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White patch on the face after using Betnovate for allergy. Will the patch go off?

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Dermatologist
Practicing since : 1996
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after i applied betnovate on my face to reduce the allergy (only 1 time), the allergy reduces. However, the area where i'd applied betnovate appears to be a big white patch. What should i do? my main concern is will the white patch goes off or it'll be there forever?
Posted Tue, 17 Apr 2012 in Skin Hair and Nails
 
 
Answered by Dr. Bharat Chawda 45 minutes later
Hi!,

Thank you for posting the query,

Betnovate is a steroid cream (betamethasone ) & it has a anti-inflammatory action on skin.I am happy that you had applied it only once ,since its a potent steroid cream and should not be used on face, even though it works good on any kind of allergies.

Because of its anti-inflammatory action it can leave a hypo-pigmented patch(white patch) on skin once the actual lesion has healed. This would become normal to skin color on its own but may take some time .You should just use a good moisturizing cream over the area couple of times a day.

Since face is an exposed area of the body the chance of recovery would be fast and good.

Hope I have answered your query, Should you have additional concern regarding the same ,I would be happy to address it.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: White patch on the face after using Betnovate for allergy. Will the patch go off? 24 hours later
Hi Dr,
Thanks for replying my query. I would like to consult you further.

I went through Fotona Laser to remove my pigmentation about 2 weeks ago (21st december 2011). After 5 days (25th decemeber 2011), the scab dropped off and the skin of my face become red in color untill now. The Dr gave me a few creams to apply in hope to reduce the redness. However, i am allergy to all the creams that the Dr gave me, and therefore she asked me to apply betamethasone. She refused to tell me the active ingredients of those creams so i do not know what ingredients i am allergy to.

My concern is WILL THE REDNESS DISAPPEAR and HOW LONG WILL IT TAKE? I am applying fucidic acid at the moment as i really don't know what to do with it anymore. My husband (a GP) asked me to stop applying anything and let it heal by itself. But without applying anything, my skin become very dry and red. :( Should i listen to him? Or should i "just use a moisturizing cream over the area couple of times a day" as you mentioned above? Any good moisturizing cream that you could suggest? Does Ezerra (Active ingredients: Stimutex AS & Saccharide Isomerate) help?
 
 
Answered by Dr. Bharat Chawda 34 hours later
Hi,

Thank you for the follow up.
As I believe that more information can help a physician arrive at an accurate diagnosis, I would request you to answer the following questions:
•     There are different varieties in Fotona laser like Nd:Yag ,Er:Yag etc. Which one you had undergone and for which condition?
•     If you had undergone Q-switched Nd:Yag laser, then which wavelength was given to you (532nm or 1064nm)?
In any case, redness can be normally expected following laser treatment. At times doctors sometimes prescribe a steroid cream to take care of the redness, but steroid withdrawal can again lead to rebound redness. So it is better to avoid steroid cream, but if at all a steroid cream is required, then a mild steroid cream (like hydrocortisone) can be used for only few days.

The safest option following laser treatment is using an Aloevera cream which would gradually take care of the redness. If the redness is severe, then a vitamin K cream can also be used if available. If the above two options are not available, then it is advisable to just stick with a moisturizer cream and a sunscreen daily.

In any case, using a sunscreen is a must since you have undergone a laser for pigmentation. Don't leave the skin as it is as direct sun rays would lead to hyper-pigmentation.

I would not recommend Ezerra cream either.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns, I would be happy to address them.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: White patch on the face after using Betnovate for allergy. Will the patch go off? 32 hours later
Hi Dr,
Thank you so much for answering my queries. I have further doubts that I would like to seek for your professional opinion.

As the Dr is not helpful, i do not know what setting did she used for my laser. I remmembered she told me there are a few ways to remove pigmentation: 1) laser once and for all, formed a scab and drop off; 2) required few times laser but with no down time. She suggested me the first choice and i innocently agreed with her. Have i made a wrong decision?

Today i noticed that the redness reduces but it turns into brown @_@. Is the brownish color supposed to be the part of the healing process? Or it has become a SCAR OR PIH??? Will the brown color disappear? Does it mean that i have to redo the laser? I am so sad, worried, and helpless.

