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Thread: V-beam Induced Hyperpigmentation

  1. #21
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    Roz, My primary concern with the Tretinoin is its potential harshness (and I've tried to contact my dermatologist about lower doses, different blends, etc, but have yet to hear back). I do not want to take a single step back with the healing, as it's so painfully slow going forward as it is. I suspect that my skin can handle the dosage that I've been prescribed (using it every other night or every third night), but I am more troubled by the potential for thinning of the skin. Although I don't feel good about the skin right now, because it's darker than the rest, for now I don't see the old thread veins (telangiectasia) that the laser targeted, and I'd very much like not to produce "new" skin that might encourage them to appear / show through. Perhaps I'm over analyzing this potential side effect, and I should trust my doctor, who's actually inspected my skin visually and tactilely and who gave me this prescription based on her assessment. But that's what I did with the doctor whose work left me in this lurch, so I'm hesitant. Besides, I got the impression from my last appointment that the retinoid *may* help, but that time *will* help with or without the retinoid. Yes, the doctor said at four months I will see improvement; that's two months away, alas, and I feel about as impatient as a child the night before Christmas these days. I want to speed up this process badly, almost desperately, but I also want to be cautious, if not conservative.

    Finally, thanks again, Yvette, for this detailed and helpful information.

  2. #22
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    Slivo--

    Hi again. My further research has now led be to be wary of even the low dose retinoids. I should say I already have thin skin, and my vbeam was mostly for broken capillaries associated with rosacea. Just like you I do not want more broken capillaries or more trouble of any kind. Of course our hyperpigmentation problem areas are right where we were treated for the broken caps, thus if we use an irritating topical in that precise area it does seem like we are courting trouble in an already problematic area. I do not know if I told you that my regular derm who has been treating me for over 2 yrs, said she did not think my skin could tolerate a retinoid and I should allow time to work its effect or try IPL conservatively.

    I will be seeing her next week and for awhile I thought I would just push the topic and tell her that I wanted to at least try ziana . But now the more I read, I think I should stay away from it.

    I do think we are sort of backed into a corner with few good options. Probably the IPL would be ok...but right now I feel like I do not want another laser treatment. The purpuric vbeam was a bit unsettling. I think my skin has been bothered enough for awhile. It is sort of an intuitive thing that I feel I need to just stop laser for awhile.

    Of course, you may be able to tolerate the retinoid better than I could. At least your derm after looking at your skin thinks you are a good candidate for tretinoin. Maybe the lower dose will work for you. I will be interested to hear what you decide and how things go for you.
    Roz
    ps---just wanted to add that I completely understand how the hyperpigmentation is so discouraging to you and how you want to be done with it now
    Last edited by roz; 16th September 2009 at 09:15 PM.

  3. #23
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    Hi Slivo,

    If the hyperpigmentation is not major, then let it resolve on it's own. I'd not use something if you're worried about it. Retinoids are great if you have aging skin, acne/clogged pores, hyperpigmentation/sun damage and want to regenerate and renew the skin. However, if you're skin is VERY sensitive and thin skin, then using retinoids may prove to be too harsh. My skin is thin and sensitive, however, I find Ziana to be quite gentle in comparison to even Metrogel. On the flip side, I use only gentle cleansers and moisterisers - nothing with SLS, harsh acids or ingredients. It evens my skin tone and helps keep my mild acne more at bay. Another example is Roz, she is using a prescription sulfa cleanser which is a strong anti-bacterial/anti-inflammatory cleanser, which can be drying, so using a retinoid in addition, would likely be too much for her skin. Finding the right balance of products to get results (without irritation) is key. I'm not sure what cleansers and other products you are using, but either way if you're apprehensive about using a prescription retinoid then pass. You don't want to worry or be unconfortable about it. Possibly, you can ask your Derm. if a gentle over the counter retinoid would be an option (ie. Avene, Neutrogena, etc.) or possibly a product with licorice, soy, arbutin, or green tea which are proven to even skin tone.

