, clean and no pigmentation before.
I consulted the same doctor again yesterday. She said this condition is normal and expected as the freckles part need longer time to get lighter than other part of the skin. But she asked me to stop the tretinoin. The other 2 medicines are still continue.
I need your opinion and will my skin go back to normal ? is my skin permanently damaged?
Submitted:
4 Days
Category:
Dermatologist
Hi,
Thanks for writing to us.
Firstly your skin is not permanently damaged and we can definitely improve your freckles and skin tone.
When we apply the medicines only over pigmented area, the surrounding skin becomes more lighter.Hence we either ask the patient to apply the medicines full face or apply it precisely over the lesion by using a tooth pick.
Now I intend to change your treatment plan a bit but for the same I need a pic of your face and a copy of your doctor's prescription. So please send me the same as early as possible.
Hoping to hear from you.
Take care
Dear Dr Kalpana,
Below are the medication prescribed by the doctor for the 1st visit:-
Morning
1) Vivier Skin Serum 5 (vitamin C) - apply on full face
2) Elidel Pimecrolimus cream 1% - apply on pigmentation area
3) Moisturizer & Vanicream SPF 50 sunblock
Night
1) Vivier Skin Serum 5 (vitamin C) - apply on full face
2) Elidel Pimecrolimus cream 1% - apply on pigmentation area
3) Lightening cream (white colour - doctor did not reveal the details) - apply on pigmentation area
4) Retacnyl tretinoin 0.05% cream - apply on pigmentation area
5) Moisturizer
Currently ( started 7/8/2015)
1) All medications remain unchanged except to stop Retacnyl tretinoin and apply lightening cream on spot area by using a tooth pick.
I found a lot of people experienced the same condition after treated with tretinoin ie getting more pigmentation and white patches.
Dr, Is the white patch permanent? I am so regret to have this treatment and really hope you can help me to get back my beautiful skin without the use of laser or skin bleaching cream.
Thank you.
Regards,
Michelle
Hi Michelle,
Thanks for providing me with all the details and images.
Your doctor's prescription seems appropriate to me. But considering that you are not satisfied with the response, we might modify your prescription.
Firstly continue your vitamin c serum, sunscreen and moisturiser.
My advise would be to take an oral antioxidant preferably procyanathidine and tranexemic acid based twice in a day.
Apply kojic acid based cream twice in a day like Biluma cream twice in a day
Apply a triple combination cream like Triluma RD which contains hydroquinone, tretinoin and a steroid in night.
Both these creams should be used in pea size amount and to be used full face. Do not rub the cream or use it excessively. Otherwise your skin might become red, irritated and itchy.
Let me know after fifteen days. Other options are lasers and chemical peels.
Vitamin c serum and moisturiser should be used before applying the medicine while sunscreen should be applied later.
Hope this would help you. As you are thin skinned and with fair complexion, please use the creams in minimal amount possible.
Take care