Client currently using retin A and hydroquinone. Where to start?

I have a client coming in, in a few days that is currently using retin A, and hydroquinone. She has had cystic acne in the past and says she has some acne now which is why she is using the retin A. She also says she has a lot of pigmentation, much of which is from the acne. My question here is where do you think I should start with her? My first thought is to try and switch her to some safer products that can still be beneficial to her, but which kind of products should I start with since her skin is probably pretty sensitized? Let me know what you all think and where you would start.

Thanks.

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Permalink Reply by Yolanda Russo on January 31, 2012 at 7:07am

Hi Sara you are absolutely right, get her off those products and be careful while in treatment. Use seaweed based products as thy are safe for any skin except for those allergic to seaweed. Dead see products such as Shira Cosmetics that I use would help her at home too.

Use high frequency if you can on her and gentle but full of minerals products. I hope this helps

FYI:

I would choose Solar Energy group of products from Shira Cosmetics. Not expensive but good. No fragrance, non drying no oils just minerals 

Permalink Reply by Sara Kaping on January 31, 2012 at 9:51am

Thanks I will look into those products 

Permalink Reply by Yolanda Russo on January 31, 2012 at 7:12am

Here is a link to this product line

http://shiraesthetics.com/index.php?cPath=58

after acne is under control, just light breakouts you can switch to this http://shiraesthetics.com/index.php?cPath=32_62

Permalink Reply by Cindy Greenwood on January 31, 2012 at 7:55am

Some people won't do any exfoliation while clients are on retin A.  Find out the % and the frequency of use (I have one client who uses hers only ONCE per WEEK and she gets iritated and flaky for a day or so), and her current reactions (if any).  I am not a fan of HQ - although it is a necessity for some people.  Find out % and how long she's been on that.

Honestly I have found that the people who want skin lighteners are the WORST when it comes to sun protection.

I would make it a requirement for this type of client to purchase and use sunscreen.  I offer a cream spf 30 and suggest that they also purchase my powdered brush on sunscreen for re-application during the day.

I would - depending on whether she has irritation or inflamed acne present - probably start with an enzyme peel and calming masque.  I would work with her to get her on a good homecare routine - this is probably where she is missing the boat. You're going to have to take it slow and sample a lot...but I would get her on a blemish control cleanser - switch that up with a gentle cleanser to start so she isn't over-drying her skin. A Hyaluronic serum would be very appropriate.  If she is NOT oily, I have had good luck using a glycolic cleanser rather than a salicylic...but I start VERY slowly - once a week increasing to every other day.

And vigilant sun protection.

I would get her off the prescription products if possible - she may not even need them.

Many people get breakouts from cosmetics and hair care products - you might want to look into that too.

Permalink Reply by Sara Kaping on January 31, 2012 at 9:49am

Thanks so much that is very helpful.

Permalink Reply by Sara Kaping on January 31, 2012 at 10:22am

So if she does have pigmentation, should I have that be the last thing I worry about? Get her off the prescription, work on her acne then focus on the pigmentation, right? And basically focus on keeping her from getting more pigmentation from the current problems.

Permalink Reply by Margo on January 31, 2012 at 12:00pm

Sara, I am new to the aesthetics world but from my experience I would say she should stop using the Rentin A as this is really drying for the skin and in turn making her super sensitive to the hydroquinone.  I would get her on a good glycolic and microdermabrasion (if available) treatment series. This will combat both issues without overdrying. She is definetly going to need a good SPF and daily moisturizer as well. Now some others may have more advanced experience in this but I can say this works as long as she is going to go along with in office treatments and home care. I use a lot of Skinceuticals products..a little pricey but works wonders. But I think someone mentioned using a good seaweed based product..those works wonders as well..

Permalink Reply by Cindy Greenwood on January 31, 2012 at 1:47pm

My people on a glycolic cleanser experience great results in evening out pigmentation.

They still have to be on sunscreen or anything you do is a waste of time.

inflammation and sun/heat exposure are the problems. So by paying attention to those you ARE treating the hyperpigmentation.

Permalink Reply by Amber on January 31, 2012 at 10:50pm
I use retin-a and have the majority of my facial clients on it as well (prescribed by a referring derm) most are on .1% micro others on the .04% micro
I personally have no issues treating these clients with peels,microdermabrasion or microccurent you just need to know what to use and what not to use. 
I also have them DC retin-a use 72hours prior to facial services and resume 48hours after. 

Hydroquinone causes major sensitivity and if I were to remove a product from her regime that would be the number 1! Not only is carcinogenic and has been pulled in every other country besides the US but
most people do not use this correctly and end up damaging their skin more by using it. 
I prefer using natural lightener/brightening products with Kojic Acid and Arbutin, L-ascorbic acid etc. 
if she is having issues with retin-a related dryness have her apply her moisturizer (night time) first then the retin-a this will help greatly. 
What other products is she using as far as cosmetics and skin care goes (that will also make a big difference)
Also with cystic acne diet and hormone balancing is key. have her keep a food diary for a week and find out what she's eating
dairy,wheat and soy are big culprits as well as refined sugars and excess caffiene and or alcohol and not enough water intake
eating a low glycemic diet will help with all of the above. 
What product line and peels do you use in office?
Permalink Reply by Sara Kaping on February 1, 2012 at 12:06am

I mostly use a line called vital therapy, it is a line dedicated to using non toxic as well as more natural ingredients. I also use some dermalogica (mostly because I have to where I work) and then a  few enzyme peels from Skin Script.

My first instinct was to first get her off the Hydroquinone as well and when I told her that she was surprised because the Estheticians she has been to never had a problem with her using it. I plan to talk to her about the risks of using it though and other safer ways to help her skin.

Permalink Reply by Kristen Dugas on February 2, 2012 at 5:32pm

Wow, so glad to see another Vital Therapy Esty, I as well use VT. The VT liquid WOW is great for hyperpigmentation, have you tried that yet? Or the Vitamin C serum as well, maybe not instant gratification but she will love the way her skin feels and looks after using for a while.

Permalink Reply by Kristen Dugas on February 2, 2012 at 5:37pm

I just re-read your first post. Knowing you use VT , start her on the Acne wash, liquid WOW, and Acne peptides. Also I would reccomend, probiotics and digestive enzymes to help flush her system.

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