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Redness appeared on face. Prescribed locoid. Is this the correct treatment?

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Dermatologist
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Hello, I went under laser resurfacing 4 weeks ago. Now my face is very red. Although redness is uneven (i.e. some areas are dark red and other less and turning pink).. my doctor prescribed me locoid for 3 days and after that hydroquinone 4% ... Is this the correct treatment? is there anything else I can do to speed the proccess? since I am still red how can i know if this is PIH?

How long will the redness last?
Posted Tue, 19 Mar 2013 in Skin Hair and Nails
 
 
Answered by Dr. Kalpana Pathak 1 hour later
Hi,
Thanks for writing to us.
Redness or erythema over face is quite common after laser resurfacing. This redness may persist for two months to three months.
However if the face is extremely red or associated with swelling it signifies impending hyperpigmentation or scar formation respectively.
To tackle redness over face
Use a sunscreen with SPF 50 at least twice in a day in between 10 am to 4 pm as uv XXXXXXX penetration is maximum in this duration. Sunscreen should be used regularly after LASER session.
Use a steroid cream twice in a day. Personally I feel if the redness is more, you should use a stronger steroid like mometasone over face for few days.
Use a mild soap and moisturiser preferably hypoallergenic and fragrant free.

Hopefully with the above suggestions, your redness should become pinkish and mild or disappear. If severe redness still persists then a course of oral steroids in tapering doses should be prescribed.

Post inflammatory hyperpigmentation appears as light to dark brown patches in areas of excessive redness or inflammation once developed these can be treated with 4 percent hydroquinone and daily application of sunscreen. Right now as long as lesions are red one should concentrate to decrease the redness. Hydroquinone should be used in the setting of developed PIH

In nutshell I would advise you to use a good sunscreen, avoid sun exposure and apply topical steroid like mometasone over face for a week.

Hope that answers your query. Take care.


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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 39 minutes later
If PIH is developed and treated appropiately with Hydroquinone and sunscreen how long will it take to disappear?

Also, for the redness, how long can the steroid cream be applied? 3 days? 1 week? are there any risk for using too much of a potent steroid?

Thank you
 
 
Answered by Dr. Kalpana Pathak 22 minutes later
Hi,
Persistent redness or inflammation may finally heal with post inflammatory hyperpigmentation. So obviously to prevent the same, inflammation or erythema needs to be treated. Mometasone has a moderate potency and can be safely used over face for a week. There is no harm in using a good strength steroid to control inflammation for a short period. Hydrocortisone is quite safe for use over face as it has a mild potency but it won't show optimum efficacy if your erythema is too dark or persistent,

As far as PIH is concerned, it is difficult to predict how much time will hydroquinone take to reduce it as the response depends upon one's skin type( skin color, tendency to develop PIH) and depth of pigmentation.

It is too early to say right now whether PIH will set up in your case or not. The basic management protocol right now is to help redness settle.

Hope that answers your query. Take care.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 24 hours later
Thank you for your answer.

The redness seems to be fading away but it is not going away evenly (i.e. some small areas are starting to look light pink while other small areas are still red). I am worried.
Is this normal?

Thank you
 
 
Answered by Dr. Kalpana Pathak 9 minutes later
Hi,
Blotchy or uneven erythema after laser isn't alarming but persistent erythema is and hence a treatment is required to settle persistent erythema. I just forgot to ask whether you underwent ablative laser resurfacing or non ablative resurfacing. With ablative lasers erythema persists for long period that is upto 2 to 3 months but with non ablative usually settles in two to three weeks time.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 8 minutes later
Thank you for your answer.

I went through a combination of both.
i had a micropeel laser which I think is ablative at 50 microns and then two passes of profractional (which I believe is non ablative) at 500 microns

 
 
Answered by Dr. Kalpana Pathak 12 hours later
Hi,
Thanks for writing back.
Both the lasers mentioned should not lead to erythema persisting beyond 3 weeks and you are still having erythema though blotchy with some areas too red. I would advise you to start applying steroid cream and sunscreen as chances of PIH are high.
Steroid creams do not lead to any harm if used for short while. Kindly use mometasone cream for a week and avoid sun exposure.
Regards
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 2 days later
Dear Doctor,

The redness has started to be reduced, but the color of the face is still uneven.
In some areas, I can see dark pink and in other light pink and in others, almost my natural skin color (I am white and have blue eyes, I think my F.T is 3).

I was not exposed to sun before the procedure (and I have been using SPF 45 UVA/B for 6 months), neither I was after it and did not use any acid product 3 months prior to the laser.

Can the uneven red/pinkness result in hyperpigmentation? if so, when will I know? and how? How can I minimize it? I have hydroquinone 4%

Should I change anything in the treatment?

Thank you.
 
 
Answered by Dr. Kalpana Pathak 2 hours later
Hi,
Fair skinned people with blue eyes usually have Fitzpatrick skin type 1 or 2.
Sunscreen use is mandatory pre and post laser session.
Before answering your queries, I would like to know whether you have started using mometasone cream or not and for how many days you have used it. I would be in a better position to answer if I would be knowing whether erythema has responed to steroid use or not.
Regards.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 1 hour later
Hi,

I was not able to get mometasone. My doctor prescribed me Locoid which I have used for 3 days. It seems to have worked since I have gone from a skin that was intense red (beet red) to a pink color.

