Brief Answer: Kindly send details & high resolution pictures Detailed Answer: Hi, Welcome and thanks for posting your query to healthcare magic. I can understand your concern towards PIH and dark circle problem in yourself. I can make out that you are young female of 28 years and the problem is present from last 10 years when you were only 18. For a female it is really bothersome to have any unwanted thing on body and especially face is the most important of all. I am really surprised to know that you have taken multiple types of treatment in last 10 years of problem including the latest of modalities including lasers. Before I can answer your concern can you please take pains in letting me know certain important information: 1. Can you tell me about your occupation/ job profile, daily schedule and personal life. 2. Sun exposure or computer activities per day. 3. Your dietary schedule. Do you take plenty of fruits and green vegetables. 4. Sleep pattern and any history of stress. 5. Tell me about your location (city and country) so that local medicines can be suggested. Most important of all- I humbly request you to kindly send few good resolution pictures of the face area ( both the side and front) so that it can be analyzed best. You have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries better. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). "Wish you good health" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)

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Brief Answer: Facial Melanosis; sun protection- most important Detailed Answer: Hello young lady, Thanks for uploading your pictures and important information. After thoroughly interpreting the complete condition and analyzing the pictures I can make out that you have the condition called as “Facial Melanosis”with Periorbital Melanosis. Futher detailing- There can be a possibility of either “Riehl’s Melanosis” or “Lichen Planus Pigmentosus”. Both of the above “Riehl’s Melanosis” & “Lichen Planus Pigmentosus” are important cause of your type of pigmentation and is actually a very deep pigmentation due to variety of causes including antigens present in cosmetics and textiles, Cosmetic allergens, hair dyes, red XXXXXXX and fragrances with multiple other causes. To tell you simply, the darkness is due to the activity of melanocytes in the skin. These melanocytes are the cells which regularly produces color/pigment known as melanin in the skin. These are superficially present in the upper skin known as epidermis. This is a tendency in ourselves to get higher activity of these melanocytes. That is why it is seen on higher side in people of Asiatic origin than in white population. Secondly face is further darkened by the process known as "Post inflammatory hyper-pigmentation" or PIH. We apply so many of cosmetics and chemical agents but this cause injury to superficial skin. This is type of repeated injury to the skin which causes over production of melanin in the skin. This pigmentation is known as "Post inflammatory hyper-pigmentation" or PIH. I am really empathetic to know that it has even hampered your job profile and despite using latest of modalities of lasers and peels, you were not benefited. Let me guide you first that for a time being period kindly stop doing all the activities of peels and laser or other similar stuff. I know it may sound weird to you but many times I have personally seen that by doing over activity on skin causes lot of harm as well as more aggravation of pigmentation on the skin. I further suggest you to not to go for any type peeling or laser session for atleast next three months. I suggest you simplest of regimen and remedies to help you out: - Photoprotection : Photoprotection is essential, because photodarkening can occur with just a couple of hours of sun exposure. - Life style modification: This entails avoiding peak hours of sunlight (in tropics, between 11 AM - 4 PM), using shady side for activities and making use of sunshades like parasols and broad rimmed hats. - Sunscreens : Opaque sunscreens containing zinc oxide, 10% (and SPF of 30) have dual benefit of camouflaging FM and preventing photo-induced darkening. Always use a sunscreen even if indoors and even in winters. Repeat every 4 hours. - Avoidance of provoking factors : As told earlier, stop any type of cosmetics including peels and other chemical compounds. - Lightening agents: For this in my opinion you can use a cream ( under dermatological supervision) containing Kojic acid with arbutin and mulberry extract in it. Alternatively Azelaic acid gel can be applied over the affected area of pigmentation. These are one of the best and safest creams to be applied. Apply any of these creams in a very thin layer at night time only so that these should not be visible to naked eye. Apply at night time before sleeping. Both of the creams can be use XXXXXXX face as well as under eye areas. - Drink 2-3 liters of water per day. Fresh fruit juices, green leafy vegetables and sprouts can help you a lot. - You can take anti oxidant tablets or even have1 cup of green tea every day. - A very important part of the regimen is to reduce your weight to up to 5 kg. Many a times we have seen fats to be important cause of increase in pigmentation due to hormonal impact. I hope this clears all your doubts. Tell me if you have any further quires. Wish you good health with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)

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Brief Answer: Kojic acid in day and Azelaic acid gel at night Detailed Answer: Hello young lady, Welcome to the forum again. If I were your treating dermatologist then would have prescribed you containing Kojic acid with arbutin and mulberry extract in it ( Clearz ultra alternated with cream Beta-white+Tyrostat +Melanostatine-5 (Advan cream) ) in day time. At night time I would have stated with Azelaic acid gel/cream (Aziderm 10%) started with low concentration and then after one month increased to 20 % (Aziderm 20%). All these cream/ gels should be applied in minimum amount. A pea size amount is sufficient for palm size area. These are to be applied in a very thin layer so that it should not be visible to the naked eye. You must have patience of atleast 3 months to reduce all the pigmentation and to see results. As stated earlier do take care of your diet, reduce weight and give yourself positive suggestions and keep your moral high. I hope this clears all your doubts. If you have any further quires I will be glad to help or if not then can close the discussion and rate the answer. "Wish you good health and glowing skin" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)

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Brief Answer: Vitamin C serum can also be applied under eye Detailed Answer: Hello, The cream Beta-white+Tyrostat +Melanostatine-5 (Advan cream) is from Alembic pharma and is one of the latest of cream which is now available in India. Tell your pharmacy person to get it from the Alembic pharma. All the creams which are enumerated in previous mail can be used for under-eye too with bit lighter application. Alternatively Vitamin C serum can also be applied at night time. "Wish you good health and glowing skin" with regards, Dr. Sanjay Kumar Kanodia (MD - Dermatology)

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