Brief Answer:
Need more information+picture

Detailed Answer:
Hello and welcome to healthcaremagic

I am Dr. Kakkar. I have gone through your query. I would like to gather some more information from you in order to be able to help you better.

-Is the patch scaly?Or is it smooth and level with the skin?
-Does it be comes raised/swell up, when you scratch it?
-Can you upload a picture of it, so that I can have a better idea after looking at it?
-Let me now the medicines which have been on for it, in the past.

Regards

---

Brief Answer:
Possibility of fixed drug eruption

Detailed Answer:
Thanks for the picture.

I would keep a possibility of Fixed Drug Eruption. This type of drug eruption commonly happens to drugs like pain killers, antibiotics etc. As the name indicates, the eruption is fixed in its occurrence. Everytime upon intake of the implicating drug, the patches becomes more prominent as well as red and inflammed and itchy.

I would like to know from you, whether is there any relation of the appearance of these patches after intake of a particular drug e.g pain killer, antibiotics(commonly suphonamides/ penicillins and quinolones like ciprofloxacin/ofloxacin and nitroimidazoles like ornidazole) etc?OR in other words do you remember taking any drug/medication before these patches appeared?

Elocon (mometasone furoate) is a good option for these patches but since the pigmentation is deep therefore treatment take months to show visible results. The more important thing is to identify the culprit drug/medication and stop it OR else you will keep having the eruptions again and again at the same sites, whenever you take the responsible drug.

Clindac-A gel is an antiacne medication and won't work for the hyperpigmented patches.

regards

---

Brief Answer:
Treatment of pigmentation

Detailed Answer:
Hello

You could use a broad spectrum sunscreen, throughout the day.

Sun protection is an essential part of the management of any pigmentation over face and other exposed areas. A good sunscreen should have broad spectrum UV A coverage in addition to UV B coverage, in order to be able to prevent su induced darkening and it needs to be applied in sufficient quantity and every 2-3 hourly.

A sunscreen with minimum 30 SPF would be adequate. It should mention both UV B and UV A coverage. Therefore it is important to select the right sunscreen for desired effects

It should be applied in the following quantity:
--3ml for face and neck(a little more than 1/2 teaspoon)
--3ml for each arm(a little more than 1/2 teaspoon).

A sunscreen should be applied every 2-3 hours.

Neutrogena Dry Touch Ultrasheer Sunscreen is available OTC. It is broad spectrum, non oily and non greasy.

At night, you could use a cream like Melalite-XL OR Clearz-Max for the patches. It is a triple combination of hydroquinone, tretinoin and mometasone. It is the gold standard combination for hyperpigmentation. However, this cream can cause irritation, therefore you need to apply it as a thin film for just 2 hours at night, wash your face and then apply Elocon for the whole night.

You can use this combination along with elocon for a month or so and you will notice improvement. Always use a sunscreen during day time.

I am still very convinced that this is nothing but Fixed Drug Eruption(FDE). FDE can happen to common day to day medicines like Paracetamol, Bruffen, Antidiarrheals etc which are found in every household and some times the patient does'nt even realize that a particular drug is causing it. You said that you take medicines only when it is really required, but that is good enough for FDE(you don't need to take a medicine daily for FDE to develop, just a single dose is enough to cause the patches of FDE) and it can happen to common medicines used for fever, cough and diarrhea etc.

regards

---