Posted by: concerned | 2009-04-22


I recently went to a Dermatologist for some help with sever melasma. she prescribed a concoction of her own which the pharmacist made up. the ingredients are: hydrouinone, retinoic acid,triancinolone all in a 90% ROH solution. I find the treatment very drying and my skin is peeling quite a lot, i imagine this is due to the 90% alcohol and the retinoic acid. i know that the triancinolone is a corticosteroid and is supposed to help with the redness etc from the retinoic acid but the list of side effects seems endless! the hydroquinone is also a bit of a worry to me as there seems to be an even worse list of problems with this product!!! i am particularly concerned about Ochronosis, but suspect that the Triamcinolone is in this concoction to prevent inflammation ? does this product look safe to you?

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Our expert says:
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Dear Concerned

Medical article that I found on the treatment of melasma:

Successful treatment of melasma involves the triad of sun blocks, bleach, and time. Without daily use of sunscreens, treatment will fail. Sunscreens should be opaque, broad-spectrum formulations with an SPF of at least 30. Bleaching preparations include 2% or 4% hydroquinone-containing creams or gels. Combination products containing sunscreens and hydroquinone are now available and are very effective and convenient for the patient. These are applied once daily. Simultaneous use of topical tretinoin gel (0.025%) is usually required as well.
For our patients, we recommend combination sunscreen/hydroquinone products in the morning and tretinoin in the evening. Also available now are combination corticosteroid/hydroquinone/tretinoin creams, which are very effective and well tolerated by patients for short periods of time (ie, 8 weeks). Another option is glycolic acid peels in patients with primarily epidermal melasma. Regardless of the treatment modality, patients need to be aware that hyperpigmentation may occur even with effective treatment.

So it seems that her combination is medically acceptable and if used under supervision and for short periods (up to 8 weeks) will be safe. However, I think you should let her know that it dries out you skin severely.
The danger with Ochronosis is usually when people buy Hydroquinone over the counter and use it inappropriately - especially in people with dark skins.

Dr Bets

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