Thank you,
 
 
Answered by Dr. Kalpana Pathak 2 hours later
Hi,
Thanks for answering promptly.
Firstly I would like you to continue with hydrocortisone cream for another 5 days to a week as the redness should subside with steroid alone. Though I will still maintain mometasone would have given a better and earlier response.
Use sunscreen daily.
Hyperpigmentation develops when erythema is persistent. As you are having good response with steroid cream, do not panic. Three days is a small period to have complete response. Hyperpigmentation can be prevented with use of steroids and sunscreen.
As you have mentioned your face was beet red prior to using steroid and now its pinkish. Personally, I feel right now you should continue with steroid alone for a week and may add hydroquinone later after a week if required. Hopefully steroid cream would do the trick and your face will clear off. If you want to use hydroquinone over face, use it once in a small quantity but continue with steroid cream for another 5 days too.

To prevent further episodes after laser
Be regular with sunscreen
Post laser use a steroid cream for three to four days to settle redness. Also do ice compresses frequently
In between the laser sessions priming creams like Glycolic acid, hydroquinone or Kojic acid can be used to prevent chances of pigmentation after laser. However these should be discontinued at least a week prior to laser session.

Hope that answers your query. Take care.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 21 minutes later
Thank you very much for your answers and understanding.

XXXXXXX
 
 
Answered by Dr. Kalpana Pathak 4 minutes later
Hi,
Wish you a speedy recovery and a flawless face!
Take care.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 23 hours later
Hello,

I have started using mometasone today. How many days using moetasone will be enough to see whether or not it is improving the condition?
Should I notice a change by the 1st day, the 3rd day,the 5th day?

Thank you
 
 
Answered by Dr. Kalpana Pathak 19 minutes later
Hi,
Use it for five days to a week to notice response. By then most of redness should subside and let me know about the response. Continue with sun protection.
Regards.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 3 days later
Hi doctor,

I followed your advice and get the prescription for a more powerful corticoseid. It was prescribed topicort and have been using it for 5 days.
When i went to see my doctor she said that my skin is just taking longer to heal than other's people and that I should just apply the topicort for one week, then hydroquinone and then visit her back in 3 weeks. Does it seem correct for you?
Also I have been in the topicort already for 5 days, skin looks pink. In some areas more dark pink. I know that topicort inhibit healing so how do I know if I should stop now (5 days after) or continue for another 2 days (7days) as she prescribed?

I dont she hiperpigmentation yet but i see darker pink areas than others... may be turning yellow in some
 
 
Answered by Dr. Kalpana Pathak 46 minutes later
Hi,
Thanks for writing back.
If most of the areas have improved with Topicort that is they have become pinkish, use it for two more days and then switch to a milder corticosteroid like hydrocortisone for another week or 10 days. As we have used a stronger steroid for a week and shifting to a milder steroid for another week or two, no harmful effect of steroid would be seen, be 100 % assured about that. Instead it would help in further reduction of erythema.
As few areas of dark erythema are still persisting as advised by your doctor, start with hydroquinone too. You may apply hydrocortisone steroid cream once ( morning)and hydroquinone once night daily. Sometimes hydroquinone 4 percent may cause little erythema so be sure to use it in very small amount, do not rub the cream over face and if any darkening in erythema or any burning sensation or stinging is seen, withhold the drug and contact your dermatologist immediately. Be sure to use sunscreen daily.

Hopefully your skin would improve completely without any erythema or hyperpigmentation in two to three weeks.
As I have nt seen your before and after images after application of corticosteroids, I would like to know your feed back regarding use of a potent steroid in reduction of your erythema. How much do you feel your erythema has reduced. I am a bit curious to know as I was not of the opinion to use milder steroid in beginning of treatment session.

Wish you a speedy recovery and should there be any doubt feel free to write back. It's always a pleasure helping someone have a glowing and flawless skin.
Regards.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 46 hours later
Doctor, the skin looks uneven in tone... some areas are dark pink other light pink and other my natural color ... how long will it take for the skin tone to even?
Fortunately there seem to be no hyperpigmentation.
Sould I continue the corticoid even if there is no redness (just pinkness)?
when you say a milder corticoseid, you mean something like elocon

Thanks
 
 
Answered by Dr. Kalpana Pathak 6 hours later
Hi,
It is a difficult to commit specifically how much time will your skin require to achieve an even tone as the response or healing time varies from person to person.
But going by your feedbacks, I can assure that your skin will definitely get even toned in few weeks time without any hyperpigmentation.

Even if skin is slightly pink than normal, a mild steroid needs to be continued as it also points towards mild inflammation and the aim of using a steroid cream is to reduce or control inflammation.

Seems like you are not reading my answers carefully! when I said a milder steroid I wanted you to use hydrocortisone. Elocon or mometasone is a moderate potency steroid.

As two days have elapsed, you can stop Topicort and start with hydrocortisone and hydroquinone. Kindly read my last post carefully to follow treatment instructions and visit your dermatologist after three weeks as she had asked you for the same.

Do not be anxious, your skin will definitely get better. Just stick to regular application of medicines and sunscreen.
Take care.
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Follow-up: Redness appeared on face. Prescribed locoid. Is this the correct treatment? 6 days later
Dear doctor Pathak,

I have seen two certified dermatologist MD surgeons in NYC.
They have proposed two solutions:

1. Although the redness faced after the topicort... it has become a dark pink . One of them proposed do a v-beam laser to reduce this pinkness.
2. There is a particular area close to the chin where the color is still quite red. One of them proposed injecting a topical steroids solution on it to reduce the redness just for that area.

What do you think? What is your recommendation?

Thank you

 
 
Answered by Dr. Kalpana Pathak 20 hours later
Hi,
Thanks for writing back.
If the redness is still persisting either a course of oral steroid or injecting steroid in areas of redness can be tried.
I would also suggest that you consult your dermatologist, who did the laser prior to taking any treatment as he knows your skin and its sensitivities or response to treatment better.
Wish you a speedy recovery.
Take care
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