Brief Answer:
Sunscreen + pigment reducing creams

Detailed Answer:
Hello. Thank you for writing to us

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

First and foremost you must use a broad spectrum sunscreen, on all exposed skin including face, throughout the day i.e every 2-3 hours. Neutrogena's ultrasheer dry touch sunblock with an spf of 50+ is one such example of a broad spectrum sunscreen and would be available over the counter.

A sunscreen would be protective not only against rosacea but is also an essential part of treatment of pigmentation elsewhere.

At night you may use a cream containing one or more of pigment reducing agents like glyolic acid, kojic acid, hydroquinone, tretinoin, topical steroids etc on areas which you feel are darker than your normal skin tone.

Mechanism of action of these pigment reducing agents is by either exfoliation of pre-existing melanin Or inhibition of synthesis of new melanin Or both.

Side effects of these creams include irritation and redness in some patients and therefore they must be used only under supervision of a dermatologist.

I request you to upload a few images of the affected areas so that I am able to have a better judgement about your concern and therefore guide you better.

You may upload Images either at "Reports Section"

Or

You may also mail me the Images at YYYY@YYYY with the subject line of this mail as Attn: Dr. Kakkar.

Regards

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Brief Answer:
Alpha Hydroxy Acid skin lightening gel Or Yellow peel

Detailed Answer:
Hi.

I have reviewed the Image.
Apart from the sunscreen which I mentioned in my previous reply I would suggest that you use a product by Dermatologic Cosmetic Laboratories (DCL) i.e AHA lightening gel, initially once daily at night for a week and thereafter twice daily.

It is available online:

http://www.dermstore.com/product_AHA+Lightening+Gel_23541.htm#reviewAnchor

Sunscreen should be used through out the day, every 2-3 hours, specially if you are outdoors.

Apart from this you may also take a few sessions of chemical peeling from a dermatologist.
The peel which I suggest is Retinol CT peel, also commonly known as Yellow peel. It is also a skin lightening peel.

Please make a note that if you would be using the DCL AHA lightening gel you should leave a gap of about 1 week before going for the Yellow peel and vce versa because if you are already using the cream and also take a peel simultaneously there might be irritation i.e you cannot use both of these together.

So the best thing would be try one of these at a time and not together i.e either a Yellow Peel Or DCL AHA lightening gel.

Regarding itching I would suggest that you take an OTC oral antihistamine e.g Cetrizine 10 mg tablet once daily in evening.

A soothing lotion e.g calamine lotion would help calm down the itch.

Regards

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Brief Answer:
Sunscreen+pigment reducing creams+chemical peeling sessions will help

Detailed Answer:
Hi.

Yes, sunscreen during day. Reapply every 2-3 hours, specially if outdoors.

The AHA lightening gel from DCL contains glycolic acid 10% and hydroquinone 2%. This is a really effective combination of skin lightening agents.
This product is an entirely cosmetic product and though it is available online but it should always be used under supervision of a dermatologist to avoid any side effects like irritation, redness etc..
Kojic acid is also a pigment reducing agent but it is not present in this particular product.

Chemical peel is a common procedure performed by dermatologists. Cost would vary from doctor to doctor and the type of peel.
I have suggested yellow peel (retinol peel) for you.
Your doctor may suggest a different peel e.g glycolic peel or nomelan phenol peel after he/she has a look at the severity of pigmentation.
All these peels are meant for reducing pigmentation.

Number of chemical peeling sessions too would depend on the severity of problem.

In general one can expect that 4-6 sessions of chemical peeling would produce a good result.

Please make sure that if you would be using the DCL AHA lightening gel Or any other skin lightening topical product you should mention that to your doctor beforehand before a peeling session.
If you would already be using a cream that contains peeling agents like glycolic acid it is advisable to give a wash off period to your skin of about 1 week before going for a chemical peel session in order to avoid irritation.

I am personally not aware of doctors in XXXXXXX
You may visit a doctor of your own choice particularly the one who specializes in cosmetology.

Regards

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Brief Answer:
FabIndia Depigmenting cream is also a good option

Detailed Answer:
Hi.

There is no XXXXXXX website that delivers AHA lightening gel free of cost. This product is available on XXXXXXX com but then there are additional shipping charges.
Nevertheless, DCL AHA Lightening gel is imported, marketed and distributed all over XXXXXXX by Zap healthcare Pvt Ltd.
I can provide you the contact number of distributor. Let me know your email ID so that I can mail you the number.

Alternatively you may also try fabIndia depigmenting cream.
This product from Fabindia contains kojic acid as the main active ingredient along with Vitamin C.
Kojic acid is also a pigment reducing agent just like glycolic acid and hydroquinone.
Kojic acid is preferred for sensitive skin because of its low irritation potential.
You may try this product along with chemical peels.

Regards

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