Hi XXXXXX,

Thanks for your question.

Your wife initially developed hyperpigmentation followed by hypopigmentation.

The causes of hyper and hypopigmentation is different.

In middle age married woman most common cause of hyperpigmentation is Addison’s disease. Other causes are melasma, acanthosis nigricans, cushings disease, peutz jegher syndrome, etc.
Hypopigmentation is usually caused by vitiligo and trauma to the local site.

But sometimes rarely vitiligo and Addison’s disease develop in same patients as both of them are auto immune disorder and one develop first followed by others after some years. I wonder if you have any such hormonal disturbances. So I suggest you to consult a dermatologist for detailed examination. The hormone levels can be assessed under the guidance of a dermatologist.

Hope this answers your query. If you have any query further please feel free to ask.

Best wishes,

Dr Sourav Ganguly

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Dear XXXXXX,

I believe that my earlier reply was not very convincing. As a general physician, I have been associated with many dermatology patients, so let me try today to provide you with an useful answer.

A hyperpigmented patch that increases during pregnancy is most probably a melasma. The whiter patches that are noticed recently might be because of two important reasons:
1) Sun damage.
2) Nutritional imbalance

Hormonal problems are common causes for both hyperpigmented and hypopigmented patches. Sometimes because of one of these the other may look hyper / hypo too. So a bright day light examination is very crucial to determine the right treatment. It is good to get few tests done before starting treatment.

The photos can be misleading. They might not be shot under bright sun light.

You can apply Glycolic acid cream available over the counter for short term DEMELAN / GLYAHA at night. You should use SUNCROSS-SPF30 sun screen lotion while going out in the sun. However AHA and Glycolic acid peeling is the most promising treatment done once in two months by the Dermatologist. I do not think any cream would give you convincing results. If you do not wish to waste time and money consulting competent Dermatologist for chemical peeling helps.

Vitamin A and Vitamin E XXXXXXX foods are advised for more beneficial results. XXXXXXX leaves, dark colored vegetables XXXXXXX in carotene and other flavenoids are advised at least five times a week.

Hope this answers your query. If you have any query further please feel free to ask.

Best wishes,
Dr Sourav Ganguly

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Dear XXXXXX,

Thanks for writing back.
Nutritional disorders would include anemia or a more generalized nutritional disorder ( in case your wife is underweight).
Hormonal disorders like Addison's ( when there is insufficient cortisol in the body) may also be responsible. Then there are others like melasma in which progesterone is implicated ( and occurs in pregnancy). However, please do remember that hormonal disorders would also cause several other problems ( like she would feel extremely tired all the time) and need to be looked at as a whole.
If she only has this pigmentation problem and does not have any other problem, I would only suggest a complete blood count ( as anemia is extremely prevalent in women in India).
Also, given that she has had a ring worm infection in the past, post inflammatory hyperpigmentation should also be considered.
I think the best way forward would be to start using a cream with glycolic acid and a sunscreen as I had suggested earlier. If after the treatment, the condition doesn’t improve, we could consider a skin biopsy from the hypopigmented and hyperpigmented area.
Hope this helps
Let me know if you need any more information
Best wishes,
Dr Sourav Ganguly

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