    Take care and chat soon.

    Yvette

  4. #24
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    I would just wait (that is what I am doing). At first it looked awful and I was paralyzed with fear that it was permanent, but with time the spots have blended into my skin. They are still visible but they are much much lighter, not scary like before.

    I can't imagine putting even the gentlest retinoid on my skin, it would burn for sure and probably cause more problems for me. I can't use any topicals except pure oils like jojoba, squalene, etc.

    I am just giving it time (around 3 mos now). I am trying to be more patient- because the last time I wanted something drastic I got the purpuric vbeam and the healing time has been soo drawn out- much longer than I expected, and it will still take a few months for all the brown to fade (I am super pale, but if I was a little darker I bet the spots wouldn't show)
    Last edited by badeliots; 17th September 2009 at 03:18 AM.

  5. #25
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    Badeliots, thanks for your post. For all that I want to this fading, or healing, to speed up, I really do not want to take a misstep and subject my skin to any more irritation than it's already undergone. The difficulty for me is the location of the discolored and blotchy looking skin, on the bridge of my nose, for it's simply always right there, exposed, and therefore near impossible to put out of my mind even temporarily.

    I mentioned the other day that my doctor prescribed Tretinoin to speed up the turn over of the skin. It turns out that my insurance will not cover this medication because, I was told, of its regular use as a wrinkle eliminator (i.e., elective cosmetics). My doctor followed up with the insurance about my situation, and still they wouldn't budge. So she gave me a bunch of retinoid samples that she had at the office, but the only one she had was Tazorac. As I understand the retinoid scale of intensity, and I can't say that I fully understand it, Tazorac (tazarotene) is the strongest (with Tretinoin in the middle and Differin and related others falling at the least intense level). When I reiterated my concern about thinning skin, especially with a stronger medication, my doctor told me that retinoids do not thin the skin like steroid creams and gels do. Instead they open the pores and encourage the reproduction of new skin at a speed swifter than normal. This description doesn't really assuage my concerns. I'm at a loss about what to do, frankly. I have the Tazorac but am not using it for the time being.

  6. #26
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    Hi -

    One option, is you could ask your Derm. if you can mix the Tazorac with a lite soothing lotion. This may give you the benefit of slightly exfoliating and regenerating the skin but "buffering" it from irritation at the same time. Also, I'd not use every night - every other night at most. Or, if you are leary to use, ask her about over-the-counter options that have retinol in them (less harsh than prescription retinoids). Such as, Neutrogena, Avene, etc.

    Yvette

  7. #27
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    Hi Slivovice, just wanted to add my two cents. Retinoids do not thin the skin. They increase the rate of cell turnover, which contributes to shedding of the epithelium more rapidly. This is why individuals who are just starting retinoids often experience a great deal of peeling, which can be a source of aggravation for many people. In fact, retinoids, used long-term, serve to thicken the skin by stimulating collagen production. Many derms prescribe retin-a for patients seeking to improve fine lines/wrinkles because of this collagen-boosting effect. Retinoids are also prescribed to individuals with acne because of its exfoliating effect due to increased cell turnover.

    If you are concerned about the possible irritation but are anxious to at least give a retinoid a try, ask your derm to prescribe retin-a micro (it comes in .04% and .1% - definitely go for the .04%). It comes in a gel base instead of a cream (regular retin-a is often prescribed in a cream base, which can cause acne), and the vehicle is designed to be slow-releasing so its overall effect on the skin is more gentle. That being said, it is still a retinoid so you can expect some irritation no matter what. I have been using Retin-a Micro (.04%) for 3 months on my nose and chin since I have breakout problems in those areas. I started by using it only twice a week, then 3 times a week, etc., until I could use it every night. I do have some peeling and some minor redness, but I think giving your skin ample time to adjust alleviates some of this. I was put on a retinoid years ago (also for acne), but did not give myself any time to adapt. My skin was red, raw, and cracked in places. Very unattractive and uncomfortable, to say the least.

