Brief Answer: details below Detailed Answer: Hi XXXXXXX Thanks for writing to us. I have seen the images attached. Your skin looks pigmented, dry and coarse. So we basically need to use right products that would hydrate your skin, reduce pigmentation and improve texture of skin. Before I could suggest a treatment plan for you, I would like to know If you suffer from eczema, dry skin, any skin allergy, frequent cold or asthma If you have dandruff If you have pigmentation at other areas like neck, underarms, inner side of thighs If your periods are regular If your weight is towards higher side Medicines, creams, treatment taken so far Any other skin condition or medical condition that you are having like polycystic ovarian disease. Answer these queries, so that we can discuss a suitable treatment plan for you. My email id is YYYY@YYYY Hoping to hear from you soon. Take care

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Brief Answer: details below Detailed Answer: Hi XXXXXXX Thanks for providing me with all your treatment details. Firstly, please continue with medicines suggested for PCOD. Also exercise daily to reduce weight. PCOD leads to hormonal imbalance and can precipitate or cause skin pigmentation too. Had you visited my clinic, I would have suggested you to use 1) An oral antioxidant like antoxid HC, one capsule daily with oral vitamin c 500 mg twice daily(limcee/celin tablet) 2) use a mild face wash and moisturiser like cetaphil 3) Sunscreen use is mandatory in morning- ansolar sunscreen SPF 30/ photoban/rivela etc. 4) Initially for a week apply hydrocortisone(efficort) cream over face twice daily to reduce any dryness, sensitivity or irritation over face and then she should start with Rejuglow gel or kojivit plus gel once in day time( should be applied when indoors) and in night mix hydroquinone 4%( melacare forte cream), hydrocortisone and tretinoin 0.1% cream(supatret/nexret) in equal quantities and apply full face half an hour prior to sleeping. These creams should be used in smallest quantity possible as may induce irritation and redness. These creams are to be applied around eyes too. To avoid any irritation, use it in small quantity possible and keep face very well hydrated. The above mentioned treatment should be followed atleast for two months with minor changes like after 15 days, hydrocortisone cream should be stopped and after a month we will reduce tretinoin strength from 0.1% to 0.05%. As such many triple combination creams are available containing hydroquinone, tretinoin and a steroid but the strength of these medicines required in your case is high thats why I have not suggested any such preparation If not much response is achieved with the same, we may add sessions of glycolic acid 50 % or Trichloroacetic acid peel 10%.. Hopefully this would give you some response. As these medicines can induce irritation or redness, it is better that you remain under a dermatologist's follow up to supervise the treatment properly. Hope this helped. Take care

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Brief Answer: details below Detailed Answer: Hi, Thanks for writing back. I will answer your questions specifically. Antioxidants alone do not reduce pigmentation but have an indirect role in preventing sun damage, improving skin texture and tone. Vitamin C intake as 500 mg twice daily can be taken. Combination of procyanathidin with tranexemic acid is available(pinodin tx tablets) in recommended doses for melasma and can be taken two times in a day. Similarly collagen and hyaluronic acid is available in recommended dose combination and should be taken two times in a day( tablet collahyal). Procyanathidin and tranexemic acid are said to have role in reducing pigmentation while collagen and hyaluronic acid present in connective tissue of skin maintain good skin texture and prevent skin ageing but has no role in reducing pigmentation. Personally, I do not prescribe collagen oral supplements as it has a questionable role as an antiageing product. I have seen the images attached and still her skin looks dry at places that is why I had advised that she should use hydrocortisone cream( mild steroid, suitable for face for few days). Even though she has used HQ 8% and tretinoin 0.05 %, I would suggest that she apply HQ 4% mixed with tretinoin 0.1% in night as the combination would be stronger than creams applied alone as when these medicines are combined and applied, these potentiate each other's effect. Moreover even if you plan to take sessions of peels or lasers, daily topical cream application is required as a priming agent to achieve better results with peels or lasers and to maintain the results achieved so far. Sunscreen use as said earlier is mandatory to prevent tanning over face and other exposed areas. Personally, i would have done glycolic acid(50%) or trichloroacetic acid ( 10 percent to 20 %) peels over your daughters face. Similarly for other exposed body areas glycolic peel 50 percent to 70 % would be required. Glycolic acid 30 percent is too mild. Combination peels like glycolic acid combined with yellow peel gives good results too. Lactic acid 90 % is used in pigmentation cases. I prefer this peel only as a maintenance therapy and in cases where people have sensitive skin. Personally I havent received encouraging results in melasma with this peel. I know you have tried everything but still I. would advise that you give my treatment suggestion a try. As far as lasers are concerned, Q switched laser offers good results in pigmentation. So if you plan further sessions of laser, just stick to q switched laser. As Far as pre and post care with peels are concerned. Prior to peels, all the topical medicines should be stopped atleast five days to a week before peels and should be restarted again after a week of peeling session No parlour procedure like threading, bleaching should be done prior to peels After peels, use a good sunscreen and moisturiser daily. Avoid sun exposure Avoid salon procedure for a week Avoid applying make up Avoid bleach and scrub over face Avoid cooking meals for a day or two as direct heat from burner may irritate skin Avoid strenuous exercise or excessive sweating for a day or two as sweat too may irritate skin Avoid any other procedure like laser etc immediately after peels. Basically the most important post peel care is strict sun avoidance and use of sunscreen. Hope this answered your query. Take care

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Brief Answer: details below Detailed Answer: Hi, Thanks for writing back. 1)Cetaphil face wash is from Galderma. Kojvit from micro labs and collahyal tablet from nexgen Rx. 2) Kojivit gel can be used for dark circles too. 3) The best prevention for develoment of new stretch marks is losing weight. Old stretch marks can be treated with tretinoin based creams, glycolic acid creams, lasers, dermarollers with peels. 4) After two months depending upon the response, we may either continue the same for another four months or replace it with mild glycolic acid/azaelaic acid/kojic acid cream 5) As such the creams would be safe to use. The only reaction could be redness, irritation or burning sensation. This occurs if skin is dry or cream is used in excess. So keep the skin well moisturised and apply the creams in very small amount.. If in case redness occurs, withold cream and use moisturiser to soothe skin. Once redness is gone, creams can be reintroduced in smaller quantity Sun protection as I have stressed earlier too is mandatory. Right now just follow a simple regimen. Do not take peels or lasers. Just continue with topical creams. Also keep realistic expectations, that is reduction in pigmentation and improvement in skin tone and texture. Hopefully, you should have desirable result with suggested treatment. Wishing you merry christmas! Take care

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