I tried to search for the Vitamin K cream that you suggested but i realized that it is not available in my country. One of the pharmacist suggested me Vitamin E cream, saying that it gives almost the same effect as Vitamin K. Is it true? Since i have no choice, I bought it, tried once, and luckily i'm not allergy to it. Will it help in reducing the redness and/or brownish color on my face? Should i continue? Will IV vitamin C helps?

Thanks and best regards,
XXXXXXX.

 
 
Answered by Dr. Bharat Chawda 2 hours later
Hi!XXXXXXX,

Thank you for writing back,

Since the type of laser used in not known and the condition which you previously had in also not known ,it would be difficult to guess the out come of laser.

If you had undergone laser for melasma (pigmentation over cheeks ) ,then the results are always very depressing.

In any case you should not repeat the laser session .Wait till it heals properly.We usually wait 6 weeks before going for a second session.

Yes there are time when while healing post laser(redness) there is brownish pigmentation(PIH-post inflammatory hyper-pigmentation) .And this is the reason we recommend strict sun protection and use of sunscreen.PIH usually goes off by itself ,but take at-least 4-6 months time .You can speed up the recovery using hydroquinone cream over the brown patch.

But since at present there is redness I think you should either use elovera cream or just a moisturizer (Sunscreen being the must).

Vit E is an anti oxidant ,might not harm you ,but won't help much in redness either.

Vit C would help only to reduce brown pigmentation ,but not on redness.

Since Vit K is also not available, you can just stick to a moisturizer/Alovera cream/vit E cream and a sunscreen .

Also that your doctor is not helpful,you can consider consulting and showing some other laser specialist .Looking at the lesion clinically and assessing is very important here .One of the experts in lasers whom I know is Dr.Niwat Polnikorn in Bangkok whom you can consider meeting personally.

I hope that the suggestion would be helpful. In case you need further guidance you can write back to me .I would be happy to help you.

Please accept my answer in case you do not have further queries.

Regards,
Dr.Bharat chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: White patch on the face after using Betnovate for allergy. Will the patch go off? 12 hours later
Dear Dr,

Thanks for the details and useful information.

I remmebered the 1st cream tat the dr gave me was a hydroquinone cream. Instead of reducing the redness, it makes my skin even more red. @_@ The Dr changed another cream for me and it makes my skin even worst. Small blisters appeared after 20 minutes and they were itchy. I asked her what's the cream but she didn't tell me. She just asked me to apply betamethasone so i do not know what active ingredient i'm allergy to @_@. Any other suggestion? Or should i just stick to vit E and sunscreen? I'm using spf 25. Is it enough? Is applying make up advisable? And yea you are right dr, my pigmentation is on my cheek, one of the most visible area. I really wish the red & brown color will goes off asap as you said.

I am from Malaysia. Do you know any good skin specialist/ dermatologist in my country?

I went through your profile and noticed that you were graduated from Manipal in 1996. My husband was graduated from Manipal in 1996 too . What a coincidence :) Maybe you and him know each other?

I also noticed that you are expert in treating hair loss. I don't know why recently (only recently) my scalp started to become oily very easily. Because of this, I have to wash my hair everyday. I feel scared seeing all my hair falling everytime after hairwash and during hair combing. I started using Biothymus from Rottapharm. Is there anyway to control the oily hairscalp and hairfall?

My apology if i asked too many questions. Thanks for being so patient to me. You are an awesome dr.

Thanks and best regards,
XXXXXXX.
 
 
Answered by Dr. Bharat Chawda 2 hours later
Hi XXXXXXX,

Good to hear from you again,

I am happy to see that somebody so far is linked with Manipal. Manipal has always been very close to my heart. Actually I did my post graduation from Manipal in dermatology . I did my under-graduation from a different state. In any case, what is your husband’s name? The world is a small place and I might just know him.
Laser has always been my favourite topic, so I love answering anything related to this subject. You can ask me any number of times, I would be happy to help you out.

Regarding use of hydroquinone, it is never given so early in the course of laser. It is given only when patient lands up with a PIH (post inflammatory hyper-pigmentation).PIH usually happens only when redness has subsided. It is true that if hydroquinone is used early then it would aggravate redness.
In fact hydroquinone can be used much before undergoing a laser treatment as a priming agent. It takes care of the extra tanning of skin.

I think you can use Vitamin E and a sunscreen at the moment and just wait and watch. An alovera cream can also help in the same way. If at all there is any relapse of pigmentation, then you can start with hydroquinone cream .

