Hi,

Thanks for writing to us.

From the description it seems, you are having melasma. Melasma may occur in pregnancy and involves cheeks, nose, forehead etc.

The response to treatment depends upon the depth of pigmentation. If pigmentation is light brown then its superficial and response will be better and fast. If the pigmentation is dark, slate grey or blue , the response will be varied.

You have used many pigmentation reducing creams but I would like to know
for how long have you used them.

If there was a response with these creams, If after getting response, there was a recurrence due to stopping of these drugs. How do you apply these medications or how many times have you used these.

If you take oral contraceptive pills or have sun light exposure or taking any other medication for any disease or having thyroid disorder.

Please answer these queries and if possible attach an image of your pigmented area, so that I can provide best personalized treatment plan to you.

Hoping to hear from you soon.

Take care,

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Hi,
Thanks for providing me with details.
The dark area over nose seems to have increased after laser sessions due to post inflammatory hyperpigmentation.
I can understand your concern when despite using every available product for melasma, you did not achieve remarkable response.

I would like to offer you a treatment plan that might work for you.
Firstly continue with sunscreen and stop sefpil cream.
Take tablet pinodin tx one tablet daily. Its a tranexemic acid and procynathidin based tablet and results show it has quite a good response in pigmentation.

Buy three creams separately- hydroquinone 4%, hydrocortsisone cream and tretinoin gel 0.1%. take equal and small amount of these three, mix with your fingers and apply over affected area. The amount applied should be very less. Initially for first week, use it on alternate nights. Then from second week every night. If in case redness or stinging occurs please decrease the concentration of tretinoin and hydroquinone and increase hydrocortisone. However if the cream is used judiciously in small amount and not rubbed vigorously, chances of irritation are less. After three weeks we will make a slight change and then you will need to apply hydroquinone 2% and tretinoin 0.05% mixed in equal quantities and applied every night for two weeks. Though this sounds a bit cumbersome but it works in resistant cases.
If in case the response is suboptimal after five weeks,I will prefer adding few sessions of spot trichloroacetic acid peels. Here we apply TCA only over pigmented areas. The compund therapy should give you results.
I would advise you to follow these steps and get back to me for follow up after a month.
If in case you have any doubt please write back for clarifications.
Regards

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Hi,
Thanks For writing back.
You can take pinodin Tx at any time however it should be a fixed time in a day.
Take it atleast for two months.
Right now i will just advise medical treatment, let us see the response after three weeks and then we can decide for spot TCA. Prior to any peels, priming of skin should always be done with pigmentation reducing creams for better results. So either way we have to begin with medical treatment first.
Spot TCA peels can be taken at any dermatologist's clinic or at any cosmetic centre like XXXXXXX skin clinic etc.
Hope that helped you
Take care

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Hi,
Apolpogies for the delayed response.
Pinodin Tx is a product by NEX GEN RX PHARMACEUTICAL COMPANY. You may ask your chemist to arrange for the same. Unfortunately only this pharma company manufactures the said product, so I cannot suggest you an alternative. As Bangalore is approachable to you, you may get it from there.

Hydroquinone 4% is available as melalite forte cream( abbott pharma)
Hydroquinone 2% is available in combination with tretinoin as Melalong( XXXXXXX pharma), skinlite ever, melapik ever etc/
Hope that helped.
Take care

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