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This teen's acne improved with Retin A, but hypopigmentation developed on the cheeks where it was applied more densely. The hypopigmentation resolved with shortening the duration of Retin A application to 2 hours and adding an oral antibiotic to prevent the inflammatory lesions. Topical treatments for acne can produce pigmentary changes. Benzoyl peroxide which is commonly used in over the counter acne preparations, is a bleaching agent and produces lightened skin color with overuse. It can also bleach eyebrows and hair. Tretinoin (Retin A) is usually well tolerated in teens with more darkly pigmented skin. However, it may produce intense inflammation which can result in hyperpigmented patches on the face that are very slow to resolve or hypopigmentation as in the case above. Stronger forms of tretinoin (0.1% cream) have been used to successfully lighten post inflammatory hyperpigmentation from acne in adults with 40 weeks of nightly treatment.
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Traction Alopecia
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