Brief Answer:
Advice regarding pigmentation and dark circles

Detailed Answer:
Hello. Thank you for writing to us at healthcaremagic

I have gone through your query and I have understood it.

You seem to have a condition known as Melasma.
Melasma commonly presents with brownish or dark colored patches on face, commonly cheeks/ malar prominences, dorsum of nose. Forehead, chin and upper lip may also be involved.

Sun protection is an important part of management of melasma.
A sunscreen should be used throughout the day.
It should be broad spectrum i.e should have both UV A as well as UV B coverage and should be reapplied every 2-3 hours.

At night you may use a pigment reducing cream containing one or more of the following ingredients like kojic acid, hydroquinone, glycolic acid, tretinoin, azaleic acid, fluocinolone acetonide etc.

The mode of action of these pigment reducing creams is either exfoliation of existing pigment Or inhibition of synthesis of new melanin Or both.

The cream that you have been asked to use is a combination of 3 ingredients i.e tretinoin, hydroquinone, fluocinolone acetonide.
It is a gold standard combination for treatment of Melasma and very effective in Melasma.
This combination of ingredients is commonly prescribed during the initial treatment of melasma i.e the first 8-10 weeks or so.
This combination cream should never be used around the eyes/ for dark circles, because it can cause irritation of delicate skin of this area.

This combination cream should never be used without the supervision of a dermatologist and never for more than 8-12 weeks regularly because it can cause side effects like acne, skin thinning, sun sensitivity, hirsutism etc.

My advice would be to continue with this cream (combination of tretinoin, hydroquinone and fluocinolone acetonide) for 8 weeks or so, by then significant improvement would have been achieved in your Melasma and then your doctor can switch over to other options like either kojic acid, azaleic acid or glycolic acid etc which are safer and can even be used over longer run without risk of side effects.

Regarding your second concern of dark circles, I must say that it is a difficult proposition to treat dark circles because the darkening is actually not always due to excess pigment as is commonly believed.
However, skin lightening agents do seem to help in some of the patients.

Hereditary seems to play a significant role in dark circles. In allergy prone individuals, a condition or state of 'atopy' exists & these atopic individuals more often than not manifest with 'dark circles' under the eyes.

Other factors that may be responsible for dark circles are subcutaneous vasculature shinning through thin under eye skin, sagging of skin.

Dark circles also depends a lot on your lifestyle pattern--diet, sleep, computer / TV use and stress.
Stressors/ Eyestrain due to working for long hours on computers & lack of sleep play a major role too as do Lack of regular and adequate sleep (6-8 hours).

In some individuals dark circles may be due to thin under eye skin as I have already mentioned; thin skin makes the blood in the blood vessels shine through and hence this appears dark.

Another important cause of undereye dark circles is Iron deficiency Anemia.

pigment reducing creams containing glycolic acid, kojic acid, Vit C can be helpful in reducing the appearance of dark circles. The same creams would also work for Post-inflammatory Hyperpigmentation on face.

Glycolic acid and Arginine peels are the two commonly used peels by dermatologists for undereye dark circles. You can try a few peeling sessions (6-8 sessions).

As can be judged from some of the reasons cited, good hydration, regular 6-8 hours of sleep, addressing stressors and a multivitamin and Iron supplement by themselves will go a long way in correcting this issue.

Regards
take care

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