Well, I don't know anybody personally in Malaysia who is in to lasers. But you can Google a dermatologist who is also involved with lasers. A dermatologist would be in a better position to help you in your case.

As far as hair loss in females is concerned there are number of reasons .It can be due to
•     Stress
•     Familial
•     Hormonal disorders
•     Deficiency of iron/haemoglobin or zinc and copper.
One needs to take a combined approach here i.e. supplementing you with iron, zinc and biotin in oral form. Locally, you can use minoxidil solution (2%) over the scalp twice a day.
Also, improve your diet by adding lots of XXXXXXX vegetables, protein, fresh fruits etc. Good sleep and plenty of water also help a lot.

I wish and hope that you recover soon.

Wish you good health.

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: White patch on the face after using Betnovate for allergy. Will the patch go off? 21 hours later
Hi Dr XXXXXXX

My husband's name is XXXXXXX. :) He loves india too. He travels to india almost every year. I've been to india once for 3 weeks but i suffered from AGE for 3 weeks, and i lost 5 kgs in 3 weeks too. :) I hereby enclosed our email address to you in hope that we can keep in touch in the future. Maybe we can pay you a visit when we visit india someday?
My email address: YYYY@YYYY .
My husband's: YYYY@YYYY .
Do you have facebook? If you do, you can add us by using the same email address.

Can i have Dr.Niwat Polnikorn's (in Bangkok) contact number and address as well? Just in case i need to do laser again in the future, i might consider flying to bangkok.

Thank you once again dr XXXXXXX for your useful advice, I am so happy to know you. You are awesome!

Thanks and best regards,
XXXXXXX.
 
 
Answered by Dr. Bharat Chawda 2 hours later
Hi XXXXXXX,

Thank you so much for the compliments .You have been a nice patient too and liked interacting with you. I'll try to be in touch with you through facebook.

I think I've a short memory, unfortunately, I can't recall your husband’s name. In any case, I would be very happy to XXXXXXX you any time when you are here in India.

As far as getting in touch with Dr.Niwat is concerned you can follow this link

There is one centre in Singapore by the name Nation skin centre, which is also of good repute if it suits you .There is a long list of doctors there, but you can consult Professor GOH Chee Leok there. He is an expert in lasers. You can check this link:
WWW.WWWW.WW sg/showpage.asp?id=19

I hope this information helps you.

Wish you good health and good luck.

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: White patch on the face after using Betnovate for allergy. Will the patch go off? 21 hours later
Hi Dr XXXXXXX

Thanks for the links and information, they are useful. :)

Can I ask you regarding dark circle? I have servere dark circles. I tried peeling, microdermabrasion, and RF before but they don't seems to help much. Should i go for laser? Any better suggestion? I'm currently using vitamin c + hyaluronic acid eye cream and i do not see dramatic improvement as well. Any better eye cream that you could suggest?

By the way, do you mind to give me your email/facebook address so that we can keep in touch in the future? Where is Bhilai? Is it far from Bangloore? If you come to Malaysia, you can contact us too. We will be more than happy to XXXXXXX you.

All the best to you :)

Thanks and best regards,
XXXXXXX.
 
 
Answered by Dr. Bharat Chawda 9 hours later
Hello.

I will definitely try to contact you whenever I visit Malyasia. It would be pleasure to XXXXXXX you and your family.

Now, as far as dark circle is concerned, it is always very resistant to treatment. I can say that it is something which can destroy the reputation of the most reputed doctor. But there still lot of options.

I think you have already tried good options like chemical peeling and microdermabrassion. Vitamin c and hylarunic acid are also good for the same. There are various reasons for dark circles like stress, lack of sleep, iron deficiency (low hemoglobin level), lack of water intake, sun exposure, familial, etc.
One has to work on all these factors. Also use a good SPF sunscreen daily thrice.

You can also try tretinoin cream and hydroquinone cream at night, but you need to be careful using it as it can cause redness and peeling of skin.

Lasers is also one good option. Since there are various types of lasers available for pigmentation, I would suggest you to go for Q-switched Nd:yag laser. Under experienced hands lasers have some good chances for the results. If you are planning to go to Bangkok to XXXXXXX Dr.Niwat, you might as well get the laser done there. I am sure they would be having Q-switched Nd:yag laser with them.