    Retin-a micro is quite expensive (more so than regular Retin-a), so if you want to try it but aren't sure if you will end up sticking with it, perhaps see if your derm can give you a free sample. Otherwise, there are websites in which you can order it without a prescription at a reduced price, but you always run the risk of getting an expired product (I have never done this myself). I think using a milder retinoid, such as retin-a micro, is worth a try if you really want to expedite the lightening process. You can always start once or twice a week, and if the ensuing irritation is not worth the trouble, you can discontinue its use. You will not develop new telangiectasia after only a couple weeks of use. Obviously, this is only my opinion, and I can't predict exactly how your skin will react. I know that for me, the trade-off (fewer breakouts) is worth a bit of dry skin and slight redness. Good luck with whatever you decide.

    Libby

  8. #28
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    Yvette and Libby, Thank you for this information about retinoids, how I might lighten the intensity of their side effects, and possible alternatives. It's all very helpful. Last night I tried the Tazorac (0.05% cream), but I mixed it with a moisturizer. This morning appears to be like all the rest as of late: I am still quite aware of the hyperpigmentation. I'll try to post from time to time about the changes, if any, as I continue the medication.

    Overall, there has been some fading of the discoloration but it's been slight. I am now at two months post-treatment. The hyperpigmentation could be getting better, but frankly it's tough to know for sure when I look at the skin so often. I'm thinking that I should remove the mirrors in my house for a month, or that soon I'll reach a threshold where I simply see things differently than I have the past 4-5 weeks.

  9. #29
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    Good luck with the Tazorac. I don't know about removing the mirrors, but I definitely tried not to look too closely for the few weeks that I was still dealing with hyperpigmentation. It's true that you will not notice the fading as much if you are scrutinizing your appearance every day. Then again, it's hard not to look when you are so eager to see improvement.

    Another bit of advice about the retinoids: their effects are not immediate. If your skin is going to get irritated, it probably won't show up until the second or third day. This is why I (and dermatologists) often recommend only using it once or twice a week at first. We are so anxious to see improvement that we are a bit overzealous with its application, and a few days later you are red and peely. Therefore, it is better to go slow, see how your skin reacts, and gradually increase its use. You may be one of the lucky ones who does not experience any irritation. But I would hate for you to have the experience I did years ago, and then throw away the medication out of frustration without giving it a chance to do its job.

    Also, I wouldn't expect for it to erase the marks instantly (your derm probably discussed this with you). I would say that if it would normally take your skin 6 months to fade the hyperpigmentation, retin-a would help you accomplish it in 3. Therefore, if you are able to tolerate it without undue irritation, keep using it for a few weeks, even if you don't see immediate improvement. It definitely does not work as fast as light-based therapy (i.e. IPL) to eradicate hyperpigmented skin, but it is a viable alternative.

  10. #30
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    Hi Slivovice,

    It may be if you continue to use the Tazorac diluted with moisteriser a few nights a week (always skipping a night your face may be able to tolerate). It's true, that often you won't see irritation/redness/peeling unless you use every night, which in our case is a no-no. I'd have to say though (through reading) Tazorac and the Retin A's are the strongest of prescription retinoids so do becareful. I would never use them full strength on my skin. If your face starts to become red or peely - stop for atleast a day or more. The newer retinoids, Ziana/Atralin/Differin are formulated to be more hydrating and less irritating for sensitive skins. But I can understand if your Derm. doesn't have samples of the others and/or you've filled your prescription already and want to give this a go.

    Again, I think if you take it slow and continue moisterising (diluting the Tazorac) it can work for you. This will mildly exfoliate your skin and the hyperpigmentation will lighten and fade much quicker than using a plain moisteriser. Wear SPF during the day - to protect your skin.

    Take care and let us know how your skin continues to do.

    Yvette

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