Try to get good sleep and drink plenty of water, this would increase the hydration of the skin below the eyes.

Hope this helps you. Please accept my answer in case you have no follow up queries.

Wish you and your husband good health.

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
Follow-up: White patch on the face after using Betnovate for allergy. Will the patch go off? 2 hours later
Hi Dr XXXXXXX

Thanks for the advice.
Some dr said microdermabrasion helps in pigmentation, but i don't see any drastic effect on my pigmentation. Maybe slightly lightened but it doesn't disappear. That's why i ended up with laser. Is it advisable to do MICRODERMABRASION AFTER LASER? By the way, I am curious to know how much does your hospital charge for laser?

I started to apply vitamin c + hyaluronic acid EYE CREAM on my FACE at the LASER AREA @_@ IS THAT OKAY? Since you said vitamin C helps in pigmentation and vitamin E helps in reducing redness, i thought of using combination of both.

I read through some articles regarding hydroquinone. FDA claims that it is carcinogenic and it's banned in some countries. I just bought 1 hydroquionone 4%, thought of using it in the future but now i hold back because of this statement. Is the statement true? Will hydroquinone 4% caused HYPO-PIGMENTATION?

I take multivitamins everyday. I looked through the ingredients and noticed that it does consist of iron, zinc, copper and biotin. But still my scalp is oily. I really have no idea why all of the sudden my scalp turns oily and hair started to drop drastically. Maybe I should change my shampoo? Or should I increase my multivitamins dosage? Or should i eat less oily/ cheesy food? Recently i eat a lot of cheese in hope to gain weight (I am only 40kgs @_@). Oily hair scalp is really annoying. I miss my dry scalp.

This might be my last follow-up question to you in XXXXXXX Thank you once again for everything. I hope to keep in touch with u through fb in the future. All the best to you and your family. :) Looking forward to hear from you soon.

Thanks and best regards,
XXXXXXX.
 
 
Answered by Dr. Bharat Chawda 3 hours later
Hi!XXXXXXX,

I have to appreciate you that you really keep yourself updated regarding the level of treatments and side effects of the creams.

Microdermabrassion is not a good option for pigmentation ,in-fact its out dated now a days.Also that it should not be immediately followed by laser .There should be a interval of at least 4-6weeks between the two.

The charges in my hospital (or in India) would depend upon the type of the laser used .Normally for a pigmentation over cheeks would cost INR 2000/- Rs per session ,but would vary from city to city.

On the laser area you should apply vit c or hylorunic acid only if the brown pigmentation has set in .Otherwise just a sunscreen and a moisturizer is good enough.You can use Vit E also over the red area.

Now regarding hydroquinone being banned in some of the countries is absolutely right because of its tendency to cause de-pigmentation and sensitivity to light.But this holds true only to those who use a very high concentration (20%).The cancer part is yet to be proved in humans.
Over use of this cream has also shown to cause ochronosis which means rebound pigmentation and darkening of skin .It has been banned in japan , Australia and Europe for this reason.But the cream is very popular in Asian countries and has been used in our country too with good result and we haven't come across any such side effects.A 2% cream is used as an OTC in US.

I would advise you that you can use it comfortably ,but just don't over use it.And the 4% cream would be slightly higher for the under eyes ,instead use a 2% one.Use it at night time only ,and don't forget to use a good sunscreen in the day time.

As far as hair loss is concerned ,zinc ,copper,biotin & iron are good but then won't help to reduce the oiliness of scalp.You need to use a good shampoo twice a week for that.You can change you shampoo ,but increasing the dose of vitamins won't help at all. Neither would change in eating habits help here.

If it is really annoying you then probably oral retinoids can help you .Now I would like to make one thing very clear that it would be a off line indication of oral retonoids ,since it is actually used for acne (pimples) and to reduce the oil from the face.It does work on sebaceous gland to make ones face dry.I've tried on few patients with similar complaints as yours and had pretty good results.But retinoids has to be taken very cautiously and needs lots of precautions while on it.So kindly consult your dermatologist for this off line indication and only take if he recommends you.A very low dose is what I prefer in such a case.In my practice its a very day prescription for acne patients.

I thank you again for submitting your question. I hope you found my response to be helpful and informative.

Good luck,

Regards,

Dr.Bharat Chawda XXXXXXX specialist, Dermatology.
Above answer was peer-reviewed by
 
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